Prognostic Factors in the Treatment of Malignant Pleural Mesothelioma at a Large Tertiary Referral Center

J Thorac Oncol. 2007 Oct;2(10):957-65. doi: 10.1097/JTO.0b013e31815608d9.

Abstract

Introduction: Most studies describing the natural history and prognostic factors for malignant pleural mesothelioma antedate accurate pathologic diagnosis, staging by computed tomography, and a universal staging system. We conducted a large single-institution analysis to identify prognostic factors and assess the association of resection with outcome in a contemporary patient population.

Methods: Patients with biopsy-proven malignant pleural mesothelioma at our institution were identified and clinical data were obtained from an institutional database. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. A p value <0.05 was considered statistically significant.

Results: From 1990 to 2005, 945 patients were identified: 755 men, 190 women; median age, 66 years (range, 26-93). Extrapleural pneumonectomy was performed in 208 (22%), pleurectomy/decortication in 176 (19%). Operative mortality was 4% (16/384). Multimodality therapy including surgery was associated with a median survival of 20.1 months. Significant predictors of overall survival included histology, gender, smoking, asbestos exposure, laterality, surgical resection by extrapleural pneumonectomy or pleurectomy/decortication, American Joint Committee on Cancer stage, and symptoms. A Cox model demonstrated a hazard ratio of 1.4 without surgical resection when controlling for histology, stage, gender, asbestos exposure, smoking history, symptoms, and laterality (p = 0.003).

Conclusions: In addition to tumor histology and pathologic stage, predictors of survival include gender, asbestos exposure, smoking, symptoms, laterality, and clinical stage. Surgical resection in a multimodality setting was associated with improved survival.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Combined Modality Therapy
  • Female
  • Humans
  • Lymphatic Metastasis
  • Male
  • Mesothelioma / drug therapy
  • Mesothelioma / pathology
  • Mesothelioma / radiotherapy
  • Mesothelioma / surgery*
  • Middle Aged
  • Neoplasm Staging
  • Neoplasms, Glandular and Epithelial / pathology
  • Neoplasms, Glandular and Epithelial / surgery
  • Outcome Assessment, Health Care
  • Pleural Neoplasms / drug therapy
  • Pleural Neoplasms / pathology
  • Pleural Neoplasms / radiotherapy
  • Pleural Neoplasms / surgery*
  • Prognosis
  • Remission Induction
  • Smoking
  • Survival Rate
  • Treatment Outcome