Deboever Nathaniel, Zhou Nicolas, McGrail Daniel J, Tomczak Katarzyna, Oliva Jacqueline L, Feldman Hope A, Parra Edwin, Zhang Jianjun, Lee Percy P, Antonoff Mara B, Hofstetter Wayne L, Mehran Reza J, Rajaram Ravi, Rice David C, Roth Jack A, Swisher Stephen S, Vaporciyan Ara A, Altan Mehmet, Weissferdt Annikka, Tsao Anne S, Haymaker Cara L, Sepesi Boris
Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Front Oncol. 2023 Aug 11;13:1216999. doi: 10.3389/fonc.2023.1216999. eCollection 2023.
Malignant pleural mesothelioma (MPM) is associated with poor prognosis despite advances in multimodal therapeutic strategies. While patients with resectable disease may benefit from added survival with oncologic resection, patient selection for mesothelioma operations often relies on both objective and subjective evaluation metrics. We sought to evaluate factors associated with improved overall survival (OS) in patients with mesothelioma who underwent macroscopic complete resection (MCR).
Patients with MPM who received neoadjuvant therapy and underwent MCR were identified in a prospectively maintained departmental database. Clinicopathologic, blood-based, and radiographic variables were collected and included in a Cox regression analysis (CRA). Response to neoadjuvant therapy was characterized by a change in tumor thickness from pretherapy to preoperative scans using the modified RECIST criteria.
In this study, 99 patients met the inclusion criteria. The median age of the included patients was 64.7 years, who were predominantly men, had smoking and asbestos exposure, and who received neoadjuvant therapy. The median change in tumor thickness following neoadjuvant therapy was -16.5% (interquartile range of -49.7% to +14.2%). CRA demonstrated reduced OS associated with non-epithelioid histology [hazard ratio (HR): 3.06, 95% confidence interval (CI): 1.62-5.78, p < 0.001] and a response to neoadjuvant therapy inferior to the median (HR: 2.70, CI: 1.55-4.72, p < 0.001). Patients who responded poorly (below median) to neoadjuvant therapy had lower median survival (15.8 months compared to 38.2 months, p < 0.001).
Poor response to neoadjuvant therapy in patients with MPM is associated with poor outcomes even following maximum surgical cytoreduction and should warrant a patient-centered discussion regarding goals of care and may therefore help guide further therapeutic decisions.
尽管多模式治疗策略取得了进展，但恶性胸膜间皮瘤（MPM）的预后仍然很差。虽然可切除疾病的患者可能从肿瘤切除增加的生存期获益，但间皮瘤手术的患者选择通常依赖于客观和主观评估指标。我们试图评估接受宏观完全切除（MCR）的间皮瘤患者中与总生存期（OS）改善相关的因素。
在一个前瞻性维护的科室数据库中识别接受新辅助治疗并接受MCR的MPM患者。收集临床病理、血液学和影像学变量，并纳入Cox回归分析（CRA）。新辅助治疗的反应通过使用改良的RECIST标准，从治疗前到术前扫描肿瘤厚度的变化来表征。
在本研究中，99例患者符合纳入标准。纳入患者的中位年龄为64.7岁，主要为男性，有吸烟和石棉暴露史，并接受了新辅助治疗。新辅助治疗后肿瘤厚度的中位变化为-16.5%（四分位间距为-49.7%至+14.2%）。CRA显示，非上皮样组织学与OS降低相关[风险比（HR）：3.06，95%置信区间（CI）：1.62-5.78，p<0.001]，且对新辅助治疗的反应低于中位数（HR：2.70，CI：1.55-4.72，p<0.001）。对新辅助治疗反应较差（低于中位数）的患者中位生存期较低（15.8个月对比38.2个月，p<0.001）。
MPM患者对新辅助治疗反应不佳与即使在最大程度手术细胞减灭后预后不良相关，应进行以患者为中心的关于治疗目标的讨论，因此可能有助于指导进一步的治疗决策。
