接受扩大性胸膜切除术加胸膜剥脱术治疗的胸膜间皮瘤女性患者的长期生存及新的预后因素
Prolonged survival and novel prognostic factors in women with pleural mesothelioma treated with extended pleurectomy decortication.
作者信息
Lapidot Moshe, Mazzola Emanuele, Bueno Raphael
机构信息
Brigham and Women's Hospital, The International Mesothelioma Program, Harvard Medical School, Boston, MA, USA.
Department of Thoracic Surgery, Galilee Medical Center, Nahariya, Israel.
出版信息
Transl Lung Cancer Res. 2024 Apr 29;13(4):811-820. doi: 10.21037/tlcr-23-797. Epub 2024 Apr 25.
BACKGROUND
Pleural mesothelioma (PM) is an uncommon and extremely aggressive malignancy associated with past exposure to asbestos. The low representation of women among PM patients is likely due to differences in occupational asbestos exposure. Due to the controversial role of female sex as a prognostic factor in PM, the study aims to evaluate the survival of females treated with lung-sparing surgery. We present a cohort of 114 consecutive female patients with PM who underwent intended extended pleurectomy decortication (ePD) over 11 years in a high-volume single institution.
METHODS
All women from 2007-2017 who underwent intended ePD were enrolled in the study. Data on clinical, operative, and outcome were collected. Kaplan-Meier estimators and log-rank tests were employed to assess the overall survival, and Cox regression models were utilized to analyze prognostic factors.
RESULTS
During the study period, 454 patients underwent thoracotomy with intended ePD in a single institution. There were 114 females (25%), and macroscopic complete resection (MCR) was achieved in 97 (85.1%). The median age was 65 years, histology was epithelioid in 81 (71.0%), biphasic in 31 (27.2%), and sarcomatoid in 2 (1.8%). The 30- and 90-day mortality were 3.5% and 6.1%, respectively. Median survival in females was 38 months, and 5-year survival was 28.2%. The median survival and 5-year survival rate for patients with epithelioid histology and MCR were 44.4 months and 36.4%, respectively. In a univariate analysis, several factors were found to be associated with patient overall survival including MCR [hazard ratio (HR): 0.3, P<0.001], early T status (HR: 1.6, P=0.03), adjuvant therapy (HR: 0.5, P=0.006), intraoperative heated chemotherapy (IOHC) (HR: 0.8, P=0.03), age (HR: 1.02, P=0.03) and epithelioid histology (HR: 0.5, P=0.009).
CONCLUSIONS
For women with epithelioid PM undergoing intended ePD within a multimodal setting, prolonged survival is anticipated.
背景
胸膜间皮瘤（PM）是一种罕见且极具侵袭性的恶性肿瘤，与既往接触石棉有关。PM患者中女性比例较低可能是由于职业性石棉暴露的差异。由于女性性别作为PM预后因素的作用存在争议，本研究旨在评估接受保肺手术治疗的女性患者的生存率。我们报告了一组连续114例女性PM患者，她们在一家大型单一机构中于11年间接受了意向性扩大胸膜剥脱术（ePD）。
方法
纳入2007年至2017年间所有接受意向性ePD的女性患者。收集临床、手术及预后数据。采用Kaplan-Meier估计量和对数秩检验评估总生存期，并利用Cox回归模型分析预后因素。
结果
在研究期间，单一机构中有454例患者接受了意向性ePD的开胸手术。其中有114例女性（25%），97例（85.1%）实现了肉眼完全切除（MCR）。中位年龄为65岁，组织学类型为上皮样的有81例（71.0%），双向性的有31例（27.2%），肉瘤样的有2例（1.8%）。30天和90天死亡率分别为3.5%和6.1%。女性患者的中位生存期为38个月，5年生存率为28.2%。上皮样组织学且实现MCR的患者的中位生存期和5年生存率分别为44.4个月和36.4%。在单因素分析中，发现几个因素与患者总生存期相关，包括MCR[风险比（HR）：0.3，P<0.001]、早期T分期（HR：1.6，P=0.03）、辅助治疗（HR：0.5，P=0.006）、术中热化疗（IOHC）（HR：0.8，P=0.03）、年龄（HR：1.02，P=0.03）和上皮样组织学（HR：0.
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