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Differential Survival Characteristics Of Sarcomatoid Subtype In Biphasic Pleural Mesothelioma.

L. Harling, S. Kolokotroni, A. Nair, J. Smelt, J. King, T. Routledge, J. Spicer, Wen Ng, A. Billè
Published 2019 · Medicine

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BACKGROUND Biphasic pleural mesothelioma (BPM) accounts for approximately 10% of all pleural mesothelioma. Our aim was to assess the clinical, radiologic, and pathologic factors impacting survival in BPM and to better identify patients most likely to benefit from active treatment. METHODS A 10-year retrospective review was made of 214 biopsy-proven BPM cases with minimum 2-year follow-up. Patients with insufficient tissue for analysis were excluded (n = 96). Clinical and pathologic factors were evaluated along with radiologic assessment of pleural thickness. Survival was measured from time of diagnosis. Univariable and multivariable predictors of survival were evaluated. RESULTS In all, 118 patients were included; 28 underwent pleurectomy/decortication, with 27 receiving additional modalities. Ninety patients underwent chemotherapy (n = 18) or radiotherapy alone (n = 9), 63 received combination therapy, and 27 received best supportive care. Median overall survival was 11.2 months (range, 0.3 to 36.2). At univariable analysis, pleurectomy/decortication (p = 0.0061), radiotherapy (p < 0.0001), and chemotherapy (p < 0.0001) were associated with superior survival when compared with best supportive care alone. Pleurectomy/decortication demonstrated 40% survival improvement compared with no surgery (p = 0.122). In a multivariable model, necrosis was negatively prognostic (hazard ratio 2.1, SE 0.76). Furthermore, increased sarcomatoid component was associated with worse survival without radiotherapy. CONCLUSIONS BPM prognosis remains poor despite multimodality treatment. Anticancer treatment is associated with superior outcome in this nonrandomized retrospective series. Our findings suggest superior survival for patients with a lower proportion of sarcomatoid disease, with selective benefit of radiotherapy in higher proportions of sarcomatoid disease. When planning active treatment, the potential survival benefits require balancing against associated morbidity and recovery period.
This paper references
10.1016/j.lungcan.2013.04.019
Radical pleurectomy and chemoradiation for malignant pleural mesothelioma: the outcome of incomplete resections.
S. Boeluekbas (2013)
10.1016/j.jtho.2016.09.121
The IASLC Mesothelioma Staging Project: Proposals for Revisions of the N Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma
D. Rice (2016)
10.1136/jclinpath-2016-203993
Myxoid variant epithelioid pleural mesothelioma defines a favourable prognosis group: an analysis of 191 patients with pleural malignant mesothelioma
F. Alchami (2016)
10.1016/S0169-5002(01)00257-4
Therapeutic outcome according to histologic subtype in 121 patients with malignant pleural mesothelioma.
G. Ceresoli (2001)
10.1097/JTO.0b013e31824ab6c5
Pleurectomy/Decortication is Superior to Extrapleural Pneumonectomy in the Multimodality Management of Patients with Malignant Pleural Mesothelioma
L. Lang-Lazdunski (2012)
10.1016/j.ejcts.2007.09.044
Malignant pleural mesothelioma: clinicopathologic and survival characteristics in a consecutive series of 394 patients.
P. Borasio (2008)
10.1016/j.athoracsur.2016.08.063
Amount of Epithelioid Differentiation Is a Predictor of Survival in Malignant Pleural Mesothelioma.
W. Vigneswaran (2017)
10.1016/j.lungcan.2015.03.005
Demographics, management and survival of patients with malignant pleural mesothelioma in the National Lung Cancer Audit in England and Wales.
P. Beckett (2015)
10.1016/j.athoracsur.2009.12.041
Therapeutic surgery for nonepithelioid malignant pleural mesothelioma: is it really worthwhile?
B. Balduyck (2010)
10.1016/S0022-5223(98)70274-0
Preoperative tumor volume is associated with outcome in malignant pleural mesothelioma.
H. Pass (1998)
10.1093/ejcts/ezr192
Long-term survival after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group Stage T3-T4) non-sarcomatoid malignant pleural mesothelioma.
A. Nakas (2012)
10.1097/JTO.0b013e3181dd0ef1
Assessment of Therapy Responses and Prediction of Survival in Malignant Pleural Mesothelioma Through Computer-Aided Volumetric Measurement on Computed Tomography Scans
F. Liu (2010)
10.1016/j.lungcan.2015.05.014
Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England.
R. Damhuis (2015)
10.1016/j.jtho.2017.02.026
Improved Outcomes with Modern Lung‐Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma
F. Shaikh (2017)
10.1007/s00508-016-1037-2
Management of malignant pleural mesothelioma – part 3
T. Klikovits (2016)
10.1097/JTO.0b013e31826915f1
Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma Database
V. Rusch (2012)
10.1634/theoncologist.2014-0122
Current issues in malignant pleural mesothelioma evaluation and management.
J. Ai (2014)
10.1016/S0022-5223(99)70469-1
Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients.
D. Sugarbaker (1999)
10.2471/BLT.11.086678
Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008.
V. Delgermaa (2011)
10.1186/s13014-015-0575-5
Long-term results in malignant pleural mesothelioma treated with neoadjuvant chemotherapy, extrapleural pneumonectomy and intensity-modulated radiotherapy
C. Thieke (2015)
10.1200/JCO.2003.11.136
Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.
N. Vogelzang (2003)
10.1016/j.jss.2015.01.043
Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database.
R. Meyerhoff (2015)
10.1371/journal.pone.0145039
Determinants of Survival in Malignant Pleural Mesothelioma: A Surveillance, Epidemiology, and End Results (SEER) Study of 14,228 Patients
E. Taioli (2015)
10.1097/JTO.0000000000000630
The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification.
W. Travis (2015)



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