Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients
Phase observationalN = 183
- Population
- 183 patients with malignant pleural mesothelioma, 140 men and 43 women (age range 31-76 years), treated 1980-1997
- Design
- Case series of 183 patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy followed by adjuvant chemotherapy and radiotherapy between 1980 and 1997; aim: to identify prognostic variables for long-term postoperative survival. Univariate analysis and Cox proportional hazards models. Median follow-up 13 months; perioperative mortality 3.8% (7 deaths), morbidity 50%; survival reported for the 176 patients who survived the perioperative period. The abstract does not say whether the series was retrospective or from a single centre (first author's affiliation: Brigham and Women's Hospital, Boston) or from when survival was counted. No comparison group.
- Arms
- EPP then adjuvant chemotherapy and radiotherapy (experimental, n = 183): Extrapleural pneumonectomy followed by adjuvant chemotherapy and radiotherapy
- People
- Sugarbaker DJ, senior author Mentzer SJ
Show the numbers
| Endpoint | Analysis | EPP then adjuvant chemotherapy and radiotherapy | Control | Effect |
|---|---|---|---|---|
| OS176 patients who survived the perioperative period | finalmedian follow-up 13 monthsSugarbaker 1999 | median 19 months; 38% at 2 y; 15% at 5 y | — | Series result with no control group. Median follow-up of 13 months is for the 183 patients as printed; the abstract gives no numbers at risk. |
| OSEpithelial cell type (univariate analysis within the series) | exploratorySugarbaker 1999 | median 26 months; 52% at 2 y; 21% at 5 y | — | P=0.0001Univariate association of epithelial cell type with longer survival within the series; the abstract gives no figures for the comparison group. |
| OSNegative resection margins (univariate analysis within the series) | exploratorySugarbaker 1999 | median 23 months; 44% at 2 y; 25% at 5 y | — | P=0.02Univariate association of negative resection margins with longer survival within the series; the abstract gives no figures for the comparison group. |
| OSExtrapleural nodes without metastases (univariate analysis within the series) | exploratorySugarbaker 1999 | median 21 months; 42% at 2 y; 17% at 5 y | — | P=0.004Univariate association of node-negative extrapleural nodes with longer survival within the series; the abstract gives no figures for the comparison group. |
| OS31 patients with epithelial type, negative margins and node-negative extrapleural nodes | exploratorySugarbaker 1999 | median 51 months; 68% at 2 y; 46% at 5 y | — | P=0.013Subgroup defined using the three variables identified in the same series, so it is a descriptive subgroup and not a validated prediction; the abstract gives no figures for the comparison group. |
| Endpoint | Analysis | EPP then adjuvant chemotherapy and radiotherapy | Control | Effect |
|---|---|---|---|---|
| OS176 patients who survived the perioperative period | finalmedian follow-up 13 monthsSugarbaker 1999 | median 19 months; 38% at 2 y; 15% at 5 y | — | Series result with no control group. Median follow-up of 13 months is for the 183 patients as printed; the abstract gives no numbers at risk. |
| OSEpithelial cell type (univariate analysis within the series) | exploratorySugarbaker 1999 | median 26 months; 52% at 2 y; 21% at 5 y | — | P=0.0001Univariate association of epithelial cell type with longer survival within the series; the abstract gives no figures for the comparison group. |
| OSNegative resection margins (univariate analysis within the series) | exploratorySugarbaker 1999 | median 23 months; 44% at 2 y; 25% at 5 y | — | P=0.02Univariate association of negative resection margins with longer survival within the series; the abstract gives no figures for the comparison group. |
| OSExtrapleural nodes without metastases (univariate analysis within the series) | exploratorySugarbaker 1999 | median 21 months; 42% at 2 y; 17% at 5 y | — | P=0.004Univariate association of node-negative extrapleural nodes with longer survival within the series; the abstract gives no figures for the comparison group. |
| OS31 patients with epithelial type, negative margins and node-negative extrapleural nodes | exploratorySugarbaker 1999 | median 51 months; 68% at 2 y; 46% at 5 y | — | P=0.013Subgroup defined using the three variables identified in the same series, so it is a descriptive subgroup and not a validated prediction; the abstract gives no figures for the comparison group. |
- EPP then adjuvant chemotherapy and radiotherapy (experimental)
Data table (modelled values)
| Months | EPP then adjuvant chemotherapy and radiotherapy |
|---|---|
| 0 | 100.0% |
| 16 | 55.2% |
| 32 | 28.2% |
| 49 | 19.8% |
| 65 | 15.0% |
- EPP then adjuvant chemotherapy and radiotherapy (experimental)
Data table (modelled values)
| Months | EPP then adjuvant chemotherapy and radiotherapy |
|---|---|
| 0 | 100.0% |
| 16 | 66.0% |
| 32 | 42.4% |
| 49 | 29.1% |
| 65 | 21.0% |
Appears in
Sources
Sugarbaker DJ, Flores RM, Jaklitsch MT, Richards WG, Strauss GM, Corson JM, 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 Thorac Cardiovasc Surg. 1999;117(1):54-63; discussion 63-5.