title: Prognostic Score of Long-Term Survival After Surgery for Malignant Pleural Mesothelioma: A Multicenter Analysis.
abstract: BACKGROUND
  Despite ongoing efforts to improve therapy in malignant pleural mesothelioma, few patients undergoing extrapleural pneumonectomy experience long-term survival (LTS). This study aims to explore predictors of LTS after extrapleural pneumonectomy and to define a prognostic score.
  
  
  METHODS
  From January 2000 to December 2010, we retrospectively reviewed clinicopathologic and oncological factors in a multicenter cohort of 468 malignant pleural mesothelioma patients undergoing extrapleural pneumonectomy. LTS was defined as survival longer than 3 years. Associations were evaluated using χ(2), Student's t, and Mann-Whitney U tests. Logistic regression, Cox regression hazard model, and bootstrap analysis were applied to identify outcome predictors. Survival curves were calculated by the Kaplan-Meier method. Receiver operating characteristic analyses were used to estimate optimal cutoff and area under the curve for accuracy of the model.
  
  
  RESULTS
  Overall, 107 patients (22.9%) survived at least 3 years. Median overall, cancer-specific, and disease-free survival times were 60 (95% confidence interval [CI], 51 to 69), 63 (95% CI, 54 to 72), and 49 months (95% CI, 39 to 58), respectively. At multivariate analysis, age (odds ratio, 0.51; 95% CI, 0.31 to 0.82), epithelioid histology (odds ratio, 7.07; 95% CI, 1.56 to 31.93), no history of asbestos exposure (odds ratio, 3.13; 95% CI, 1.13 to 8.66), and the ratio between metastatic and resected lymph nodes less than 22% (odds ratio, 4.12; 95% CI, 1.68 to 10.12) were independent predictors of LTS. According to these factors, we created a scoring system for LTS that allowed us to correctly predict overall, cancer-specific, and disease-free survival in the total sample, obtaining two different groups with favorable or poor prognosis (area under the curve, 0.74; standard error, 0.04; p < 0.0001).
  
  
  CONCLUSIONS
  Our prognostic model facilitates the prediction of LTS after surgery for malignant pleural mesothelioma and can help to stratify the outcome and, eventually, tailor postoperative treatment.
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy. Electronic address: gio.leuzzi@yahoo.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Leuzzi
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.affiliation: Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy.
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: Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Alessandrini
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: Thoracic Surgery Unit, Community Hospital, Brescia, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bovolato
authors.affiliation: Thoracic Surgery Unit, Community Hospital, Brescia, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pariscenti
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, Humanitas Research Hospital-Rozzano, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Infante
authors.affiliation: Division of Thoracic Surgery, Ospedale di Mestre, Venezia-Mestre, Italy.
authors.forename: Vittore
authors.initials: V
authors.lastname: Pagan
authors.affiliation: Division of Thoracic Surgery, Ospedale di Mestre, Venezia-Mestre, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontana
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: 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, IRCCS AOU "San Martino" IST, Genoa, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Ratto
authors.affiliation: Division of Thoracic Surgery, IRCCS AOU "San Martino" IST, Genoa, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Leoncini
authors.affiliation: Division of Surgery, Università-ASL, Chieti, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Division of Surgery, Università-ASL, Chieti, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Mucilli
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Facciolo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000401:mortality* / Q000601:surgery*; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000401:mortality* / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors