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Titolo:
Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: Results in 183 patients
Autore:
Sugarbaker, DJ; Flores, RM; Jaklitsch, MT; Richards, WG; Strauss, GM; Carson, JM; DeCamp, MM; Swanson, SJ; Bueno, R; Lukanich, JM; Baldini, EH; Mentzer, SJ;
Indirizzi:
Brigham & Womens Hosp, Div Thorac Surg, Boston, MA 02115 USA Brigham & Womens Hosp Boston MA USA 02115 orac Surg, Boston, MA 02115 USA Brigham & Womens Hosp, Dept Pathol, Boston, MA 02115 USA Brigham & Womens Hosp Boston MA USA 02115 pt Pathol, Boston, MA 02115 USA HarvardSAniv, Sch Med, Dana Farber Canc Inst, Surg Serv, Boston, MA 02115 U Harvard Univ Boston MA USA 02115 Canc Inst, Surg Serv, Boston, MA 02115 U Harvard02115, Sch Med, Dana Farber Canc Inst, Dept Adult Oncol, Boston, MAHarvard Univ Boston MA USA 02115 Canc Inst, Dept Adult Oncol, Boston, MA Univ Massachusetts, Worcester, MA 01605 USA Univ Massachusetts Worcester MA USA 01605 usetts, Worcester, MA 01605 USA
Titolo Testata:
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
fascicolo: 1, volume: 117, anno: 1999,
pagine: 54 - 63
SICI:
0022-5223(199901)117:1<54:RMENSA>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
LUNG-CANCER; INTRAPERITONEAL CHEMOTHERAPY; UNITED-STATES; MULTIMODALITY THERAPY; PHOTODYNAMIC THERAPY; BIWEEKLY PACLITAXEL; 1-HOUR INFUSION; OVARIAN-CANCER; PHASE-I; CISPLATIN;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
43
Recensione:
Indirizzi per estratti:
Indirizzo: Sugarbaker, DJ Brigham & Womens Hosp, Div Thorac Surg, 75 Francis St, Boston, MA 02115 USA Brigham & Womens Hosp 75 Francis St Boston MA USA 02115 USA
Citazione:
D.J. Sugarbaker et al., "Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: Results in 183 patients", J THOR SURG, 117(1), 1999, pp. 54-63

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 and15% 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 (OR3.0, 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/12/20 alle ore 20:05:21