Unit of Thoracic Surgery, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Laboratory of Translational Research, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
J Thorac Cardiovasc Surg. 2020 Apr;159(4):1584-1593.e2. doi: 10.1016/j.jtcvs.2019.08.027. Epub 2019 Sep 9.
The best strategy of care for biphasic malignant pleural mesothelioma (Biph-MPM) is controversial. In this study, a large dataset of Biph-MPM cases was reviewed to identify prognostic factors and to evaluate the role of a multimodal approach, including cancer-directed surgery.
A total of 213 patients with Biph-MPM treated at 4 tertiary centers who experienced MPM from January 2009 to December 2016 were selected, and clinical, pathologic, and surgical information was retrieved. A Cox regression model was used to identify predictors of survival, and the Kaplan-Meier method was used to summarize overall survival.
The mean age and the male/female ratio were 68.4 ± 9.5 years and 5:1, respectively. Tumors were assigned to stages I (127, 59.6%), II (3, 1.4%), III (76, 35.4%), and IV (7, 3.3%) according to the Eighth Tumor, Node, Metastasis (TNM) edition. A multimodal treatment including pleurectomy/decortication was performed in 58 patients (27.2%), chemotherapy alone in 99 patients (46.5%), and best supportive care in 56 (26.3%). The median overall survival was 11 months. A univariate analysis revealed that survival was significantly associated with the percentage forced expiratory volume in 1 second (P < .0001), performance status (P = .0002), multimodal treatment including surgery (P < .0001), and TNM stage (P = .011). A multivariable analysis confirmed performance status, percentage forced expiratory volume in 1 second, TNM, and a multimodal approach as independent variables affecting long-term survival.
Despite the overall poor prognosis of biphasic histology, a multimodal approach, including cancer-directed surgery, is associated with improved long-term results in very selected patients with Biph-MPM.
双相恶性胸膜间皮瘤（Biph-MPM）的最佳治疗策略存在争议。本研究回顾了大量 Biph-MPM 病例，以确定预后因素，并评估包括癌症定向手术在内的多模式方法的作用。
选择 2009 年 1 月至 2016 年 12 月在 4 家三级中心接受治疗的 213 例 Biph-MPM 患者，检索临床、病理和手术信息。使用 Cox 回归模型确定生存的预测因素，并使用 Kaplan-Meier 方法总结总生存。
平均年龄和男女比例分别为 68.4±9.5 岁和 5:1。根据第八版肿瘤、淋巴结、转移（TNM）分期，肿瘤分为 I 期（127 例，59.6%）、II 期（3 例，1.4%）、III 期（76 例，35.4%）和 IV 期（7 例，3.3%）。58 例（27.2%）患者接受包括胸膜切除术/剥脱术在内的多模式治疗，99 例（46.5%）患者接受单纯化疗，56 例（26.3%）患者接受最佳支持治疗。中位总生存期为 11 个月。单因素分析显示，生存与 1 秒用力呼气量百分比（P<0.0001）、体能状态（P=0.0002）、包括手术在内的多模式治疗（P<0.0001）和 TNM 分期（P=0.011）显著相关。多变量分析证实体能状态、1 秒用力呼气量百分比、TNM 和多模式方法是影响双相间皮瘤患者长期生存的独立变量。
尽管双相组织学总体预后较差，但包括癌症定向手术在内的多模式方法与非常选择的 Biph-MPM 患者的长期结果改善相关。
