title: Prognostic features of long-term survivors after surgical management of malignant pleural mesothelioma.
abstract: BACKGROUND
  The primary aim of this study was to evaluate prognostic features of long-term survivors with pleural mesothelioma.
  
  
  METHODS
  Overall survival outcome was analyzed in 456 patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy (EPP), pleurectomy/decortications, or pleurodesis/biopsy with at least 18 months of follow-up. Prospectively collected clinicopathologic and treatment data were assessed for their correlations with actual 18-month survivors in both univariate and multivariate analyses.
  
  
  RESULTS
  The actual 18-month survival was 28%. Epithelial subtype was present in 185 patients (41%) and nonepithelial subtype in 183 (40%). Procedures were EPP in 59 patients (13%), pleurectomy/decortication in 250 (55%), and pleurodesis/biopsy in 147 (32%). Forty-two patients (9%) underwent positron emission tomography (PET) scanning. Forty patients (9%) received adjuvant radiotherapy and 45 (10%) received postoperative pemetrexed combination chemotherapy. In univariate analysis, age 65 years or younger (p < 0.001), malignant pleural effusion (p = 0.041), epithelial subtype (p < 0.001), EPP (p < 0.001), PET scan (p = 0.012), adjuvant radiotherapy (p = 0.042), and postoperative pemetrexed combination chemotherapy (p = 0.035) were strongly associated with 18-month survivors. In multivariate analysis, epithelial histopathologic subtype (p < 0.001) and EPP (p < 0.001) were independently associated with 18-month survivors.
  
  
  CONCLUSIONS
  The actual 18-month survival was 28% in 456 pleural mesothelioma patients who underwent operation. Epithelial histologic subtype and EPP were identified as independent predictors for 18-month survivors.
authors.affiliation: Department of Cardiothoracic Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Michael
authors.initials: M
authors.lastname: Boyer
authors.forename: Mo Mo
authors.initials: MM
authors.lastname: Tin
authors.forename: Junyang
authors.initials: J
authors.lastname: Sim
authors.forename: Catherine
authors.initials: C
authors.lastname: Kennedy
authors.forename: Jocelyn
authors.initials: J
authors.lastname: McLean
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.forename: Brian C
authors.initials: BC
authors.lastname: McCaughan
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010996:Pleural Effusion / Q000453:epidemiology / Q000473:pathology; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors