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MINI 38 - Biology and Prognosis (ID 167)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
MINI38.13 - Survival Outcomes in Malignant Pleural Mesothelioma Patients Fit for Surgery According to Type of Procedure and Completeness of Resection (ID 2786)
18:30 - 20:00 | Author(s): M. Alloisio
The value of surgical treatment for malignant pleural mesothelioma is still an open question. We analysed a surgical series of MPM patients undergoing surgery for MPM in a single institution
A retrospective analysis was carried out of all surgical patients treated in our Department from 2000 to February 2015. Selection criteria were age<75, performance status 0-1, non-sarcomatoid histology, pretreatment stage I-III, and fit for major surgery. The procedure of choice was extrapleural pneumonectomy (EPP) until 2010 and radical pleurectomy/decortication (PD) thereafter. Patients that were found to be unresectable underwent palliative pleurectomy. The IMIG system was used for pathological staging, complications were scored based on WHO-derived criteria and the Charlson Co-morbidity Index was used to stratify patients.
Radical surgery was attempted in 163 patients: 91 received EPP, 47 underwent PD (1 with macroscopic residual disease) and 25 a palliative pleurectomy. Their main features and survival outcomes are summarized in table 1. Mean age and Charlson score were higher in PD than in EPP patients. A mixed histology was more prevalent in those who received palliative pleurectomy. Complications were equally frequent after EPP and PD but less frequent after palliative surgery. However, EPP patients had a high frequency of early- and late-occurring (30-600+ days postop) pleural sepsis (p=0.002) that had an unfavorable effect on OS (p=0.035). Induction chemotherapy was associated with better outcomes in PD but not in EPP. At multivariate analysis, epithelial histology (p=0.0419, grade 3+ complications (p=0.001) and Charlson index (p=0.001) were associated with better overall survival (OS). PD was associated with better OS compared with palliative pleurectomy (p=0.05), while EPP was not. Figure 1
Title table: Patients' features and survival outcomes in surgical MPM patients * Surgery + either chemo or RT, **induction + Surgery + Postoperative radiotherapy, IQI= Interquartile Interval
EP (%) P/D (%) R2 (%) N° 91 47 25 Mean Age (95% CI) 60 (58 - 61) 65 (62 - 67) 63 (60 - 66) Males 66 (72) 31 (66) 22 (88) Trimodal** 28 (30.77) 33 (70.21) 6 (24.00) Epithelioid 81 (89.01) 46 (97.87) 20 (80.00) p-Stage 0-II 18 (19.8) 18 (38.3) - p-Stage III 68 (74.73) 20 (42.55) 2 (8.00) p-Stage IV 5 (5.49) 9 (19.15) 21 (92.00) Grade 3+ Complications 25 (25.47) 12 (25.53) 2 (8.00) 30-Day Mortality 3 (3.30) 1 (2.13) - Median OS (IQI) 19.0 (9.3 - 35.6) 29.9 (13.7 - 35.2) 13.3 (4.7 - 31.6) Median DFS (IQI) 11.5 (7.1 - 21.8) 12.1 (6.4 - 19.2) -
EPP does not offer a significant benefit while PD may offer an advantage over palliative pleurectomy. The Charlson index is a major independent prognosticator in patients undergoing surgery for MPM.
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