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Ann Thorac Surg. 2014 Jun;97(6):1859-65. doi: 10.1016/j.athoracsur.2014.01.050. Epub 2014 Apr 14.

Extrapleural pneumonectomy for malignant mesothelioma: an Italian multicenter retrospective study.

Author information

1
Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy. Electronic address: lorenzo.spaggiari@ieo.it.
2
Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
3
Thoracic Surgery Unit, Community Hospital, Brescia, Italy.
4
Division of Thoracic Surgery, Humanitas Research Hospital-Rozzano, Milan, Italy.
5
Division of Thoracic Surgery, Ospedale di Mestre, Venezia-Mestre, Italy.
6
Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy.
7
Division of Thoracic Surgery, IRCCS AOU "San Martino" IST, Genoa, Italy.
8
Thoracic Surgery Unit, Department of Surgical Oncology, National Cancer Institute, Rome, Italy.
9
Division of Surgery, Università-ASL, Chieti, Italy.
10
Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy.
11
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.

Abstract

BACKGROUND:

This study assessed perioperative outcome and long-term survival in a large series of patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy (EPP) to identify prognostic factors allowing better patient selection.

METHODS:

We retrospectively collected data from nine referral centers for thoracic surgery in Italy. Perioperative outcome and survival data were available for 518 malignant pleural mesothelioma patients (84.4% with epithelial tumors, 68.0% with pathologic stage 3 disease) who underwent EPP with intention-to-treat (R0/R1) between 2000 and 2010. Induction chemotherapy was administered in 271 patients (52.3%) and adjuvant therapy in 373 patients (72.0%), including radiotherapy in 213 patients (41.1%), adjuvant chemotherapy in 43 patients (8.3%), and both in 117 patients (22.6%).

RESULTS:

In all, 136 patients (26.3%) had major complications after EPP, and 36 (6.9%) died within 90 days after surgery. The median overall survival was 18 months, with a 1-, 2-, and 3-year overall survival of 65%, 41%, and 27%, respectively. At multivariable analysis adjusted for age and disease stage, male sex (hazard ratio [HR] 1.47, 95% confidence interval [CI]: 1.12 to 1.92), nonepithelial histology (HR 1.96, 95% CI: 1.48 to 2.58), and trimodality treatment using induction chemotherapy (HR 0.61, 95% CI: 0.43 to 0.85) were significantly associated with survival. Development of a major complication also significantly worsened outcome (HR 1.85, 95% CI: 1.37 to 2.50).

CONCLUSIONS:

The success of EPP in the context of a multimodality treatment depends on a series of patient characteristics. Female patients, patients with epithelial tumors, and patients who received induction chemotherapy will best benefit from EPP.

[Indexed for MEDLINE]

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