Bellini Alice, Dell'Amore Andrea, Terzi Stefano, Zambello Giovanni, Zuin Andrea, Pasello Giulia, Calabrese Fiorella, Schiavon Marco, Rea Federico
Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy.
Medical Oncology, Veneto Institute of Oncology IOV IRCCS, 35128 Padova, Italy.
J Clin Med. 2021 Mar 8;10(5):1134. doi: 10.3390/jcm10051134.
To date, there have been no established therapies for recurrent malignant pleural mesothelioma (MPM) after multimodality treatment. Aims of this retrospective study are to analyze the recurrence pattern, its treatment and to identify the predictors of best oncological outcomes for relapsed MPM, comparing extrapleural pneumonectomy (EPP) vs. pleurectomy/decortication (PD). Study population: 94 patients with recurrence of MPM after multimodality treatment underwent macroscopic complete resection (52.1% with EPP and 47.9% with PD) between July 1994 and February 2020. Distant spread was the most frequent pattern of recurrence (71.3%), mostly in the EPP group, while the PD group showed a higher local-only failure rate. Post-recurrence treatment was administered in 86.2%, whereas best supportive care was administered in 13.8%. Median post-recurrence survival (PRS) was 12 months (EPP 14 vs. PD 8 months, = 0.4338). At multivariate analysis, predictors of best PRS were epithelial histology ( = 0.026, HR 0.491, IC95% 0.263-0.916), local failure ( = 0.027, HR 0.707, IC95% 0.521-0.961), DFS ≥ 12 months ( = 0.006, HR 0.298, IC95% 0.137-0.812) and post-recurrence medical treatment ( = 0.046, HR 0.101, IC95% 0.897-0.936). The type of surgical intervention seems not to influence the PRS if patients are fit enough to face post-recurrence treatments. In patients with a prolonged disease-free interval, in the case of recurrence the most appropriate treatment seems to be the systemic medical therapy, even in the case of local-only relapse.
迄今为止，多模式治疗后复发性恶性胸膜间皮瘤（MPM）尚无既定的治疗方法。这项回顾性研究的目的是分析复发模式、其治疗方法，并确定复发MPM的最佳肿瘤学结局预测因素，比较胸膜外全肺切除术（EPP）与胸膜切除术/剥脱术（PD）。研究人群：1994年7月至2020年2月期间，94例多模式治疗后复发的MPM患者接受了宏观完全切除（52.1%接受EPP，47.9%接受PD）。远处转移是最常见的复发模式（71.3%），大多出现在EPP组，而PD组仅局部失败率较高。86.2%的患者接受了复发后治疗，13.8%的患者接受了最佳支持治疗。复发后中位生存期（PRS）为12个月（EPP组14个月，PD组8个月，P = 0.4338）。多变量分析显示，最佳PRS的预测因素为上皮组织学（P = 0.026，HR 0.491，95%CI 0.263 - 0.916）、局部失败（P = 0.027，HR 0.707，95%CI 0.521 - 0.961）、无病生存期（DFS）≥12个月（P = 0.006，HR 0.298，95%CI 0.137 - 0.812）和复发后药物治疗（P = 0.046，HR 0.101，95%CI 0.897 - 0.936）。如果患者身体状况足以接受复发后治疗，手术干预类型似乎不影响PRS。在无病间期延长的患者中，复发时最合适的治疗似乎是全身药物治疗，即使是仅局部复发的情况。
