Outcome and prognostic factors of pleural mesothelioma after surgical diagnosis and/or pleurodesis.
OBJECTIVE
The objective of this study was to evaluate long-term survival and prognostic factors in patients with malignant pleural mesothelioma.


METHODS
All consecutive patients referred for surgical diagnosis and/or pleurodesis for malignant pleural mesothelioma between 2000 and 2010 were studied. The following parameters were prospectively recorded: age, sex, tobacco consumption, asbestos exposure, type and duration of symptoms, American Society of Anesthesiologists (ASA) score, body mass index, preoperative C-reactive protein levels, white blood cells and platelet count, pachypleuritis on chest radiograph, type of diagnostic surgical procedure, histologic type, modality of pleurodesis, and chemotherapy. Survival was assessed on March 1, 2011.


RESULTS
A total of 170 patients were included. For the entire population, median survival was 12 months (95% confidence interval [CI], 10-15). Two-, 5-, and 7-year overall survival was 26% (95% CI, 19-35), 11% (95% CI, 6-21), and 5% (95% CI, 9-22), respectively. Asbestos exposure, age, ASA class III versus ASA classes I and II, nonepithelioid histology, C-reactive protein levels >3 mg/L, and white cell count >12,000/mm(3) influenced outcome in univariate analysis. Multivariate analysis showed that nonepithelioid histology (hazard ratio [HR], 2.76; 95% CI, 1.50-5.08); age (HR, 1.05; 95% CI, 1.01-1.08); C-reactive protein levels between 4 and 50 mg/L, and >51 (HR, 2.28; 95% CI, 1.18-4.42; and HR, 2.69; CI, 1.29-5.60, respectively); and leukocytosis >12,000/mm(3) (HR, 2.28; 95% CI, 1.22-4.25) were independent worse survival predictors.


CONCLUSIONS
Median survival in an unselected population of patients with malignant pleural mesothelioma treated nonsurgically is 12 months. Nonepithelioid histology, older age, abnormal C-reactive protein levels, and leukocytosis are independent predictors of worse survival.
INSERM Unit 938, CdR Saint Antoine, Paris, France.
Mariette
M
Baud
Salvatore
S
Strano
Agnes
A
Dechartres
Rami
R
Jouni
Frederic
F
Triponez
Christos
C
Chouaid
Patricia
P
Forgez
Diane
D
Damotte
Nicolas
N
Roche
Jean-François
JF
Régnard
Marco
M
Alifano
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007964:Leukocytosis / Q000401:mortality; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D018700:Pleurodesis / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D002097:C-Reactive Protein