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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.

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Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy. Electronic address:
Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy.
Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy.
Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy.
Thoracic Surgery Unit, Community Hospital, Brescia, Italy.
Division of Thoracic Surgery, Humanitas Research Hospital-Rozzano, Milan, Italy.
Division of Thoracic Surgery, Ospedale di Mestre, Venezia-Mestre, Italy.
Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy.
Division of Thoracic Surgery, IRCCS AOU "San Martino" IST, Genoa, Italy.
Division of Surgery, Università-ASL, Chieti, Italy.



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.


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.


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).


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.

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