Kai Yuichiro, Tsutani Yasuhiro, Tsubokawa Norifumi, Ito Masaoki, Mimura Takeshi, Miyata Yoshihiro, Okada Morihito
Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan.
Oncol Lett. 2019 Mar;17(3):3607-3614. doi: 10.3892/ol.2019.9979. Epub 2019 Jan 28.
The present study analyzed surgical results in patients with malignant pleural mesothelioma (MPM) who underwent extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D). Data for 44 patients who achieved macroscopic complete resection following neoadjuvant chemotherapy followed by EPP (n=29) or P/D (n=15) were reviewed. Patient demographics and oncological outcomes were compared between the EPP and P/D groups. The median overall (OS) and progression-free survival (PFS) times were 22 and 14 months, respectively. OS was significantly different between the EPP and P/D groups (median OS, 17 vs. 34 months; 5-year OS, 11 vs. 44%; P=0.019); no difference was noted in PFS (median PFS, 13 vs. 21 months; 5-year PFS, 11 vs. 17%; P=0.373). Univariate analysis demonstrated that epithelial histology (P=0.0003) and P/D (P=0.018) were significant favorable prognostic factors for OS. Using multivariate analysis, epithelial histology (P=0.001) remained the only significant factor. Post-recurrence survival (PRS) among all patients was significantly longer in the P/D group (median PRS, 3 vs. 20 months; 1.5-year PRS, 5 vs. 54%; P=0.003), even among patients with epithelial-type MPM (median PRS, 6 s vs. 20 months; 1.5-year PRS, 8 vs. 61%; P=0.012). Chemotherapy following recurrence (P=0.033) was significantly associated with superior PRS in multivariate analysis. Postoperative pulmonary function was significantly improved in the P/D group. In summary, P/D may be an alternative procedure to EPP for resectable MPM providing similar PFS and improved PRS.
本研究分析了接受胸膜外全肺切除术（EPP）或胸膜剥脱术/去皮质术（P/D）的恶性胸膜间皮瘤（MPM）患者的手术结果。回顾了44例在新辅助化疗后接受EPP（n = 29）或P/D（n = 15）并实现宏观完全切除的患者的数据。比较了EPP组和P/D组的患者人口统计学和肿瘤学结局。总生存期（OS）和无进展生存期（PFS）的中位数分别为22个月和14个月。EPP组和P/D组的OS有显著差异（OS中位数，17个月对34个月；5年OS率，11%对44%；P = 0.019）；PFS无差异（PFS中位数，13个月对21个月；5年PFS率，11%对17%；P = 0.373）。单因素分析表明，上皮组织学类型（P = 0.0003）和P/D（P = 0.018）是OS的显著有利预后因素。多因素分析显示，上皮组织学类型（P = 0.001）仍然是唯一的显著因素。P/D组所有患者的复发后生存期（PRS）明显更长（PRS中位数，3个月对20个月；1.5年PRS率，5%对54%；P = 0.003），即使是上皮型MPM患者也是如此（PRS中位数，6个月对20个月；1.5年PRS率，8%对61%；P = 0.012）。多因素分析显示，复发后化疗（P = 0.033）与较好的PRS显著相关。P/D组术后肺功能有显著改善。总之，对于可切除的MPM，P/D可能是EPP的替代手术，可提供相似的PFS并改善PRS。
