Background/Objectives: Unlike other thoracic malignancies, seeding malignant cells along surgical tracts is a known complication of invasive diagnostic or therapeutic procedures for pleural mesothelioma (PM). We report the tract dissemination rate and risk factors in 308 consecutive patients treated over 9 years in a single institution who underwent pleurectomy decortication (PD).Methods: Clinical and outcome data were reviewed. Fisher’s exact test, Kaplan–Meier estimators, and log-rank tests were used to identify significant risk factors for surgical tract dissemination and to compare overall survival.Results: There were 233 males (75.6%), 187 right-sided operations (61%), 190 (61.7%) epithelioid histology cases, and the median age was 69 (29–84). During the study, malignant cell dissemination in resected surgical tracts was diagnosed in 69 (22.4%) patients. The dissemination rates in epithelioid, biphasic, and sarcomatoid tumors were 24.7%, 20.4%, and 0%, respectively. Disseminated malignant surgical tract was associated with advanced nodal status (p= 0.001), advanced staging by the American Joint Committee on Cancer (AJCC 8th edition,p= 0.03), female sex (0.02), side of surgery (p= 0.03), and the number of video-assisted thoracoscopic surgery (VATS) ports (p= 0.003). In epithelioid mesothelioma, the median survival from diagnosis was 19.7 months in patients with tract seeding versus 36.3 months in patients without seeding (hazard ratio, 1.9;p= 0.001).Conclusions: Procedure tract dissemination occurs in almost every fourth patient with pleural mesothelioma and is associated with shorter overall survival in the epithelioid subtype.
背景/目的：与其他胸部恶性肿瘤不同，胸膜间皮瘤（PM）在侵入性诊断或治疗操作后沿手术路径播散恶性细胞是一种已知并发症。本研究回顾性分析了单中心9年间连续收治的308例接受胸膜切除剥脱术（PD）患者，报告其手术路径播散率及相关危险因素。 方法：回顾性分析临床资料与预后数据。采用Fisher精确检验、Kaplan-Meier估计量和对数秩检验，识别手术路径播散的重要危险因素并比较总生存期差异。 结果：全组男性233例（75.6%），右侧手术187例（61%），上皮样组织学类型190例（61.7%），中位年龄69岁（29-84岁）。研究期间，69例（22.4%）患者在切除的手术路径中发现恶性细胞播散。上皮样、双相性和肉瘤样肿瘤的播散率分别为24.7%、20.4%和0%。手术路径恶性播散与淋巴结晚期转移（p=0.001）、美国癌症联合委员会（AJCC）第八版分期较晚（p=0.03）、女性（p=0.02）、手术侧别（p=0.03）以及电视辅助胸腔镜手术（VATS）切口数量（p=0.003）显著相关。在上皮样间皮瘤患者中，发生路径播散者自诊断起中位生存期为19.7个月，未播散者为36.3个月（风险比1.9，p=0.001）。 结论：约四分之一胸膜间皮瘤患者会发生操作路径播散，且在上皮样亚型中与较短的总生存期显著相关。
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