General thoracic surgery
Outcome and prognostic factors of pleural mesothelioma after surgical diagnosis and/or pleurodesis

Presented in part at the Congress of French Society of Thoracic and Cardiovascular Surgery, Paris, France, December 9, 2011.
https://doi.org/10.1016/j.jtcvs.2012.09.023Get rights and content
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Objective

The objective of this study was to evaluate long-term survival and prognostic factors in patients with malignant pleural mesothelioma.

Methods

All consecutive patients referred for surgical diagnosis and/or pleurodesis for malignant pleural mesothelioma between 2000 and 2010 were studied. The following parameters were prospectively recorded: age, sex, tobacco consumption, asbestos exposure, type and duration of symptoms, American Society of Anesthesiologists (ASA) score, body mass index, preoperative C-reactive protein levels, white blood cells and platelet count, pachypleuritis on chest radiograph, type of diagnostic surgical procedure, histologic type, modality of pleurodesis, and chemotherapy. Survival was assessed on March 1, 2011.

Results

A total of 170 patients were included. For the entire population, median survival was 12 months (95% confidence interval [CI], 10-15). Two-, 5-, and 7-year overall survival was 26% (95% CI, 19-35), 11% (95% CI, 6-21), and 5% (95% CI, 9-22), respectively. Asbestos exposure, age, ASA class III versus ASA classes I and II, nonepithelioid histology, C-reactive protein levels >3 mg/L, and white cell count >12,000/mm3 influenced outcome in univariate analysis. Multivariate analysis showed that nonepithelioid histology (hazard ratio [HR], 2.76; 95% CI, 1.50-5.08); age (HR, 1.05; 95% CI, 1.01-1.08); C-reactive protein levels between 4 and 50 mg/L, and >51 (HR, 2.28; 95% CI, 1.18-4.42; and HR, 2.69; CI, 1.29-5.60, respectively); and leukocytosis >12,000/mm3 (HR, 2.28; 95% CI, 1.22-4.25) were independent worse survival predictors.

Conclusions

Median survival in an unselected population of patients with malignant pleural mesothelioma treated nonsurgically is 12 months. Nonepithelioid histology, older age, abnormal C-reactive protein levels, and leukocytosis are independent predictors of worse survival.

CTSNet classification

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Abbreviations and Acronyms

CI
confidence interval
CRP
C-reactive protein
IL
interleukin
MPM
malignant pleural mesothelioma

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Disclosures: Authors have nothing to disclose with regard to commercial support.

M.B. and S.S. contributed equally to this work.