Zhang Ting, Wang Zhaotong, Zuo Yuanhang, Yin Shuoxin, Wang Ning
Department of Oncology, Nanyang Central Hospital, Nanyang, 473000, China.
Department of Psychiatry, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210000, China.
Eur J Surg Oncol. 2025 Jan;51(1):109372. doi: 10.1016/j.ejso.2024.109372. Epub 2024 Nov 7.
Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer with limited treatment options. This study aims to assess the impact of surgical intervention on overall survival (OS) in patients with MPM and to identify prognostic factors influencing survival outcomes.
Data from the SEER-17 Database between 2000 and 2019 were analyzed. Patients were categorized into surgery and no-surgery groups. Survival analyses were conducted using Kaplan-Meier curves and Cox proportional hazards models. Propensity score matching (PSM) was applied to reduce biases.
The study included a total of 3901 MPM patients, with 1190 in the surgery group and 2711 in the no-surgery group. The median OS for the entire cohort was 10 months. The surgery group had a median OS of 15 months compared to 8 months in the no-surgery group (p < 0.001). The 1-year and 5-year OS rates for surgery patients were 56.9 % and 11.2 %, respectively, while for no-surgery patients, they were 34.9 % and 3.7 % (p < 0.001). Multivariate analysis indicated that no-surgery was an independent risk factor for worse OS (HR 1.38, 95 % CI 1.21-1.39, p < 0.001). After PSM, no-surgery remained an independent risk factor influencing OS. Subgroup analysis indicated that surgery benefited most groups except those aged ≥80 years, bilateral disease, N3 stage, and certain histological grades.
Surgical intervention significantly improves survival in patients with MPM. However, benefits vary across subgroups, and careful consideration of patient-specific factors is essential.
恶性胸膜间皮瘤（MPM）是一种罕见且侵袭性强的癌症，治疗选择有限。本研究旨在评估手术干预对MPM患者总生存期（OS）的影响，并确定影响生存结局的预后因素。
分析了2000年至2019年期间SEER-17数据库中的数据。患者被分为手术组和非手术组。使用Kaplan-Meier曲线和Cox比例风险模型进行生存分析。应用倾向得分匹配（PSM）以减少偏差。
该研究共纳入3901例MPM患者，其中手术组1190例，非手术组2711例。整个队列的中位OS为10个月。手术组的中位OS为15个月，而非手术组为8个月（p<0.001）。手术患者的1年和5年OS率分别为56.9%和11.2%，而非手术患者分别为34.9%和3.7%（p<0.001）。多变量分析表明，非手术是OS较差的独立危险因素（HR 1.38，95%CI 1.21-1.39，p<0.001）。PSM后，非手术仍然是影响OS的独立危险因素。亚组分析表明，除年龄≥80岁、双侧病变、N3期和某些组织学分级的患者外，手术对大多数组有益。
手术干预显著提高了MPM患者的生存率。然而，各亚组的获益情况不同，仔细考虑患者的具体因素至关重要。
