Orlandi Riccardo, Leuzzi Giovanni, Rolli Luigi, Ferrari Michele, Stanzi Alessia, Valsecchi Camilla, Pastorino Ugo
Department of Thoracic Surgery, University of Milan, Milan, Italy.
Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy.
Clin Lung Cancer. 2024 Jan;25(1):e5-e10. doi: 10.1016/j.cllc.2023.10.010. Epub 2023 Oct 24.
to date, no consensus has been reached on the surgical gold-standard in pleural mesothelioma (PM). We retrospectively reviewed our experience as a tertiary referral centre, to compare short- and long-term survival of PM patients undergoing different types of surgery.
in retrospective, observational, single-centre study, we analysed all the patients histologically diagnosed with PM undergoing surgical procedures with palliative or curative intent at IRCCS Istituto Nazionale dei Tumori of Milan, Italy, from January 2003 to December 2020. The primary study endpoint was 10-year overall survival (OS) in three different types of resections: extra-pleural-pneumonectomy (EPP), pleurectomy/decortication (P/D), partial-pleurectomy/pleural-biopsy (PP/B). Secondary endpoints were postoperative hospital stay and postoperative 30-day and 90-day mortality rates. The survival function was estimated using Kaplan-Meier, and the Log-rank test was used for testing differences. Univariable and Multivariable Cox regression models were implemented to estimate Hazard Ratio (HR) for all variables of interest.
243 consecutive patients were enrolled, EPP was performed in 49 (20.2%), P/D in 58 (23.8%), PP/B in 136 (56.0%) patients. The median follow-up time was 19.8 months. 10-year OS was significantly better for P/D group (16%, Log-Rank test p<0.0001) compared to PP/B (1.8%) and EPP (0%). No statistically significant differences were found among the 3 surgical groups in 30- and 90-day mortality rates. At multivariable analysis, gender (male, HR=1.58), type of resection (P/D, HR=0.55) and surgery date (recent years, HR=0.61) were found to be independent prognostic factors for OS.
in PM, lung-sparing curative approach (e.g. P/D) should be preferred in highly selected patients and in highly experienced centres, whenever appropriate. Anyway, when P/D is not indicated, adopting palliative/conservative management (e.g. PP/B) could ensure comparable results as extremely aggressive surgeries (e.g. EPP). The aim of surgery in PM should not be reaching complete resection, but rather accomplishing significant resection allowing to complete the multimodality treatment in highly selected patients in experienced centers.
迄今为止，关于胸膜间皮瘤（PM）的手术金标准尚未达成共识。我们回顾性分析了我们作为三级转诊中心的经验，以比较接受不同类型手术的PM患者的短期和长期生存率。
在一项回顾性、观察性、单中心研究中，我们分析了2003年1月至2020年12月期间在意大利米兰IRCCS国家肿瘤研究所接受姑息性或根治性手术的所有经组织学诊断为PM的患者。主要研究终点是三种不同类型切除术的10年总生存率（OS）：胸膜外全肺切除术（EPP）、胸膜剥脱术/去皮质术（P/D）、部分胸膜切除术/胸膜活检（PP/B）。次要终点是术后住院时间以及术后30天和90天死亡率。使用Kaplan-Meier法估计生存函数，并使用对数秩检验来检验差异。实施单变量和多变量Cox回归模型以估计所有感兴趣变量的风险比（HR）。
连续纳入243例患者，49例（20.2%）接受了EPP，58例（23.8%）接受了P/D，136例（56.0%）接受了PP/B。中位随访时间为19.8个月。与PP/B组（1.8%）和EPP组（0%）相比，P/D组的10年总生存率显著更好（16%，对数秩检验p<0.0001）。3个手术组在30天和90天死亡率方面未发现统计学显著差异。在多变量分析中，性别（男性，HR=1.58）、切除类型（P/D，HR=0.55）和手术日期（近年来，HR=0.61）被发现是总生存率的独立预后因素。
在PM中，对于经过严格筛选的患者以及经验丰富的中心，只要合适，应首选保留肺的根治性方法（如P/D）。无论如何，当不适合进行P/D时，采用姑息性/保守性治疗（如PP/B）可确保与极其激进的手术（如EPP）取得相当的结果。PM手术的目标不应是实现完全切除，而应是完成显著切除，以便在经验丰富的中心对经过严格筛选的患者完成多模式治疗。
