Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center Journal Article
| Authors: | Flores, R. M.; Zakowski, M.; Venkatraman, E.; Krug, L.; Rosenzweig, K.; Dycoco, J.; Lee, C.; Yeoh, C.; Bains, M.; Rusch, V. |
| Article Title: | Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center |
| 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. © 2007International Association for the Study of Lung Cancer. |
| Keywords: | adult; cancer survival; human tissue; treatment outcome; aged; aged, 80 and over; middle aged; survival rate; major clinical study; overall survival; multimodality cancer therapy; cancer patient; combined modality therapy; cancer staging; lymphatic metastasis; neoplasm staging; diagnostic accuracy; lung resection; smoking; reference database; prediction; medical assessment; outcome assessment (health care); survival time; symptom; proportional hazards model; statistical significance; malignant mesothelioma; mesothelioma; remission induction; surgical mortality; tertiary health care; kaplan meier method; lung biopsy; extrapleural pneumonectomy; decortication; pleurectomy; pleural neoplasms; log rank test; neoplasms, glandular and epithelial; asbestos; asbestosis; hazard assessment |
| Journal Title: | Journal of Thoracic Oncology |
| Volume: | 2 |
| Issue: | 10 |
| ISSN: | 1556-0864 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2007-10-01 |
| Start Page: | 957 |
| End Page: | 965 |
| Language: | English |
| DOI: | 10.1097/JTO.0b013e31815608d9 |
| PUBMED: | 17909360 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 48" - "Export Date: 17 November 2011" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work