Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
J Thorac Oncol. 2023 Sep;18(9):1233-1247. doi: 10.1016/j.jtho.2023.06.011. Epub 2023 Jun 23.
Pleural mesothelioma (PM) is an aggressive malignancy with increasing prevalence and poor prognosis. Real-life data are a unique approach to reflect the reality of PM epidemiology, treatment, and prognosis in Europe.
A joint analysis of the European Thoracic Oncology Platform Mesoscape and the European Society of Thoracic Surgeons (ESTS) databases was performed to better understand the characteristics and epidemiology of PM, including histologic subtype, staging, and treatment. Overall survival (OS) was assessed, adjusting for parameters of clinical interest.
The analysis included 2766 patients (Mesoscape: 497/10 centers/ESTS: 2269/77 centers). The primary histologic subtype was epithelioid (71%), with 57% patients on stages III to IV. Within Mesoscape, the patients received either multimodality (59%) or palliative intention treatment (41%). The median follow-up was 47.2 months, on the basis of 1103 patients (Mesoscape: 491/ESTS: 612), with 823 deaths, and median OS was 17.4 months. In multivariable analysis, female sex, epithelioid subtype, and lower stage were associated with longer OS, when stratifying by cohort, age, and Eastern Cooperative Oncology Group Performance Status. Within Mesoscape, multimodality treatment including surgery was predictive of longer OS (hazard ratio = 0.56, 95% confidence interval: 0.45-0.69), adjusting for sex, histologic subtype, and Eastern Cooperative Oncology Group Performance Status. Overall, surgical candidates with a macroscopic complete resection had a significantly longer median OS compared with patients with R2 (25.2 m versus 16.4 m; log-rank p < 0.001).
This combined European Thoracic Oncology Platform/ESTS database analysis offers one of the largest databases with detailed clinical and pathologic outcome. Our finding reflects a benefit for selected patients that undergo multimodality treatment, including macroscopic complete resection, and represents a valuable resource to inform the epidemiology and treatment options for individual patients.
胸膜间皮瘤（PM）是一种侵袭性恶性肿瘤，其发病率和预后均较差。真实世界的数据是反映欧洲间皮瘤流行病学、治疗和预后的独特方法。
对欧洲胸肿瘤平台 Mesoscape 和欧洲胸外科医师学会（ESTS）数据库进行联合分析，以更好地了解 PM 的特征和流行病学，包括组织学亚型、分期和治疗。评估总生存期（OS），并对临床相关参数进行调整。
该分析纳入了 2766 名患者（Mesoscape：497/10 个中心/ESTS：2269/77 个中心）。主要组织学亚型为上皮样（71%），其中 57%的患者处于 III 期至 IV 期。在 Mesoscape 中，患者接受了多模式治疗（59%）或姑息治疗（41%）。基于 1103 名患者（Mesoscape：491/ESTS：612）的中位随访时间为 47.2 个月，有 823 例死亡，中位 OS 为 17.4 个月。多变量分析显示，女性、上皮样亚型和较低的分期与 OS 延长相关，在分层时考虑了队列、年龄和东部肿瘤协作组体能状态。在 Mesoscape 中，包括手术在内的多模式治疗与 OS 延长相关（风险比=0.56，95%置信区间：0.45-0.69），调整了性别、组织学亚型和东部肿瘤协作组体能状态。总体而言，具有宏观完全切除的手术候选者的中位 OS 明显长于 R2 患者（25.2 个月与 16.4 个月；对数秩检验 p < 0.001）。
这项欧洲胸肿瘤平台/ESTS 数据库联合分析提供了最大的数据库之一，其中包含详细的临床和病理结果。我们的发现反映了对接受多模式治疗（包括宏观完全切除）的特定患者的获益，这代表了一个有价值的资源，可以为个体患者的流行病学和治疗选择提供信息。
