Department of Thoracic and Cardiovascular Surgery, The University of Texas MD, Anderson Cancer Center, Houston, Tex.
Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex.
J Thorac Cardiovasc Surg. 2023 Aug;166(2):362-371.e9. doi: 10.1016/j.jtcvs.2022.12.003. Epub 2022 Dec 14.
Neoadjuvant systemic therapy in resectable malignant pleural mesothelioma remains controversial and demonstrates variable responses. We sought to evaluate tumor thickness as a predictor of response to neoadjuvant therapy and as a prognostic marker for overall survival.
Data from patients who underwent neoadjuvant therapy followed by cytoreductive surgery from 2002 to 2019 were reviewed. Baseline and postneoadjuvant therapy tumor thickness were measured on computed tomography. Radiological tumor response was categorized as progressive disease (≥20% increase), partial response (≥30% decrease), or stable disease (in between). Tumor response outcomes were modeled using logistic regression and multinomial regression models. Overall survival was evaluated based on tumor thickness and tumor response.
Of the 143 patients reviewed, 36 (25%) had progressive disease, 54 (38%) had stable disease, and 56 (39%) had partial response. The baseline tumor thickness of the progressive disease group (36 mm) was lower than in both stable disease and partial response groups (both 63 mm; P < .001). Both logistic regression and multinomial regression analyses demonstrated that thicker baseline tumor thickness was associated with decreased probability of progressive disease and increased probability of partial response. In a multivariable Cox model, thicker postneoadjuvant therapy tumor thickness was associated with worse overall survival (hazard ratio, 1.01, 95% confidence interval, 1.00-1.01, P = .008). The same trend was observed for thicker baseline tumor thickness (hazard ratio, 1.02, 95% confidence interval, 1.01-1.04, P = .008), and the risk was decreased in tumors with partial response (hazard ratio, 0.98, 95% confidence interval, 0.96-0.100, P = .014).
We present the first study demonstrating the relationship between baseline tumor thickness and differential radiographic response to neoadjuvant therapy and survival. Further studies are needed to validate tumor thickness as both a prognostic and predictive biomarker.
可切除恶性胸膜间皮瘤的新辅助全身治疗仍存在争议，并表现出不同的反应。我们试图评估肿瘤厚度作为新辅助治疗反应的预测因子和总生存的预后标志物。
回顾了 2002 年至 2019 年间接受新辅助治疗后行细胞减灭性手术的患者的数据。在计算机断层扫描上测量基线和新辅助治疗后的肿瘤厚度。将影像学肿瘤反应分为进展性疾病（增加≥20%）、部分缓解（减少≥30%）或稳定疾病（介于两者之间）。使用逻辑回归和多项回归模型对肿瘤反应结果进行建模。根据肿瘤厚度和肿瘤反应评估总生存。
在回顾的 143 名患者中，36 名（25%）患者疾病进展，54 名（38%）患者病情稳定，56 名（39%）患者部分缓解。进展性疾病组的基线肿瘤厚度（36mm）低于稳定疾病组和部分缓解组（均为 63mm；P<.001）。逻辑回归和多项回归分析均表明，基线肿瘤厚度越厚，疾病进展的可能性越低，部分缓解的可能性越高。在多变量 Cox 模型中，新辅助治疗后肿瘤厚度越厚与总生存较差相关（风险比，1.01，95%置信区间，1.00-1.01，P=.008）。基线肿瘤厚度较厚时也观察到相同趋势（风险比，1.02，95%置信区间，1.01-1.04，P=.008），而部分缓解的肿瘤风险降低（风险比，0.98，95%置信区间，0.96-0.100，P=.014）。
我们首次展示了基线肿瘤厚度与新辅助治疗反应和生存的关系。需要进一步的研究来验证肿瘤厚度作为预后和预测生物标志物的作用。
