Thoracic: Lung Cancer
Survival results in biphasic malignant pleural mesothelioma patients: A multicentric analysis

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Abstract

Objective

The best strategy of care for biphasic malignant pleural mesothelioma (Biph-MPM) is controversial. In this study, a large dataset of Biph-MPM cases was reviewed to identify prognostic factors and to evaluate the role of a multimodal approach, including cancer-directed surgery.

Methods

A total of 213 patients with Biph-MPM treated at 4 tertiary centers who experienced MPM from January 2009 to December 2016 were selected, and clinical, pathologic, and surgical information was retrieved. A Cox regression model was used to identify predictors of survival, and the Kaplan–Meier method was used to summarize overall survival.

Results

The mean age and the male/female ratio were 68.4 ± 9.5 years and 5:1, respectively. Tumors were assigned to stages I (127, 59.6%), II (3, 1.4%), III (76, 35.4%), and IV (7, 3.3%) according to the Eighth Tumor, Node, Metastasis (TNM) edition. A multimodal treatment including pleurectomy/decortication was performed in 58 patients (27.2%), chemotherapy alone in 99 patients (46.5%), and best supportive care in 56 (26.3%). The median overall survival was 11 months. A univariate analysis revealed that survival was significantly associated with the percentage forced expiratory volume in 1 second (P < .0001), performance status (P = .0002), multimodal treatment including surgery (P < .0001), and TNM stage (P = .011). A multivariable analysis confirmed performance status, percentage forced expiratory volume in 1 second, TNM, and a multimodal approach as independent variables affecting long-term survival.

Conclusions

Despite the overall poor prognosis of biphasic histology, a multimodal approach, including cancer-directed surgery, is associated with improved long-term results in very selected patients with Biph-MPM.

Key Words

malignant pleural mesothelioma
pleurectomy
decortication
pleural tumor
surgery

Abbreviations and Acronyms

Biph
biphasic
BSC
best supportive care
CI
confidence interval
CT
computed tomography
FEV1
forced expiratory volume in 1 second
HR
hazard ratio
MCR
macroscopic complete resection
MPM
malignant pleural mesothelioma
P/D
pleurectomy/decortication
%EpC
percentage of epithelioid differentiation
TNM
Tumor, Node, Metastasis

Cited by (0)

This study was supported by “5 per Mille-Year 2014” funding, assigned to IRCCS-Reggio Emilia.