Prognostic factors after multimodality treatment for pleural mesothelioma
Masaki Hashimoto, Shota Nakamura, Akifumi Nakamura, Toru Nakamichi, Ayumi Kuroda, Kyoshiro Takegahara, Taketo Kato, Koichi Fukumoto, Seiji Matsumoto, Nobuyuki Kondo, Toyofumi Fengshi Chen-Yoshikawa, Seiki Hasegawa, Soichiro FunakiAbstract
Objectives
To investigate prognostic factors associated with overall survival (OS) in patients with pleural mesothelioma (PM) undergoing curative-intent surgery as part of multimodality treatment (MMT).
Methods
This retrospective two-centre cohort included 255 patients treated between 2006 and 2019. OS was measured from the date of histological diagnosis and analyzed using Cox proportional hazards regression as the primary analysis. A secondary logistic regression analysis evaluated 5-year survival among patients with ascertainable 5-year vital status. A sensitivity Cox analysis used the date of surgery as the time origin.
Results
Among 255 patients, 77 (30.2%) survived ≥5 years after diagnosis. All 255 patients and 192 deaths were included in the primary Cox analysis. Age ≥70 years (HR 1.49, 95% CI 1.04–2.14; P=.029), non-epithelioid histology (HR 2.22, 95% CI 1.33–3.72; P=.002), preoperative T2–4 disease according to the 9th edition TNM classification (HR 2.47, 95% CI 1.78–3.43; P<.001), severe postoperative complications (HR 2.62, 95% CI 1.85–3.70; P<.001), and blood loss >1465 mL (HR 1.39, 95% CI 1.03–1.87; P=.030) were independently associated with poorer OS. Fifteen patients alive at last contact but censored before 5 years were excluded from the secondary 5-year analysis, leaving 240 patients (77 surviving ≥5 years and 163 dying before 5 years). Results were materially unchanged when OS was measured from surgery.
Conclusions
Advanced age, non-epithelioid histology, higher preoperative T category according to the 9th edition TNM classification, severe postoperative complications, and greater intraoperative blood loss were independently associated with poorer OS in this highly selected surgically treated cohort.