Multimodal Treatment of Pleural Mesothelioma with Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy: Impact of Additive Chemotherapy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. Patient Selection
2.2. Definition of Variables
2.3. Statistical Analysis
3. Results
3.1. Surgical Approach
3.2. Postoperative Data
3.3. Multimodal Treatment and Follow-Up
3.4. Survival Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Clinical Parameters | n = 260 | |
---|---|---|
Sex (n, %) | ||
female | 49 (18.8) | |
male | 211 (81.2) | |
Age (years) (mean ± SD) | 65.5 ± 9.0 | |
BMI (m2/kg) (mean ± SD) | 26.3 ± 3.9 | |
ECOG (n, %) | ||
0 | 159 (61.2) | |
1 | 89 (34.2) | |
2 | 1 (0.4) | |
missing | 11 (4.2) | |
Asbestos exposure (n, %) | ||
no | 56 (21.5) | |
yes | 171 (65.8) | |
missing/unknown | 33 (12.7) | |
Side (n, %) | ||
right | 156 (60.0) | |
left | 104 (40.0) | |
MPM histology (n, %) | ||
epithelioid | 220 (84.6) | |
biphasic | 35 (13.5) | |
sarcomatoid | 5 (1.9) | |
MPM tumor stage (UICC) (n, %) | ||
IA | 15 (5.8) | |
IB | 110 (42.3) | |
II | 39 (15.0) | |
III | 90 (34.6) | |
IV | 6 (2.3) |
Intraoperative Parameters | n = 260 | |
---|---|---|
Resection method (n, %) | ||
P/D | 60 (23.1) | |
eP/D | 193 (74.2) | |
EPP | 7 (2.7) | |
Resection of diaphragm (n, %) | ||
no | 87 (54.6) | |
yes | 173 (66.5) | |
Replacement of diaphragm (n, %) | ||
no | 193 (74.2) | |
yes | 67 (25.8) | |
Resection of pericardium (n, %) | ||
no | 142 (54.6) | |
yes | 118 (45.4) | |
Replacement of pericardium (n, %) | ||
no | 199 (76.5) | |
yes | 61 (23.5) | |
Resection of chest wall (n, %) | ||
no | 235 (90.4) | |
yes | 25 (9.6) | |
Resection status | ||
MCR | 222 (85.4) | |
R2 | 38 (14.6) | |
Blood loss (median, IQR) * | 800 (500, 1200) | |
Transfusion (n, %) | ||
no | 112 (43.1) | |
yes | 145 (55.8) | |
missing | 3 (1.2) | |
Chemotherapy substances (n, %) | ||
cisplatin alone | 152 (58.5) | |
cisplatin plus doxorubicin | 108 (41.5) | |
Cisplatin dosage (n, %) | ||
low dose (≤125 mg/m2 BSA) | 191 (73.2) | |
high dose (>125 mg/m2 BSA) | 70 (26.8) | |
Intraoperative complication | ||
no | 252 (96.9) | |
yes | 8 (3.1) |
Postoperative Parameters | n = 260 | |
---|---|---|
Postoperative complications (n, %) | ||
no | 118 (45.4) | |
yes/Clavien–Dindo classification | 142 (54.6) | |
I | 12 (4.6) | |
II | 52 (20.0) | |
IIIa | 28 (10.8) | |
IIIb | 37 (14.2) | |
IVa | 1 (0.4) | |
IVb | 3 (1.2) | |
V | 9 (3.5) | |
Revision (n, %) | ||
no | 224 (86.2) | |
yes/revision due to | 36 (13.8) | |
coagulothorax | 9 (3.5) | |
pleural empyema | 3 (1.2) | |
chylothorax | 5 (1.9) | |
parenchymal fistula/bronchial fistula | 8 (3.1) | |
other | 11 (4.2) | |
Prolonged ventilation > 24 h (n, %) | ||
no | 251 (96.5) | |
yes | 9 (3.5) | |
Extubation in the OR (n, %) | ||
no | 21 (8.1) | |
yes | 239 (91.9) | |
ICU stay [days] (median, IQR) | 2 (1, 4) | |
Hospital stay [days] (median, IQR) | 20 (15, 29) | |
In-hospital mortality (n, %) | 9 (3.5) |
Postoperative Course | n = 260 | |
---|---|---|
Neoadjuvant chemotherapy (n, %) | ||
no | 197 (75.8) | |
yes | 63 (24.2) | |
Adjuvant chemotherapy (n, %) | ||
no | 171 (65.8) | |
yes | 86 (33.1) | |
missing | 3 (1.2) | |
Additive chemotherapy (n, %) | ||
no | 121 (46.5) | |
yes | 136 (52.3) | |
missing | 3 (1.2) | |
Adjuvant radiotherapy (n, %) | ||
no | 199 (76.5) | |
yes | 58 (22.3) | |
missing | 3 (1.2) | |
Recurrence (MCR, n = 222) (n, %) | ||
no | 52 (23.4) | |
yes | 170 (76.6) | |
Progression (R2, n = 38) (n, %) | ||
no | 13 (34.2) | |
yes | 38 (65.8) | |
Location of recurrence/progression (n = 195) (n, %) | ||
locoregional | 157 (80.5) | |
distant metastasis | 15 (5.8) | |
locoregional and distant metastasis | 17 (8.7) | |
missing | 6 (3.1) | |
Site of recurrence/progression (n = 195) (n, %) | ||
ipsilateral | 174 (89.2) | |
contralateral | 6 (3.1) | |
missing | 15 (5.8) | |
Therapy for recurrence/progression (n = 195) (n, %) | ||
no | 11 (5.6) | |
unknown | 16 (8.2) | |
yes/type | 168 (86.2) | |
surgery | 19 (9.7) | |
chemotherapy | 117 (60.0) | |
radiotherapy | 30 (15.4) | |
supportive care | 14 (7.2) | |
other | 3 (1.5) | |
Time between the start of primary therapy until the end of follow-up in months * (reverse Kaplan–Meier OS) (median, 95% CI) | 48 (38, 58) |
Overall Survival | Disease-Free Survival | |||||||
---|---|---|---|---|---|---|---|---|
Sig. | HR | 95% CI | Sig. | HR | 95% CI | |||
cisplatin dosage | 0.350 | 0.81 | 0.53 | 1.25 | 0.831 | 1.04 | 0.74 | 1.45 |
chemotherapeutic agent | 0.114 | 1.35 | 0.93 | 1.95 | 0.556 | 1.10 | 0.80 | 1.53 |
resection status | <0.001 | 2.25 | 1.45 | 3.49 | 0.010 | 1.72 | 1.14 | 2.60 |
histological subtype | <0.001 | 2.27 | 1.50 | 3.41 | <0.001 | 2.43 | 1.63 | 3.61 |
UICC stage | 0.544 | 1.11 | 0.79 | 1.57 | 0.986 | 1.00 | 0.74 | 1.34 |
postoperative AKI | 0.897 | 1.03 | 0.64 | 1.65 | 0.515 | 1.14 | 0.77 | 1.70 |
additive chemotherapy | 0.184 | 0.79 | 0.56 | 1.12 | 0.003 | 0.64 | 0.47 | 0.85 |
time between the initial diagnosis and start of primary therapy | 0.712 | 1.01 | 0.97 | 1.05 | 0.772 | 1.00 | 0.98 | 1.04 |
N = 255 *; n = 162 dead, n = 93 censored | N = 256 **; n = 218 recurrence/progression or dead, n = 38 censored |
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Klotz, L.V.; Zimmermann, J.; Müller, K.; Kovács, J.; Hassan, M.; Koller, M.; Schmid, S.; Huppertz, G.; Markowiak, T.; Passlick, B.; et al. Multimodal Treatment of Pleural Mesothelioma with Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy: Impact of Additive Chemotherapy. Cancers 2024, 16, 1587. https://doi.org/10.3390/cancers16081587
Klotz LV, Zimmermann J, Müller K, Kovács J, Hassan M, Koller M, Schmid S, Huppertz G, Markowiak T, Passlick B, et al. Multimodal Treatment of Pleural Mesothelioma with Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy: Impact of Additive Chemotherapy. Cancers. 2024; 16(8):1587. https://doi.org/10.3390/cancers16081587
Chicago/Turabian StyleKlotz, Laura V., Julia Zimmermann, Karolina Müller, Julia Kovács, Mohamed Hassan, Michael Koller, Severin Schmid, Gunnar Huppertz, Till Markowiak, Bernward Passlick, and et al. 2024. "Multimodal Treatment of Pleural Mesothelioma with Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy: Impact of Additive Chemotherapy" Cancers 16, no. 8: 1587. https://doi.org/10.3390/cancers16081587