Division of Cardiothoracic Surgery, University of Arizona, Tucson, Arizona.
Division of Cardiothoracic Surgery, University of Arizona, Tucson, Arizona.
Ann Thorac Surg. 2019 Jan;107(1):194-201. doi: 10.1016/j.athoracsur.2018.07.081. Epub 2018 Sep 29.
Benefits of surgical resection for early-stage nonepithelioid malignant pleural mesothelioma (MPM) have not been clearly elucidated. This study investigated whether cancer-directed surgery affects overall survival compared with nonsurgical therapies for T1-T2 N0 M0 sarcomatoid or biphasic MPM patients.
Adult patients with clinical stage I or II MPM were identified in the National Cancer Database from 2004 to 2103. Patients who underwent cancer-directed surgery were matched by propensity score with patients who had received chemotherapy/radiotherapy or no treatments. Overall survival was compared using a Cox proportional hazard regression model.
From National Cancer Database queries, 878 patients with clinical stage I or II MPM with sarcomatoid (n = 524) or biphasic (n = 354) histology were identified. Overall median survival was 5.5 months for patients with sarcomatoid mesothelioma. The cancer-directed surgery improved overall survival compared with no operation (median survival, 7.56 months vs 4.21 months, respectively; p < 0.01). In the biphasic group, median overall survival was 12.2 months. Again, the cancer-directed surgery improved survival compared with no operation (15.8 months vs 9.3 months, p < 0.01). For both histologies, the cancer-directed surgery improved overall survival compared with those who underwent chemotherapy or radiotherapy, or both, without resection (p < 0.05). Perioperative mortality was 6.0% at 30 days and 21.4% at 90 days.
The cancer-directed surgery is associated with improved survival in early-stage MPM patients with nonepithelioid histology compared with those who did not undergo resection or chose medical therapy. Given the high perioperative mortality, a careful patient selection and multidisciplinary evaluation is recommended.
对于早期非上皮样恶性胸膜间皮瘤（MPM），手术切除的益处尚未明确阐明。本研究旨在探讨与非手术治疗相比，癌症定向手术是否会影响 T1-T2 N0 M0 肉瘤样或双相 MPM 患者的总生存。
从 2004 年至 2013 年，国家癌症数据库中确定了临床 I 期或 II 期 MPM 成人患者。通过倾向评分匹配接受癌症定向手术的患者与接受化疗/放疗或未治疗的患者。使用 Cox 比例风险回归模型比较总生存。
从国家癌症数据库查询中，确定了 878 例临床 I 期或 II 期 MPM 患者，其中肉瘤样（n=524）或双相（n=354）组织学。肉瘤样间皮瘤患者的总体中位生存期为 5.5 个月。与无手术相比，癌症定向手术改善了总体生存（中位生存期分别为 7.56 个月和 4.21 个月，p<0.01）。在双相组中，中位总生存期为 12.2 个月。同样，与无手术相比，癌症定向手术改善了生存（15.8 个月比 9.3 个月，p<0.01）。对于两种组织学类型，与未接受切除术或选择化疗或放疗的患者相比，癌症定向手术改善了总体生存（p<0.05）。术后 30 天和 90 天的围手术期死亡率分别为 6.0%和 21.4%。
与未接受切除术或选择化疗或放疗的患者相比，癌症定向手术可改善早期非上皮样 MPM 患者的生存。鉴于围手术期死亡率较高，建议进行仔细的患者选择和多学科评估。
