University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
University of Maryland School of Medicine, Baltimore, MD, United States.
Lung Cancer. 2019 Jun;132:94-98. doi: 10.1016/j.lungcan.2019.03.026. Epub 2019 Mar 26.
The lymphangitic carcinomatosis (LC) pattern of metastatic malignancy is associated with a poor prognosis but is currently not well defined in malignant pleural mesothelioma (MPM). Here, we report the incidence and prognostic significance of the radiographic development of LC in MPM following extended pleurectomy/decortication (EPD).
Consecutive patients with biopsy-proven MPM undergoing EPD with intraoperative photodynamic therapy (PDT) at our institution from 2008 to 2014 were included in this retrospective study. Patients without available post-surgical clinical or imaging data for direct review were excluded. CT images were reviewed by an experienced, board-certified thoracic radiologist and confirmed by consensus review. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan Meier methodology. Hazard ratios were compared with a cox proportional hazard model.
44 patients underwent EPD with PDT during the study period and had available clinical and imaging data. During the follow-up period (median 34 months), 17 patients (39%) developed LC at a median of 10 months after surgery (IQR 5-21 months). 16 of the 17 patients who developed LC (94%) died during the follow-up period, compared to 17 of the 27 who did not develop LC (63%). OS for the LC versus non-LC group was 53% versus 93% at 1 year and 18% versus 67% at 3 years. LC was significantly associated with a lower OS (HR 4.07; 95% confidence interval 1.44-11.48; p = 0.008). PFS for the LC group versus non-LC group was 8 months (IQR 5-9 months) compared to 17 months (IQR 11-24 months) (p < 0.001).
LC is a common form of failure in MPM following EPD and is associated with a poor prognosis. Thus, further studies are warranted to determine if any evidence of preoperative LC should be an absolute contraindication to EPD and may warrant an EPP or no surgery at all.
转移性恶性肿瘤的淋巴管癌病（LC）模式与预后不良相关，但在恶性胸膜间皮瘤（MPM）中尚未得到很好的定义。在这里，我们报告了在我们机构进行的扩大性胸膜切除术/剥脱术（EPD）后，MPM 中 LC 放射学发展的发生率和预后意义。
回顾性分析了 2008 年至 2014 年在我院接受 EPD 并术中接受光动力治疗（PDT）的经活检证实的 MPM 连续患者。排除了没有术后临床或影像学资料可供直接复查的患者。CT 图像由一位经验丰富的、经董事会认证的胸部放射科医生进行审查，并通过共识审查进行确认。采用 Kaplan-Meier 方法计算总生存期（OS）和无进展生存期（PFS）。用 cox 比例风险模型比较危险比。
在研究期间，44 例患者接受了 EPD 加 PDT，并有临床和影像学资料。在随访期间（中位数 34 个月），17 例患者（39%）在手术后中位数 10 个月（IQR 5-21 个月）时发生 LC。在随访期间，17 例发生 LC 的患者中有 16 例（94%）死亡，而 27 例未发生 LC 的患者中有 17 例（63%）死亡。LC 组与非 LC 组的 1 年 OS 分别为 53%和 93%，3 年 OS 分别为 18%和 67%。LC 与较低的 OS 显著相关（HR 4.07；95%置信区间 1.44-11.48；p=0.008）。LC 组与非 LC 组的 PFS 分别为 8 个月（IQR 5-9 个月）和 17 个月（IQR 11-24 个月）（p<0.001）。
LC 是 EPD 后 MPM 失败的常见形式，与预后不良相关。因此，需要进一步研究以确定术前 LC 的任何证据是否应绝对排除 EPD，并可能需要 EPP 或根本不手术。
