Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center

被引:185
作者
Flores, Raja M.
Zakowski, Maureen
Venkatraman, Ennapadam
Krug, Lee
Rosenzweig, Kenneth
Dyeoeo, Joseph
Lee, Catherine
Yeoh, Cindy
Bains, Manjit
Rusch, Valerie
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Surg, Thorac Serv, New York, NY 10021 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Pathol, New York, NY 10021 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, Biostat Serv, New York, NY 10021 USA
[4] Mem Sloan Kettering Canc Ctr, Dept Med, Thorac Oncol Serv, New York, NY 10021 USA
[5] Mem Sloan Kettering Canc Ctr, Dept Radiat Oncol, New York, NY 10021 USA
关键词
malignant mesothelioma; extrapleural pneumonectomy; pleurectomy; decortication;
D O I
10.1097/JTO.0b013e31815608d9
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Introduction: Most studies describing the natural history and prognostic factors for malignant pleural mesothelioma antedate accurate pathologic diagnosis, staging by computed tomography, and a universal staging system. We conducted a large single-institution analysis to identify prognostic factors and assess the association of resection with outcome in a contemporary patient population. Methods: Patients with biopsy-proven malignant pleural mesothelioma at our institution were identified and clinical data were obtained from an institutional database. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. A p value < 0.05 was considered statistically significant. Results: From 1990 to 2005, 945 patients were identified: 755 men, 190 women; median age, 66 years (range, 26-93). Extrapleural pneumonectomy was performed in 208 (22%), pleurectomy/decortication in 176 (19%). Operative mortality was 4% (16/384). Multimodality therapy- including surgery was associated with a median survival of 20.1 months. Significant predictors of overall survival included histology, gender, smoking, asbestos exposure, laterality, surgical resection by extrapleural pneumonectomy or pleurectomy/ decortication, American Joint Committee on Cancer stage, and symptoms. A Cox model demonstrated a hazard ratio of 1.4 without surgical resection when controlling for histology, stage, gender, asbestos exposure, smoking history, symptoms, and laterality (p 0.003). Conclusions: In addition to tumor histology and pathologic stage, predictors of survival include gender, asbestos exposure, smoking, symptoms, laterality, and clinical stage. Surgical resection in a multimodality setting was associated with improved survival.
引用
收藏
页码:957 / 965
页数:9
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