Département multidisciplinaire de pneumologie et de chirurgie thoracique, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, Quebec, Canada.
Lung Cancer. 2021 Jun;156:151-156. doi: 10.1016/j.lungcan.2021.04.025. Epub 2021 May 3.
Medical management based on palliative chemotherapy is currently the standard of care in malignant pleural mesothelioma (MPM). Median survival of 12-16 months has been reported with modern chemotherapy regimens with or without anti-angiogenic agents. Multimodality therapy incorporating cytoreductive surgery, systemic chemotherapy and radiotherapy has been offered for years to fit patients with early-stage disease, but its role remains debated. Our objective was to compare overall survival in patients offered multimodality therapy in a specialized clinic setting in London, UK to that of patients offered exclusively medical treatment at another academic institution in Quebec, Canada.
We retrospectively compared the survival rates of 2 separate cohorts of patients treated consecutively: Cohort 1 (n = 106) received multimodality therapy including systemic chemotherapy, extended pleurectomy/decortication (P/D) and prophylactic radiotherapy in London (United Kingdom) between 2009 and 2016, while Cohort 2 (n = 98) received medical treatment at the Quebec Heart and Lung Institute (Canada) during the same period.
In Cohort 1, all patients but two completed trimodality therapy. In cohort 2, 51 % received palliative care only and 40 % received systemic chemotherapy. Median survival was 32 months vs 10 months in Cohort 1 and Cohort 2, respectively (hazard ratio with age, gender, pathology and TNM staging as covariates: 3.81; 95 % CI: 2.67-5.45; p < 0.0001). Similar results were obtained in sensitivity analyses, after excluding those who received best supportive care only and in a propensity score-matched analysis.
Aggressive therapy of MPM using cancer-directed surgery, systemic chemotherapy and prophylactic radiotherapy may provide a significant survival benefit in selected patients.
基于姑息化疗的医学治疗是恶性胸膜间皮瘤（MPM）的标准治疗方法。采用现代化疗方案（联合或不联合抗血管生成药物），中位生存期为 12-16 个月。多年来，细胞减灭术、全身化疗和放疗相结合的多模式治疗已用于早期疾病患者，但其作用仍存在争议。我们的目的是比较在英国伦敦的一家专门诊所接受多模式治疗的患者与在加拿大魁北克的另一家学术机构接受单纯药物治疗的患者的总生存率。
我们回顾性比较了 2 个连续队列的患者的生存率：队列 1（n=106）在 2009 年至 2016 年期间在英国伦敦接受了多模式治疗，包括全身化疗、广泛胸膜切除术/剥脱术（P/D）和预防性放疗，而队列 2（n=98）在同期在魁北克心脏和肺研究所（加拿大）接受了药物治疗。
在队列 1 中，除了两名患者外，所有患者都完成了三联治疗。在队列 2 中，51%的患者仅接受姑息治疗，40%的患者接受全身化疗。队列 1 和队列 2 的中位生存期分别为 32 个月和 10 个月（调整年龄、性别、病理学和 TNM 分期后的风险比：3.81；95%置信区间：2.67-5.45；p<0.0001）。在排除仅接受最佳支持治疗的患者和倾向评分匹配分析后，也得到了类似的结果。
使用针对癌症的手术、全身化疗和预防性放疗的积极 MPM 治疗可能为选定患者提供显著的生存获益。
