Clinical and pathological features of three-year survivors of malignant pleural mesothelioma following extrapleural pneumonectomy.

Objective: Surgery-based multimodality therapy is associated with long-term survival in a significant number of pleural mesothelioma patients. Weexploredfactorsassociatedwith3-yearsurvivalinpatientswithmalignantpleuralmesothelioma,whounderwentextrapleuralpneumonectomy, to help refinepatientselection criteriaforsurgeryand other therapies.Methods:With Institutional ReviewBoard approval, wereviewedrecords in the International Mesothelioma Program Patient Data Registry to identify all patients, who underwent extrapleural pneumonectomy for malignant pleuralmesotheliomabetween1January1988and31May2007.Vitalstatusasof31May2010wasconfirmed.Fisher’sexacttestwasusedtocompare dichotomousvariablesforpatientswhosurvivedatleast3yearswiththosewhodidnot.Kaplan—Meieranalysiswasusedtoestimatethecumulative survival probabilityforall 3-yearsurvivors.Results:Among636 patientswhounderwentextrapleuralpneumonectomy, 117(18%) survivedatleast3 yearsfollowingsurgery,including26remainingaliveandfourlosttofollow-up.Ofthe3-yearsurvivors,39(33%)werefemale,61(52%)hadleft-sided disease,andthemedianagewas56years(range27—77).Relativelymore3-yearsurvivorswereyoungerthan,oratthemedianage( p = 0.0005),or female (p = 0.0007), had epithelial tumor histology ( p < 0.0001) and/or had normal white blood cell count (p = 0.0001), hemoglobin (p < 0.0001), or platelet count (p < 0.0001) preoperatively. The median survival of the 117 patients who survived 3-years was 59 months. Among these patients, a significant association between age and survival was found only for women. Conclusions: A significant proportion of patients undergoing extrapleural pneumonectomy for pleural mesothelioma experienced extended survival. Although favorable prognostic features were morecommon,thecohortof3-yearsurvivorsincludedasubstantialnumberofpatientswithlate-stagedisease.Thelongestsurvival(mediangreater than 7 years) was experienced by women under the median age of 56 years. These data support the role of macroscopic cytoreduction through