title: Persistent lung expansion after pleural talc poudrage in non-surgically resected malignant pleural mesothelioma.
abstract: BACKGROUND
  To investigate the prognostic effect of persistent lung expansion after pleural talcage and other variables in non-surgically resected malignant pleural mesothelioma (MPM) patients.
  
  
  METHODS
  All consecutive patients submitted to video-assisted thoracoscopic (VAT) pleurodesis by talc poudrage for MPM between 2006 and 2011 were studied. The following parameters were prospectively recorded: age; sex; smoking history; asbestos exposure; C-reactive protein (CRP) levels; platelet (PLT) count; Eastern Cooperative Oncology Group performance status (ECOG PS); histologic subtype; clinical stage (cStage); chemotherapy; pleural fluid volume; and persistence of lung expansion at 3 months follow-up. Survival was assessed in June 2013.
  
  
  RESULTS
  A total of 172 patients were considered; 146 of 172 patients demonstrated a complete lung expansion at discharge, whereas only 85 of 172 patients had persistent expanded lung on the affected side at the 3-month follow-up chest x-ray. Median survival was 11.5 months (95% confidence interval [CI], 10% to 14%) and 2-year disease-specific survival was 13% (95% CI, 7% to 24%) for the entire cohort. Multivariate analysis showed that non-epithelioid histology (hazard ratio [HR], 2.81; 95% CI, 1.82% to 5.09%), pleural fluid recurrence (HR 2.54; 95% CI, 1.73% to 4.40%), cStage greater than II (HR 2.36; 95% CI, 1.50% to 4.32%), ECOG PS greater than 1 (HR 2.19; 95% CI, 1.26% to 4.23%), CRP greater than 5 mg/L (HR 2.01; 95% CI, 1.18% to 4.12%), and PLT count greater than 400,000 (HR 1.76; 95% CI 1.14% to 3.92%) were independent predictors of poor prognosis.
  
  
  CONCLUSIONS
  Persistent lung expansion after pleural talc poudrage and absence of fluid recurrence is demonstrated to be a stronger factor in predicting survival rather than clinical stage and other clinical variables in not surgically resected MPM patients.
authors: Thoracic Surgery Unit, University of Eastern Piedmont, Novara, Italy. Electronic address: ottaviorena@libero.it.
authors: Ottavio
authors: O
authors: Rena
authors: Department of Pathology, University of Eastern Piedmont, Novara, Italy.
authors: Renzo
authors: R
authors: Boldorini
authors: Thoracic Surgery Unit, University of Eastern Piedmont, Novara, Italy.
authors: Esther
authors: E
authors: Papalia
authors: Division of Genetics and Cell Biology, San Raffaele University, Milan, Italy.
authors: Rosanna
authors: R
authors: Mezzapelle
authors: Thoracic Surgery Unit, University of Eastern Piedmont, Novara, Italy.
authors: Guido
authors: G
authors: Baietto
authors: Thoracic Surgery Unit, University of Eastern Piedmont, Novara, Italy.
authors: Alberto
authors: A
authors: Roncon
authors: Thoracic Surgery Unit, University of Eastern Piedmont, Novara, Italy.
authors: Caterina
authors: C
authors: Casadio
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001707:Biopsy, Needle; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000469:parasitology / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods* / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D015626:Tissue Expansion / Q000379:methods; D016896:Treatment Outcome
chemical_list: D013627:Talc