Background:The benefit of surgery for malignant pleural mesothelioma is highly debated, as few robust clinical trials show its effectiveness.Objective:To examine the long-term survival of patients with malignant pleural mesothelioma who underwent surgical treatment combined with neoadjuvant chemotherapy versus those who received chemotherapy alone.Methods:We analyzed a historical cohort of 122 patients diagnosed with mesothelioma, confirmed through histopathological examination. We compared the clinical and laboratory characteristics of the surgery and chemotherapy groups at baseline. We calculated Kaplan–Meier survival curves and used Cox’s proportional hazards model to evaluate the relationship between surgery and mortality.Results:Surgery was performed in 16 out of 122 cases. Pleurectomy/decortication (PD) represented 8 cases, while extrapleural pneumonectomy (EPP) accounted for the remaining 8 cases. At five years, survival rates for those who underwent surgery compared to chemotherapy alone were 53% (95% CI 15–81%) versus 23% (95% CI 10–40%), respectively. Survival among those who had PD was 67%, compared to 40% for those who had EPP. Surgical treatment was associated with improved survival, with a hazard ratio (HR) of 0.34 (95% CI 0.19–0.61) after adjusting for factors such as age over 65, the duration from symptom onset to diagnosis, hemoglobin levels below 10 g, a neutrophil-to-lymphocyte ratio over 6, and ECOG scores greater than 2.Conclusions:Mesothelioma surgery, whether it be PD or EPP, enhances patients’ survival compared to chemotherapy. PD produces better outcomes than EPP.
背景：恶性胸膜间皮瘤手术治疗的获益存在较大争议，目前缺乏强有力的临床试验证明其有效性。目的：比较接受新辅助化疗联合手术治疗与单纯化疗的恶性胸膜间皮瘤患者的长期生存差异。方法：我们分析了经组织病理学确诊的122例间皮瘤患者的历史队列数据，比较手术组与化疗组基线期的临床及实验室特征。采用Kaplan-Meier法绘制生存曲线，并运用Cox比例风险模型评估手术与死亡率的关系。结果：122例患者中16例接受手术治疗，其中胸膜切除/剥脱术（PD）8例，胸膜外全肺切除术（EPP）8例。五年生存率数据显示：手术组为53%（95%CI 15-81%），单纯化疗组为23%（95%CI 10-40%）。PD术式患者生存率达67%，显著高于EPP术式的40%。在校正年龄>65岁、症状出现至确诊时间、血红蛋白<10g、中性粒细胞/淋巴细胞比值>6及ECOG评分>2等因素后，手术治疗与生存改善显著相关，风险比（HR）为0.34（95%CI 0.19-0.61）。结论：与单纯化疗相比，无论是PD还是EPP术式，手术治疗均能显著提升恶性胸膜间皮瘤患者的生存率，其中PD术式的临床获益优于EPP术式。
Effectiveness of Surgical Treatment on Survival of Patients with Malignant Pleural Mesothelioma
肿瘤(癌症)患者之家