Breda Cristiano, Furia Simone, Lucchini Giuseppe, Zaccaria Antonio, Verderi Enrico, Natale Giuseppe, Lo Giudice Fabio, Cavallin Roberta, Ferronato Andrea, Fontana Paolo
Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy.
Department Healthcare Medical Management, Biostatistic Service, ASST Mantova, Mantova, Italy.
J Thorac Dis. 2021 Nov;13(11):6283-6293. doi: 10.21037/jtd-21-691.
This observational study evaluates retrospectively the long-term outcomes after pleurectomy/decortication for pleural mesothelioma, with and without the resection/reconstruction of diaphragm and pericardium.
Data from 155 consecutive patients undergoing lung-sparing surgery for epithelial pleural mesothelioma were reviewed. Selection criteria for surgery were cT1-3, cN0-1, good performance status, age <80 years. Perioperative Pemetrexed-Platinum regimen was administered as induction in 101 cases (65.2%) and as adjuvant treatment in 54 cases (34.8%). Extended pleurectomy/decortication was performed in 87 cases (56.12%). In 68 patients (43.87%) standard pleurectomy/decortication was performed without resection/reconstruction of diaphragm and pericardium, when tumour infiltration was deemed absent after intraoperative frozen section. The log-rank test and Cox regression model were used to assess the factors affecting overall survival and recurrence free survival.
Median follow-up was 20 months. The 2- and 5-year survival rate was 60.9% and 29.2% with a median survival of 34 months. An improved survival was observed when standard pleurectomy/decortication was carried out (P=0.007). A significant impact on survival was found comparing the TNM-stages (P=0.001), pT (P=0.002) and pN variables (P=0.001). Multivariate analysis identified the pN-status (P=0.003) and standard pleurectomy/decortication (P=0.017) as predictive for longer survival. The recurrence-free survival >12 months was strongly related to the overall survival (P<0.001). The macroscopic complete resection (P=0.001), TNM-stage (P=0.003) and pT-status (P=0.001) are related to relapse.
Within multimodal management of pleural mesothelioma, lung-sparing surgery is a valid option even with more conservative technique. A benefit for a longer survival was observed in the early stage of disease, with pN0 and when pleurectomy/decortication is carried out, preserving diaphragm and pericardium. Recurrence is not affected by the type of surgery, and a recurrence-free interval >12 months is predictive of an increased survival when the macroscopic complete resection is achieved.
本观察性研究回顾性评估了胸膜间皮瘤行胸膜切除术/纤维板剥脱术，伴或不伴膈肌及心包切除/重建后的长期预后。
回顾了155例连续接受保留肺手术治疗上皮性胸膜间皮瘤患者的数据。手术选择标准为cT1 - 3、cN0 - 1、身体状况良好、年龄<80岁。101例（65.2%）患者围手术期给予培美曲塞 - 铂类方案作为诱导治疗，54例（34.8%）作为辅助治疗。87例（56.12%）患者行扩大胸膜切除术/纤维板剥脱术。68例（43.87%）患者在术中冰冻切片显示无肿瘤浸润时，行标准胸膜切除术/纤维板剥脱术，未进行膈肌及心包的切除/重建。采用对数秩检验和Cox回归模型评估影响总生存和无复发生存的因素。
中位随访时间为20个月。2年和5年生存率分别为60.9%和29.2%，中位生存期为34个月。行标准胸膜切除术/纤维板剥脱术时观察到生存改善（P = 0.007）。比较TNM分期（P = 0.001）、pT（P = 0.002）和pN变量（P = 0.001）发现对生存有显著影响。多因素分析确定pN状态（P = 0.003）和标准胸膜切除术/纤维板剥脱术（P = 0.017）是更长生存期的预测因素。无复发生存>12个月与总生存密切相关（P<0.001）。肉眼完整切除（P = 0.001）、TNM分期（P = 0.003）和pT状态（P = 0.001）与复发有关。
在胸膜间皮瘤的多模式管理中，即使采用更保守的技术，保留肺手术也是一种有效的选择。在疾病早期、pN0且行胸膜切除术/纤维板剥脱术并保留膈肌和心包时，观察到生存期延长的益处。复发不受手术类型影响，当实现肉眼完整切除时，无复发间隔>12个月可预测生存期增加。
