title: Extrapleural pneumonectomy for malignant mesothelioma: an Italian multicenter retrospective study.
abstract: BACKGROUND
  This study assessed perioperative outcome and long-term survival in a large series of patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy (EPP) to identify prognostic factors allowing better patient selection.
  
  
  METHODS
  We retrospectively collected data from nine referral centers for thoracic surgery in Italy. Perioperative outcome and survival data were available for 518 malignant pleural mesothelioma patients (84.4% with epithelial tumors, 68.0% with pathologic stage 3 disease) who underwent EPP with intention-to-treat (R0/R1) between 2000 and 2010. Induction chemotherapy was administered in 271 patients (52.3%) and adjuvant therapy in 373 patients (72.0%), including radiotherapy in 213 patients (41.1%), adjuvant chemotherapy in 43 patients (8.3%), and both in 117 patients (22.6%).
  
  
  RESULTS
  In all, 136 patients (26.3%) had major complications after EPP, and 36 (6.9%) died within 90 days after surgery. The median overall survival was 18 months, with a 1-, 2-, and 3-year overall survival of 65%, 41%, and 27%, respectively. At multivariable analysis adjusted for age and disease stage, male sex (hazard ratio [HR] 1.47, 95% confidence interval [CI]: 1.12 to 1.92), nonepithelial histology (HR 1.96, 95% CI: 1.48 to 2.58), and trimodality treatment using induction chemotherapy (HR 0.61, 95% CI: 0.43 to 0.85) were significantly associated with survival. Development of a major complication also significantly worsened outcome (HR 1.85, 95% CI: 1.37 to 2.50).
  
  
  CONCLUSIONS
  The success of EPP in the context of a multimodality treatment depends on a series of patient characteristics. Female patients, patients with epithelial tumors, and patients who received induction chemotherapy will best benefit from EPP.
authors.affiliation: Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy. Electronic address: lorenzo.spaggiari@ieo.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.affiliation: Thoracic Surgery Unit, Community Hospital, Brescia, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bovolato
authors.affiliation: Division of Thoracic Surgery, Humanitas Research Hospital-Rozzano, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Alloisio
authors.affiliation: Division of Thoracic Surgery, Ospedale di Mestre, Venezia-Mestre, Italy.
authors.forename: Vittore
authors.initials: V
authors.lastname: Pagan
authors.affiliation: Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Oliaro
authors.affiliation: Division of Thoracic Surgery, IRCCS AOU "San Martino" IST, Genoa, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Ratto
authors.affiliation: Thoracic Surgery Unit, Department of Surgical Oncology, National Cancer Institute, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Facciolo
authors.affiliation: Division of Surgery, Università-ASL, Chieti, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Brambilla
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Patrick
authors.initials: P
authors.lastname: Maisonneuve
authors.affiliation: Division of Surgery, Università-ASL, Chieti, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Mucilli
authors.affiliation: Thoracic Surgery Unit, Department of Surgical Oncology, National Cancer Institute, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Alessandrini
authors.affiliation: Division of Thoracic Surgery, IRCCS AOU "San Martino" IST, Genoa, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Leoncini
authors.affiliation: Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.affiliation: Division of Thoracic Surgery, Ospedale di Mestre, Venezia-Mestre, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontana
authors.affiliation: Division of Thoracic Surgery, Humanitas Research Hospital-Rozzano, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Infante
authors.affiliation: Thoracic Surgery Unit, Community Hospital, Brescia, Italy.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Pariscenti
authors.affiliation: Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Casiraghi
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; 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; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies