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. 2014 Oct;260(4):577-80; discussion 580-2.
doi: 10.1097/SLA.0000000000000903.

Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients

David J Sugarbaker  1 , William G Richards, Raphael Bueno
Affiliations

Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients

David J Sugarbaker et al. Ann Surg. 2014 Oct.

Abstract

Objective: We review our 24-year experience with extrapleural pneumonectomy (EPP) in the treatment of epithelioid malignant pleural mesothelioma (MPM).

Background: Recent publications, particularly the MARS (Mesothelioma and Radical Surgery) feasibility study by Treasure et al, have questioned the safety and efficacy of EPP for MPM.

Methods: An institutional review board-approved, prospective, single-center database was retrospectively reviewed. Descriptive statistics and Kaplan-Meier analysis of overall survival are reported.

Results: From 1988 to 2011, a total of 529 patients with epithelioid MPM underwent complete resection by EPP as part of a multimodality strategy. Among these, 131 (25%) were women, and the median age was 59 (range, 17-79) years. Median postoperative hospital stay was 10 (range, 1-101) days. Twenty-six patients (5%) experienced 30-day or in-hospital mortality. Median overall survival was 18 months, with 1-, 3-, 5-, and 10-year survival rates of 67%, 28%, 14%, and 4%, respectively. Outcome by pathologic lymph node status (N, median overall survival) was N0: 224, 26 months; N1: 118, 17 months; N2: 181, 13 months; N3: 5, 7 months; Nx: 1, not evaluable.

Conclusions: EPP has evolved as an effective method for macroscopic complete resection. This study confirms that lymph node status is significantly correlated with overall survival in patients with epithelioid MPM undergoing EPP and suggests that those with simultaneous involvement of N1 and N2 stations are at increased risk. This observation underscores the need for thorough staging of both N1 and N2 stations and has implications for revision of MPM staging criteria.

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Conflict of interest statement

Disclosure: The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan-Meier estimate of overall survival function for the entire cohort of 529 patients with epithelioid MPM treated with EPP.
FIGURE 2
FIGURE 2
A, Kaplan-Meier plot depicting estimated survival functions according to AJCC nodal status. B, Analysis as in (A) but with N2 cases divided into 2 subgroups according to whether simultaneous metastasis to N1 lymph nodes was detected. CI indicates confidence interval; HR, hazard ratio; LNS, lymph node status.
See this image and copyright information in PMC

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