Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: Results in 183 patients

D. J. Sugarbaker*, R. M. Flores, M. T. Jaklitsch, W. G. Richards, G. M. Strauss, J. M. Corson, Jr DeCamp M.M., S. J. Swanson, R. Bueno, J. M. Lukanich, E. H. Baldini, S. J. Mentzer, L. R. Kaiser, G. A. Patterson, L. P. Faber

*Corresponding author for this work

Research output: Contribution to journalArticle

767 Scopus citations

Abstract

Objectives: Our aim was to identify prognostic variables for long-term postoperative survival in trimodality management of malignant pleural mesothelioma. Methods: From 1980 to 1997, 183 patients underwent extrapleural pneumonectomy followed by adjuvant chemotherapy and radiotherapy. Results: Forty-three women and 140 men (age range 31-76 years) had a median follow-up of 13 months. The perioperative mortality rate was 3.8% (7 deaths) and the morbidity, 50%. Survival in the 176 remaining patients was 38% at 2 years and 15% at 5 years (median 19 months). Univariate analysis identified 3 prognostic variables associated with improved survival: epithelial cell type (52% 2-year survival, 21% 5-year survival, 26-month median survival; P = .0001), negative resection margins (44% at 2 years, 25% at 5 years, median 23 months; P = .02), and extrapleural nodes without metastases (42 % at 2 years, 17% at 5 years, median 21 months; P = .004). Using the Cox proportional hazards, the relative risk of death was calculated for nonepithelial cell type (OR 3.0, CI 2.0-4.5; P < .0001), positive resection margins (OR 1.7, CI 1.2-2.6; P = .0082), and metastatic extrapleural nodes (OR 2.0, CI 1.3-3.2; P = .0026). Thirty-one patients with 3 positive variables had the best survival (68% 2-year survival, 46% 5-year survival, median 51 months; P = .013). A previously published staging system using these variables stratified survival (P < .05). Conclusions: (1) Multimodality therapy including extrapleural pneumonectomy is feasible in selected patients with malignant pleural mesotheliomas, (2) pre-resectional evaluation of extrapleural nodes may select patients for radical therapy, (3) microscopic resection margins affect long-term survival, highlighting the need for further investigation of locoregional control, and (4) patients with epithelial, margin-negative, extrapleural node-negative resection had extended survival.

Original languageEnglish (US)
Pages (from-to)54-65
Number of pages12
JournalJournal of Thoracic and Cardiovascular Surgery
Volume117
Issue number1
DOIs
StatePublished - Jan 1 1999

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: Results in 183 patients'. Together they form a unique fingerprint.

  • Cite this

    Sugarbaker, D. J., Flores, R. M., Jaklitsch, M. T., Richards, W. G., Strauss, G. M., Corson, J. M., DeCamp M.M., J., Swanson, S. J., Bueno, R., Lukanich, J. M., Baldini, E. H., Mentzer, S. J., Kaiser, L. R., Patterson, G. A., & Faber, L. P. (1999). Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: Results in 183 patients. Journal of Thoracic and Cardiovascular Surgery, 117(1), 54-65. https://doi.org/10.1016/S0022-5223(99)70469-1