Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy.
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
Eur J Cardiothorac Surg. 2017 Nov 1;52(5):975-981. doi: 10.1093/ejcts/ezx122.
While the best approach to malignant pleural mesothelioma has yet to be demonstrated, surgery remains the mainstay of treatment. We analysed a group of candidates for trimodality treatment, aiming to identify prognostic factors guiding patient selection.
Between 2003 and 2015, 83 (31.6%) of the 283 patients with malignant pleural mesothelioma were considered for trimodality treatment to perform induction chemotherapy, extrapleural pneumonectomy and adjuvant radiotherapy. All patients underwent cisplatin-based chemotherapy. Radiotherapy was administered at a mean dose of 50.4 Gy.
Thirty-six patients (43.4%) had 3 cycles of chemotherapy, whereas 21 (25.3%) had more than 3. Progression to chemotherapy was observed in 10.9% (9 of 83) of patients, partial response in 30.1% (25 of 83) and stable disease in 59% (49 of 83). Sixty-three patients underwent extrapleural pneumonectomy. Fifty-five patients (87.3%) had epithelial tumour. Forty-two patients (66.7%) were in pathological Stage 3. Major complications after extrapleural pneumonectomy were observed in 28 patients (44.4%), whereas 30-day postoperative mortality was 11.1% (7/63). Radiotherapy was not administered in 24 patients (38.1%) due to major complications after surgery or patient intolerance. Two patients (3.2%) died within 90 days after the end of radiotherapy. The trimodality treatment was completed in 37 (44.6%) patients. Median overall survival was 35.6 months, with 1- and 3-year overall survival of 82% and 48% for patients who completed the trimodality treatment compared with 32% and 14% for patients who did not undergo radiotherapy.
Only 45% of patients completed the planned trimodality treatment, and morbidity/mortality remained high. Nonetheless, the patients who completed treatment showed good loco-regional disease control and better overall survival.
虽然恶性胸膜间皮瘤的最佳治疗方法尚未确定，但手术仍然是治疗的主要手段。我们分析了一组接受三联治疗的患者，旨在确定指导患者选择的预后因素。
在 2003 年至 2015 年间，283 例恶性胸膜间皮瘤患者中有 83 例（31.6%）被认为适合接受三联治疗，即诱导化疗、胸膜外全肺切除术和辅助放疗。所有患者均接受顺铂为基础的化疗。放疗平均剂量为 50.4Gy。
36 例（43.4%）患者接受了 3 个周期的化疗，而 21 例（25.3%）患者接受了 3 个周期以上的化疗。10.9%（83 例中的 9 例）的患者对化疗进展，30.1%（83 例中的 25 例）患者出现部分缓解，59%（83 例中的 49 例）患者病情稳定。63 例患者接受了胸膜外全肺切除术。55 例（87.3%）患者为上皮肿瘤。42 例（66.7%）患者处于病理分期 3 期。胸膜外全肺切除术后发生严重并发症的患者有 28 例（44.4%），30 天术后死亡率为 11.1%（63 例中的 7 例）。由于术后严重并发症或患者不耐受，24 例（38.1%）患者未接受放疗。2 例（3.2%）患者在放疗结束后 90 天内死亡。37 例（44.6%）患者完成了三联治疗。中位总生存期为 35.6 个月，完成三联治疗的患者 1 年和 3 年总生存率分别为 82%和 48%，而未接受放疗的患者分别为 32%和 14%。
只有 45%的患者完成了计划的三联治疗，且发病率/死亡率仍然很高。然而，完成治疗的患者表现出良好的局部区域疾病控制和更好的总体生存。
