title: Does surgery improve survival of patients with malignant pleural mesothelioma?: a multicenter retrospective analysis of 1365 consecutive patients.
abstract: BACKGROUND
  Surgery with pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP) can be an option for selected patients with resectable malignant pleural mesothelioma (MPM). The aim of this study was to investigate the impact of surgical treatment on the outcome of patients with MPM.
  
  
  METHODS
  We retrospectively reviewed data from 1365 consecutive patients with histologically proven MPM, treated from 1982 to 2012 in six Institutions. Patients received chemotherapy alone (n = 172), best supportive care (n = 690), or surgical treatment (n = 503), by either P/D (n = 202) or EPP (n = 301) with or without chemotherapy.
  
  
  RESULTS
  After a median follow-up of 6.7 years (range, 1.1-14.8), 230 patients (16.8%) were alive; median survival for patients who received palliative treatment or chemotherapy alone, P/D, and EPP were 11.7 (95% CI, 10.5-12.5), 20.5 (95% CI, 18.2-23.1), and 18.8 (95% CI, 17.2-20.9) months, respectively. The 30-day mortality was 2.6% after P/D and 4.1% after EPP (p = 0.401). According to multivariate analysis (n = 1227), age less than 70, epithelial histology, and chemotherapy were independent favorable prognostic factors. In the subset of 313 patients (25.5%) with all favorable prognostic factors, median survival was 18.6 months after medical therapy alone, 24.6 months after P/D, and 20.9 months after EPP (p = 0.596).
  
  
  CONCLUSIONS
  Our data suggest that patients with good prognostic factors had a similar survival whether they received medical therapy only, P/D, or EPP. The modest benefit observed after surgery during medical treatment requires further investigation, and a large multicenter, randomized trial, testing P/D after induction chemotherapy versus chemotherapy alone in MPM patients with good prognostic factors, is needed.
authors: *Department of Thoracic Surgery, Ospedale Civili Brescia, Brescia, Italy; †Department of Thoracic Surgery, Ospedale Maggiore Novara, Novara, Italy; ‡Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; §Department of Thoracic Surgery, San Luigi Hospital, Orbassano, Torino, Italy; ‖Department of Thoracic Surgery, Ospedale Policlinico, Milan, Italy; ¶Department of Thoracic Surgery, IRCCS Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; #Department of Thoracic Surgery, Ospedale San Gerardo, Monza, Italy; and **Laboratory of Methodology for Biomedical Research, Oncology Department, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors: Pietro
authors: P
authors: Bovolato
authors: Caterina
authors: C
authors: Casadio
authors: Andrea
authors: A
authors: Billè
authors: Francesco
authors: F
authors: Ardissone
authors: Luigi
authors: L
authors: Santambrogio
authors: Giovanni Battista
authors: GB
authors: Ratto
authors: Giuseppe
authors: G
authors: Garofalo
authors: Amedeo Vittorio
authors: AV
authors: Bedini
authors: Marina
authors: M
authors: Garassino
authors: Luca
authors: L
authors: Porcu
authors: Valter
authors: V
authors: Torri
authors: Ugo
authors: U
authors: Pastorino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008654:Mesothelioma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000401:mortality*