Annals of Thoracic Surgery 2020 January 16 [Link]Nakamura A1, Takuwa T2, Hashimoto M2, Kuroda A2, Nakamichi T2, Matsumoto S2, Kondo N2, Kijima T3, Yamakado K4, Hasegawa S2.
Most patients with malignant pleural mesothelioma experience recurrence following treatment. However, no clinical studies have evaluated post-recurrence survival after pleurectomy/decortication for malignant pleural mesothelioma. This study aimed to clarify the post-recurrence survival, treatment, prognostic factors, and recurrence pattern after pleurectomy/decortication.
We conducted a retrospective cohort study of 90 patients who underwent neoadjuvant chemotherapy followed by pleurectomy/decortication at our hospital between September 2012 and December 2017. Survival and recurrence were calculated using the Kaplan-Meier method with the log-rank test. Clinical factors related to post-recurrence survival were assessed using multivariate analysis with the Cox proportional hazards model.
Of the 90 patients, 57 (63.3%) developed recurrence. The 1- and 3-year recurrence-free survival rates were 69.7% and 34.0%, respectively (median recurrence-free survival time, 19.0 months). With regard to initial recurrence, 39 patients (68.4%) developed local recurrence, 6 (10.5%) developed distant recurrence, and 12 (21.1%) developed both local and distant recurrences. The 1-year post-recurrence survival rate was 59.5% (median post-recurrence survival time, 14.4 months). Total 43 patients (75.4%) underwent a post-recurrence treatment. Multivariate analysis revealed that post-recurrence treatment [hazard ratio: 0.2, 95% confidence interval (CI): 0.07-0.55; P = 0.002], performance status 0-1 (hazard ratio: 0.24, 95%CI: 0.08-0.76; P = 0.01) and disease-free interval of >12 months (hazard ratio: 0.4, 95%CI: 0.16-0.99; P = 0.04) were the independent, favorable, and significant prognostic factors of post-recurrence survival.
Post-recurrence survival after pleurectomy/decortication is acceptable, and post-recurrence treatment, performance status, and disease-free interval are important prognostic factors of post-recurrence survival.