title: Epithelial malignant pleural mesothelioma after extrapleural pneumonectomy: stratification of survival with CT-derived tumor volume.
abstract: OBJECTIVE
  The purpose of this study was to assess the usefulness of CT-derived tumor volume, with control for other prognostic factors, for stratifying survival after surgery-based multimodality treatment of a large cohort of patients with epithelial malignant pleural mesothelioma.
  
  
  METHODS
  We retrospectively reviewed 338 patients with mesothelioma who underwent extrapleural pneumonectomy between 2001 and 2007. The study cohort comprised 88 patients with epithelial subtype tumors, DICOM-format CT scans, and data regarding neoadjuvant and adjuvant therapy. Tumor volume was calculated, and Kaplan-Meier survival and Cox regression analyses were performed to compare the estimated survival functions of patient subgroups based on volume and other covariates related to outcome (sex, age, preoperative platelet count, hemoglobin concentration, WBC count, clinical and pathologic TNM category, and administration of neoadjuvant and adjuvant therapy). A multivariate regression model was derived on the basis of the most significant univariate predictors.
  
  
  RESULTS
  The median estimated tumor volume was 319 cm(3) (range, 4-3256 cm(3)). In univariate analysis, tumor volume, hemoglobin concentration, platelet count, pathologic TNM category, and administration of adjuvant chemotherapy or radiation therapy met the criteria for inclusion in the reverse stepwise regression analysis. In the final model, tumor volume, hemoglobin concentration, and administration of adjuvant chemotherapy or radiotherapy were identified as independently associated with overall survival.
  
  
  CONCLUSIONS
  With control of prognostic covariates, CT-derived tumor volume can be used to stratify survival of patients with epithelial mesothelioma after extrapleural pneumonectomy and should be included in prognostic evaluation of patients for whom resection is being considered.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. rgill@partners.org
authors.forename: Ritu R
authors.initials: RR
authors.lastname: Gill
authors.forename: William G
authors.initials: WG
authors.lastname: Richards
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
authors.forename: Shin
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Wolf
authors.forename: Victor H
authors.initials: VH
authors.lastname: Gerbaudo
authors.forename: Raphael
authors.initials: R
authors.lastname: Bueno
authors.forename: David J
authors.initials: DJ
authors.lastname: Sugarbaker
authors.forename: Hiroto
authors.initials: H
authors.lastname: Hatabu
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D003287:Contrast Media; D007472:Iohexol; C038192:iopromide