title: Surgically debulked malignant pleural mesothelioma: results and prognostic factors.
abstract: BACKGROUND
  We analyzed morbidity and mortality, sites of recurrence, and possible prognostic factors in 95 (78 male, 17 female) patients with MPM on phase I-III trials since 1990. A debulking resection to a requisite, residual tumor thickness of < or = 5 mm was required for inclusion.
  
  
  METHODS
  Preoperative tumor volumes were determined by three-dimensional reconstruction of chest computerized tomograms. Pleurectomy (n = 39) or extrapleural pneumonectomy (EPP; n = 39) was performed. Seventeen patients could not be debulked. Preoperative EPP platelet counts (404,000) and mean tumor volume (491 cm3) were greater than that seen for pleurectomy (344,000, 114 cm3).
  
  
  RESULTS
  Median survival for all patients was 11.2 months, with that for pleurectomy 14.5 months, that for EPP 9.4 months, and that for unresectable patients 5.0 months. Arrhythmia (n = 14; 15%) was the most common complication, and there were two deaths related to surgery (2.0%). Tumor volume of > 100 ml, biphasic histology, male sex, and elevated platelet count were associated with decreased survival (p < 0.05). Both EPP and pleurectomy had equivalent recurrence rates (27 of 39 [69%] and 31 of 39 [79%], respectively); however, 17 of 27 EPP recurrences as opposed to 28 of 31 pleurectomy recurrences were locoregional (p2 = 0.013).
  
  
  CONCLUSIONS
  Debulking resections for MPM can be performed with low operative mortality. Size and platelet count are important preoperative prognostic parameters for MPM. Patients with poor prognostic indicators should probably enter nonsurgical, innovative trials where toxicity or response to therapy can be evaluated.
authors.affiliation: Thoracic Oncology Section, National Cancer Institute/National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: H I
authors.initials: HI
authors.lastname: Pass
authors.forename: K
authors.initials: K
authors.lastname: Kranda
authors.forename: B K
authors.initials: BK
authors.lastname: Temeck
authors.forename: I
authors.initials: I
authors.lastname: Feuerstein
authors.forename: S M
authors.initials: SM
authors.lastname: Steinberg
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D010789:Phototherapy; D010997:Pleural Neoplasms / Q000453:epidemiology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014481:United States / Q000453:epidemiology