Annals of Thoracic Surgery 2018 October 30 [Link]

Harling L, Kolokotroni SM, Nair A, Smelt J, King J, Routledge T, Spicer J, Ng W, Bille A


Biphasic mesothelioma (BPM) accounts for approximately 10% of all pleural mesothelioma. Our aim was to assess the clinical, radiological and pathological factors impacting survival in BPM and to better identify patients most likely to benefit from active treatment.
Ten-year retrospective review of 214 biopsy-proven BPM cases with minimum 2-year follow-up. Patients with insufficient tissue for analysis were excluded (n=96). Clinical and pathological factors were evaluated along with radiological assessment of pleural thickness. Survival was measured from time of diagnosis. Uni- and multi-variable predictors of survival were evaluated.
118 patients were included. 28 underwent pleurectomy/decortication (P/D), with 27 receiving additional modalities. 90 underwent chemotherapy (n=18) or radiotherapy alone (n=9), 63 received combination therapy, and 27 received best supportive care (BSC). Median overall survival was 11.2 months (0.3-36.2). At univariable analysis, P/D (p=0.0061), radiotherapy (RT; p<0.0001) and chemotherapy (p<0.0001) were associated with superior survival when compared to BSC alone. Pleurectomy-Decortication demonstrated 40% survival improvement compared with no surgery (p=0.122). In a multivariable model, the presence of necrosis was negatively prognostic (HR 2.1, SE 0.76). Furthermore, increased sarcomatoid component was associated with worse survival without radiotherapy. CONCLUSIONS: BPM prognosis remains poor despite multimodality treatment. Anti-cancer treatment is associated with superior outcome in this non-randomised retrospective series. Our findings suggest superior survival for those with a lower proportion of sarcomatoid disease, with selective benefit of RT in higher proportions of sarcomatoid disease. When planning active treatment, the potential survival benefits require balancing against associated morbidity and recovery period.