Affiliations of authors: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA.
J Natl Cancer Inst. 2020 Nov 1;112(11):1118-1127. doi: 10.1093/jnci/djaa002.
There is no standard of care with respect to the use of neoadjuvant chemotherapy (NAC) in resectable malignant pleural mesothelioma (MPM). We performed an intention-to-treat analysis with data from a single institution and the National Cancer Database (NCDB) to identify whether the use of NAC impacts survival in resectable MPM.
Patients with MPM who had surgery with curative intent at Duke University from 1995 to 2017 were selected, and the 2004-2015 NCDB was used to identify MPM patients with clinical stage I-IIIB who underwent definitive surgery. For both cohorts, patients were stratified by receipt of NAC. Primary outcomes were overall survival and postresection survival (RS), which were estimated using Kaplan-Meier and multivariable Cox proportional hazards models.
A total of 257 patients met inclusion criteria in the Duke cohort. Compared with immediate resection (IR), NAC was associated with similar overall survival but an increased risk for postresection mortality in both unmatched (adjusted hazard ratio [HR] = 1.85, 95% confidence interval [CI] = 1.21 to 2.83) and propensity-matched (HR = 1.62, 95% CI = 1.03 to 2.55) cohorts. A total of 1949 NCDB patients were included: 1597 (81.9%) IR and 352 (18.1%) NAC. RS was worse for patients undergoing NAC in both unmatched (HR = 1.85, 95% CI = 1.21 to 2.83) and propensity-matched (HR = 1.29, 95% CI = 1.06 to 1.57) analyses compared with patients receiving IR.
In this intention-to-treat study, NAC was associated with worse RS compared with IR in patients with MPM. The risks and benefits of induction therapy should be weighed before offering it to patients with resectable MPM.
在可切除恶性胸膜间皮瘤（MPM）中，使用新辅助化疗（NAC）没有标准的治疗方法。我们对来自一个机构和国家癌症数据库（NCDB）的数据进行了意向治疗分析，以确定可切除 MPM 中 NAC 的使用是否会影响生存。
选择了 1995 年至 2017 年在杜克大学接受根治性手术治疗的 MPM 患者，并使用 2004-2015 年的 NCDB 确定了接受确定性手术的临床分期 I-IIIB 的 MPM 患者。对于这两个队列，根据接受 NAC 的情况对患者进行分层。主要结果是总生存率和术后生存率（RS），使用 Kaplan-Meier 和多变量 Cox 比例风险模型进行估计。
在杜克大学队列中，共有 257 名患者符合纳入标准。与直接切除（IR）相比，NAC 与相似的总生存率相关，但在未匹配（调整后的危险比[HR] = 1.85，95%置信区间[CI] = 1.21 至 2.83）和倾向匹配（HR = 1.62，95% CI = 1.03 至 2.55）队列中，NAC 增加了术后死亡率的风险。共纳入了 1949 名 NCDB 患者：1597 名（81.9%）接受 IR，352 名（18.1%）接受 NAC。在未匹配（HR = 1.85，95% CI = 1.21 至 2.83）和倾向匹配（HR = 1.29，95% CI = 1.06 至 1.57）分析中，接受 NAC 的患者与接受 IR 的患者相比，RS 更差。
在这项意向治疗研究中，与 IR 相比，NAC 与 MPM 患者的 RS 更差。在向可切除 MPM 患者提供诱导治疗之前，应权衡其风险和获益。
