title: Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma--institutional review and current update.
abstract: Extrapleural pneumonectomy (EPP) has been established as a viable surgical option in the treatment of malignant pleural mesothelioma (MPM) for selected patients. A number of pathological staging systems have been developed to prognosticate survival outcomes. We assessed 91 patients with MPM who underwent EPP in our institution and evaluated the applicability of the most updated staging systems in the current literature. After a mean follow-up of 20 months, the median overall survival was 27.6 months. Postoperative pathological staging according to the International Mesothelioma Interest Group criteria (P = 0.026) and the Brigham and Women's Hospital criteria (P = 0.039) were both found to be significant prognostic factors. Adjuvant chemotherapy (P = 0.022) and radiotherapy (P = 0.008) were associated with improved survival outcomes. These findings are consistent with previous reports that demonstrated the usefulness of pathological staging systems as a prognostic tool in patients with MPM after undergoing EPP. However, preoperative clinical staging systems need to be developed to facilitate the patient selection process prior to surgery.
authors.affiliation: Department of Cardiothoracic Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cao
authors.forename: Sarah Karen
authors.initials: SK
authors.lastname: Krog Andvik
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Catherine
authors.initials: C
authors.lastname: Kennedy
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.forename: Brian C
authors.initials: BC
authors.lastname: McCaughan
mesh_terms: D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009517:New South Wales; D018579:Patient Selection; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011237:Predictive Value of Tests; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome