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Ann Thorac Surg. 2015 Sep;100(3):890-7. doi: 10.1016/j.athoracsur.2015.04.087. Epub 2015 Jul 9.

Prognostic Score of Long-Term Survival After Surgery for Malignant Pleural Mesothelioma: A Multicenter Analysis.

Author information

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

Abstract

BACKGROUND:

Despite ongoing efforts to improve therapy in malignant pleural mesothelioma, few patients undergoing extrapleural pneumonectomy experience long-term survival (LTS). This study aims to explore predictors of LTS after extrapleural pneumonectomy and to define a prognostic score.

METHODS:

From January 2000 to December 2010, we retrospectively reviewed clinicopathologic and oncological factors in a multicenter cohort of 468 malignant pleural mesothelioma patients undergoing extrapleural pneumonectomy. LTS was defined as survival longer than 3 years. Associations were evaluated using χ(2), Student's t, and Mann-Whitney U tests. Logistic regression, Cox regression hazard model, and bootstrap analysis were applied to identify outcome predictors. Survival curves were calculated by the Kaplan-Meier method. Receiver operating characteristic analyses were used to estimate optimal cutoff and area under the curve for accuracy of the model.

RESULTS:

Overall, 107 patients (22.9%) survived at least 3 years. Median overall, cancer-specific, and disease-free survival times were 60 (95% confidence interval [CI], 51 to 69), 63 (95% CI, 54 to 72), and 49 months (95% CI, 39 to 58), respectively. At multivariate analysis, age (odds ratio, 0.51; 95% CI, 0.31 to 0.82), epithelioid histology (odds ratio, 7.07; 95% CI, 1.56 to 31.93), no history of asbestos exposure (odds ratio, 3.13; 95% CI, 1.13 to 8.66), and the ratio between metastatic and resected lymph nodes less than 22% (odds ratio, 4.12; 95% CI, 1.68 to 10.12) were independent predictors of LTS. According to these factors, we created a scoring system for LTS that allowed us to correctly predict overall, cancer-specific, and disease-free survival in the total sample, obtaining two different groups with favorable or poor prognosis (area under the curve, 0.74; standard error, 0.04; p < 0.0001).

CONCLUSIONS:

Our prognostic model facilitates the prediction of LTS after surgery for malignant pleural mesothelioma and can help to stratify the outcome and, eventually, tailor postoperative treatment.

[Indexed for MEDLINE]

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