Source: Annual Congress 2002 - Thoracic oncology: clinical management
Disease area: Thoracic oncology

Abstract

OBJECTIVES: The value of Tumour-Nodes-Metastasis staging in patients with malignant mesothelioma (MM) undergoing radical surgery has been questioned. The aim of this study was to analyse the impact clinical, pathological and biological prognostic factors on survival in these patients.
METHODS: Extrapleural pneumonectomy (EPP) or radical pleurectomy / decortication (P/D) was performed in appropriately staged and selected patients. Snap-frozen and paraffin embedded tumour samples were evaluated prospectively. Angiogenesis was assessed by anti-CD34 immunohistochemistry and Chalkley microvessel counting. Cyclooxygenase(COX)-2 expression was evaluated by semi-quantitative Western Blotting and immunohistochemistry. Established prognostic factors, pathological data and novel biological prognostic factors were examined for prognostic significance by Kaplan-Meier analysis, using the Log Rank test.
RESULTS: EPP was performed in 22 and P/D in 6 patients. 30-day mortality was one patient (3.6%). Overall median survival was 12.6 months. Survival rates at 6, 12 and 18 months were 75%, 56% and 31% respectively. Significant predictors of survival were the Cancer and Leukaemia Group B prognostic group (p=0.0009), preoperative haemoglobin [lte]14 g/dL (p=0.03), and COX-2 levels >median values (p=0.03). Neither IMIG TNM (p=0.87) nor Brigham Stage (p=0.32) predicted postoperative survival. Similarly, poor survival was not predicted by the presence of positive resection margins (9 out of 22 (41%) EPPs, p=0.90) or positive extrapleural lymph nodes (8 patients, p=0.31).
CONCLUSION: In the selected patients with MM who undergo radical surgery, biological and clinicopathological prognostic factors may as important as anatomical stage in determining outcome.

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Citations should be made in the following way:
J. G. Edwards, K. J. O'Byrne, D. A. Waller (Leicester, United Kingdom). Predictors of survival in patients undergoing radical surgery for malignant mesothelioma. Eur Respir J 2002; 20: Suppl. 38, 1193

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