Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Weil Cornell Medical College, Houston, TX, 77030, USA.
Ann Surg Oncol. 2019 Jun;26(6):1879-1885. doi: 10.1245/s10434-019-07235-9. Epub 2019 Feb 24.
Pleural mesothelioma is a rare but aggressive form of cancer. Local recurrence represents the majority of treatment failures and overall survival (OS) outcomes remain dismal. Adding locoregional treatment with radiotherapy after surgical resection has been considered but its role remains uncertain.
The purpose of this study was to evaluate the outcomes of adjuvant radiation therapy (RT) for patients with malignant pleural mesothelioma.
The National Cancer Data Base (NCDB) was queried (2004-2013) for patients with malignant mesothelioma. Patients were divided into three groups: observation, surgery alone, and surgery followed by adjuvant RT. Statistics included Fisher's exact or Chi square tests to analyze categorical proportions between groups, Kaplan-Meier analysis to evaluate OS, and Cox proportional hazards modeling to determine variables associated with OS. Propensity matching was performed to make comparisons between homogenous groups.
Overall, the surgery plus radiotherapy group had a higher median survival (21.4 months) compared with surgery alone (16.59 months) [p < 0.001]. RT was more likely to be delivered after extrapleural pneumonectomy than with lung-sparing surgical approaches. On multivariable analysis, receipt of surgery plus radiotherapy, chemotherapy administration, and higher socioeconomic status were associated with improved OS (p < 0.0001). After propensity matching, receipt of surgery plus radiotherapy and chemotherapy administration were still associated with improved OS (p < 0.05).
In the treatment of malignant pleural mesothelioma, adjuvant radiotherapy after surgical intervention was associated with improved OS. This study is the largest study of adjuvant radiotherapy to date, and our findings highlight the need for additional prospective data.
胸膜间皮瘤是一种罕见但侵袭性很强的癌症。局部复发是大多数治疗失败的原因，总体生存（OS）结果仍然不容乐观。在手术切除后增加局部区域治疗放疗已被考虑，但作用仍不确定。
本研究旨在评估胸膜间皮瘤患者辅助放疗的结果。
国家癌症数据库（NCDB）（2004-2013 年）对恶性间皮瘤患者进行了查询。患者分为三组：观察组、单纯手术组和手术加辅助 RT 组。统计学方法包括 Fisher 确切检验或卡方检验，用于分析组间分类比例，Kaplan-Meier 分析评估 OS，Cox 比例风险模型确定与 OS 相关的变量。进行倾向匹配以在同质组之间进行比较。
总体而言，手术加放疗组的中位生存期（21.4 个月）高于单纯手术组（16.59 个月）[p < 0.001]。与肺保留手术方法相比，外膜切除术更有可能接受放疗。多变量分析显示，接受手术加放疗、化疗和较高的社会经济地位与 OS 改善相关（p < 0.0001）。在倾向匹配后，接受手术加放疗和化疗仍与 OS 改善相关（p < 0.05）。
在恶性胸膜间皮瘤的治疗中，手术干预后的辅助放疗与 OS 改善相关。本研究是迄今为止最大规模的辅助放疗研究，我们的研究结果强调了需要进一步的前瞻性数据。
