Division of Thoracic Surgery, Department of Surgery, Hyogo Medical University, Hyogo, Japan.
Division of Thoracic Surgery, Department of Surgery, Hyogo Medical University, Hyogo, Japan.
Ann Thorac Surg. 2024 Jul;118(1):216-223. doi: 10.1016/j.athoracsur.2024.02.022. Epub 2024 Feb 28.
The effects of surgery on the survival of patients with pleural mesothelioma remain poorly understood. We compared the therapeutic outcomes of patients receiving neoadjuvant chemotherapy, followed by surgery or refusing surgery, for pleural mesothelioma.
This retrospective study included consecutive patients who were eligible for curative-intent surgery after 3 cycles of neoadjuvant chemotherapy with platinum plus pemetrexed at our hospital during January 2011 to December 2021. Patients were divided into 2 groups. The surgery group comprised patients who underwent curative-intent surgery for pleural mesothelioma. The refusal-of-surgery group comprised patients who were medically eligible for surgery but refused to consent to surgery. Overall survival and progression-free survival were calculated using the Kaplan-Meier method with the generalized Wilcoxon test.
Of the 296 eligible patients for the study, 272 underwent surgery and 24 refused surgery. During the surgery, 204 patients (75.0%), 43 (15.8%), and 25 (9.2%) underwent pleurectomy/decortication, extrapleural pneumonectomy, and exploratory thoracotomy, respectively. The median follow-up length was 28.4 months. The median overall survival periods were 40.7 months (95% CI, 32.2-45.6 months) for surgery and 23.6 months (95% CI, 15.2-43.0 months) for refusal of surgery (P = .03). The median progression-free survival periods were 20.2 months (95% CI, 17.0-22.5 months) for surgery and 12.9 months (95% CI, 8.3-16.8 months) for refusal of surgery (P < .001).
Overall survival and progression-free survival were significantly better in surgery than in refusal of surgery. Surgery may improve the survival outcomes of patients with pleural mesothelioma.
手术对间皮瘤患者生存的影响仍知之甚少。我们比较了接受新辅助化疗后接受手术或拒绝手术的间皮瘤患者的治疗结果。
这项回顾性研究纳入了 2011 年 1 月至 2021 年 12 月期间在我院接受 3 个周期含铂培美曲塞新辅助化疗后有机会接受根治性手术的连续患者。患者分为两组。手术组包括接受间皮瘤根治性手术的患者。拒绝手术组包括符合手术条件但拒绝手术的患者。使用 Kaplan-Meier 法和广义 Wilcoxon 检验计算总生存期和无进展生存期。
在 296 名符合研究条件的患者中，272 名患者接受了手术，24 名患者拒绝了手术。手术中，204 名患者（75.0%）、43 名患者（15.8%）和 25 名患者（9.2%）分别接受了胸膜切除术/剥脱术、胸膜外全肺切除术和探查性开胸术。中位随访时间为 28.4 个月。手术组的中位总生存时间为 40.7 个月（95%CI，32.2-45.6 个月），拒绝手术组为 23.6 个月（95%CI，15.2-43.0 个月）（P =.03）。手术组的中位无进展生存时间为 20.2 个月（95%CI，17.0-22.5 个月），拒绝手术组为 12.9 个月（95%CI，8.3-16.8 个月）（P<.001）。
手术组的总生存和无进展生存明显优于拒绝手术组。手术可能改善间皮瘤患者的生存结局。
