title: Improving survival results after surgical management of malignant pleural mesothelioma: an Australian institution experience.
abstract: BACKGROUND
  There has been an evolving role of surgery for malignant pleural mesothelioma (MPM) over the past 25 years. The objective of this study was to investigate whether the survival results for MPM patients after surgery have improved within this time period by an analysis of a prospective cohort of 540 patients.
  
  
  METHODS
  Five hundred and forty consecutive patients with MPM were treated by a thoracic surgical team. These patients were categorized into two groups: Group I (before September 1999, n = 270) and Group II (after September 1999, n = 270). The two groups were compared for clinicopathologic data and survival results. The statistical analyses of all prognostic parameters used overall survival as the endpoint.
  
  
  RESULTS
  Group II had higher proportions of epithelial tumors and patients who had preoperative PET scan, extrapleural pneumonectomy (EPP), postoperative radiotherapy and pemetrexed chemotherapy. The overall survival results were significantly better in Group II compared with Group I (p = 0.004). Four factors were found to be independently associated with an improved survival in multivariate analysis: epithelial subtype (p <0.001); surgeon's experience with >100 cases (p = 0.006), patients who underwent EPP (p = 0.001) and those who received pemetrexed chemotherapy (p = 0.016). The median survival for patients selected for EPP was 20 months, as compared to 9 months for pleurodesis/decortication and pleurodesis.
  
  
  CONCLUSIONS
  Significant improvement of overall survival results has been achieved in the more recent 270 MPM patients through accumulated experience in a specialist treatment center.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia. tristan.yan@hotmail.com
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Christopher Q
authors.initials: CQ
authors.lastname: Cao
authors.forename: Michael
authors.initials: M
authors.lastname: Boyer
authors.forename: Mo Mo
authors.initials: MM
authors.lastname: Tin
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; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009517:New South Wales; D010997:Pleural Neoplasms / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome