title: Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center.
abstract: BACKGROUND
  Most studies describing the natural history and prognostic factors for malignant pleural mesothelioma antedate accurate pathologic diagnosis, staging by computed tomography, and a universal staging system. We conducted a large single-institution analysis to identify prognostic factors and assess the association of resection with outcome in a contemporary patient population.
  
  
  METHODS
  Patients with biopsy-proven malignant pleural mesothelioma at our institution were identified and clinical data were obtained from an institutional database. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. A p value <0.05 was considered statistically significant.
  
  
  RESULTS
  From 1990 to 2005, 945 patients were identified: 755 men, 190 women; median age, 66 years (range, 26-93). Extrapleural pneumonectomy was performed in 208 (22%), pleurectomy/decortication in 176 (19%). Operative mortality was 4% (16/384). Multimodality therapy including surgery was associated with a median survival of 20.1 months. Significant predictors of overall survival included histology, gender, smoking, asbestos exposure, laterality, surgical resection by extrapleural pneumonectomy or pleurectomy/decortication, American Joint Committee on Cancer stage, and symptoms. A Cox model demonstrated a hazard ratio of 1.4 without surgical resection when controlling for histology, stage, gender, asbestos exposure, smoking history, symptoms, and laterality (p = 0.003).
  
  
  CONCLUSIONS
  In addition to tumor histology and pathologic stage, predictors of survival include gender, asbestos exposure, smoking, symptoms, laterality, and clinical stage. Surgical resection in a multimodality setting was associated with improved survival.
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. floresr@mskcc.org
authors.forename: Raja M
authors.initials: RM
authors.lastname: Flores
authors.forename: Maureen
authors.initials: M
authors.lastname: Zakowski
authors.forename: Ennapadam
authors.initials: E
authors.lastname: Venkatraman
authors.forename: Lee
authors.initials: L
authors.lastname: Krug
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rosenzweig
authors.forename: Joseph
authors.initials: J
authors.lastname: Dycoco
authors.forename: Catherine
authors.initials: C
authors.lastname: Lee
authors.forename: Cindy
authors.initials: C
authors.lastname: Yeoh
authors.forename: Manjit
authors.initials: M
authors.lastname: Bains
authors.forename: Valerie
authors.initials: V
authors.lastname: Rusch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010997:Pleural Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011379:Prognosis; D012074:Remission Induction; D012907:Smoking; D015996:Survival Rate; D016896:Treatment Outcome