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. 2024 Apr 29;13(4):811-820.
doi: 10.21037/tlcr-23-797. Epub 2024 Apr 25.

Prolonged survival and novel prognostic factors in women with pleural mesothelioma treated with extended pleurectomy decortication

Moshe Lapidot  1   2 , Emanuele Mazzola  3 , Raphael Bueno  1
Affiliations

Prolonged survival and novel prognostic factors in women with pleural mesothelioma treated with extended pleurectomy decortication

Moshe Lapidot et al. Transl Lung Cancer Res. .

Abstract

Background: Pleural mesothelioma (PM) is an uncommon and extremely aggressive malignancy associated with past exposure to asbestos. The low representation of women among PM patients is likely due to differences in occupational asbestos exposure. Due to the controversial role of female sex as a prognostic factor in PM, the study aims to evaluate the survival of females treated with lung-sparing surgery. We present a cohort of 114 consecutive female patients with PM who underwent intended extended pleurectomy decortication (ePD) over 11 years in a high-volume single institution.

Methods: All women from 2007-2017 who underwent intended ePD were enrolled in the study. Data on clinical, operative, and outcome were collected. Kaplan-Meier estimators and log-rank tests were employed to assess the overall survival, and Cox regression models were utilized to analyze prognostic factors.

Results: During the study period, 454 patients underwent thoracotomy with intended ePD in a single institution. There were 114 females (25%), and macroscopic complete resection (MCR) was achieved in 97 (85.1%). The median age was 65 years, histology was epithelioid in 81 (71.0%), biphasic in 31 (27.2%), and sarcomatoid in 2 (1.8%). The 30- and 90-day mortality were 3.5% and 6.1%, respectively. Median survival in females was 38 months, and 5-year survival was 28.2%. The median survival and 5-year survival rate for patients with epithelioid histology and MCR were 44.4 months and 36.4%, respectively. In a univariate analysis, several factors were found to be associated with patient overall survival including MCR [hazard ratio (HR): 0.3, P<0.001], early T status (HR: 1.6, P=0.03), adjuvant therapy (HR: 0.5, P=0.006), intraoperative heated chemotherapy (IOHC) (HR: 0.8, P=0.03), age (HR: 1.02, P=0.03) and epithelioid histology (HR: 0.5, P=0.009).

Conclusions: For women with epithelioid PM undergoing intended ePD within a multimodal setting, prolonged survival is anticipated.

Keywords: Pleural mesothelioma (PM); extended pleurectomy decortication (ePD); macroscopic complete resection (MCR); women.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-23-797/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier plot depicting estimated survival functions according to sex status.
Figure 2
Figure 2
Kaplan-Meier plot depicting estimated survival functions in MCR group according to sex status. MCR, macroscopic complete resection.
Figure 3
Figure 3
Kaplan-Meier plot depicting estimated survival functions in females according to MCR status. MCR, macroscopic complete resection.
Figure 4
Figure 4
Kaplan-Meier plot depicting estimated survival functions in females according to histology.
Figure 5
Figure 5
Kaplan-Meier plot depicting estimated survival functions in patients with biphasic mesothelioma according to sex status.
See this image and copyright information in PMC

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