European Journal of Cardiothoracic Surgery. 2007 Dec 27 [Epub ahead of print] [Link]

Borasio P, Berruti A, Billé A, Lausi P, Levra MG, Giardino R, Ardissone

University of Turin, Department of Clinical & Biological Sciences,
Thoracic Surgery Unit, Italy.


Objective: Treatment of malignant pleural mesothelioma (MPM) remains
disappointing, although recent reports suggest that multimodality therapy
including surgery may provide a significant survival benefit. The aims of
this single institution study were: to investigate clinicopathologic
characteristics and potential prognostic factors in MPM patients, and to
ascertain whether surgery followed by adjuvant therapy had an independent
prognostic role.

Methods: Retrospective review of a prospectively compiled computerized
database of all patients with MPM evaluated between 1989 and 2003.
Kaplan-Meier method, log-rank test, and Cox model were used in the
statistical analysis.

Results: There were 394 patients: 270 men (68.5%), 124 women, median age 64 (range 28-93). Twenty-seven patients (6.8%) underwent surgical resection
(extrapleural pneumonectomy 15, pleurectomy/decortication 12), followed by
adjuvant therapy. As of March 2006, 381 patients (96.7%) had died (median
survival, 11.7 months; range 0.03-117.9). Median follow-up of 13 surviving
patients (3.3%) was 45.2 months (range 28.7-126.5). Overall survival at 2
years was 18.8%. Multimodality therapy including surgery yielded a median
survival of 14.5 months and a 2-year survival rate of 29.6%. Using univariate
analysis, age (p=0.009), chest pain (p=0.01), weight loss (p=0.001),
performance status (p=0.0001), platelet count (p=0.008), histology
(p=0.0001), macroscopic appearance of pleural surface (non-specific
inflammation, tumor-like thickening, or nodules; p=0.0001), visceral pleura
involvement (p=0.0001), degree of involvement of pleural cavity (less than or
more than one third of the cavity; p=0.0001), and multimodality therapy
(p<0.01) were found to be significant prognostic factors. At multivariate
analysis, performance status, platelet count, histology, and degree of
involvement of pleural cavity remained independently associated with
survival, whereas multimodality therapy failed to enter the model.

Conclusions: Significant predictors of survival include performance
status, platelet count, histology, and degree of involvement of pleural
cavity. Within the confines of this retrospective study and the small number
of patients undergoing multimodality therapy, the role of surgery in the
treatment of MPM remains unclear. Further investigation is warranted to
determine the optimal treatment strategy in this disease.