Prognostic score of long-term survival after surgery for malignant pleural mesothelioma: A multicenter analysis

Giovanni Leuzzi, Federico Rea, Lorenzo Spaggiari, Giuseppe Marulli, Isabella Sperduti, Gabriele Alessandrini, Monica Casiraghi, Pietro Bovolato, Gianluca Pariscenti, Marco Alloisio, Maurizio Infante, Vittore Pagan, Paolo Fontana, Alberto Oliaro, Enrico Ruffini, Giovanni Battista Ratto, Giacomo Leoncini, Rocco Sacco, Felice Mucilli, Francesco Facciolo

Research output: Contribution to journalArticle

11 Citations (Scopus)

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 χ2, 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.

Original languageEnglish
Pages (from-to)890-897
Number of pages8
JournalAnnals of Thoracic Surgery
Volume100
Issue number3
DOIs
Publication statusPublished - Sep 1 2015

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Confidence Intervals
Survival
Pneumonectomy
Odds Ratio
Disease-Free Survival
Area Under Curve
Malignant Mesothelioma
Asbestos
Nonparametric Statistics
Proportional Hazards Models
ROC Curve
Neoplasms
Histology
Multivariate Analysis
Logistic Models
Lymph Nodes
Students
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Prognostic score of long-term survival after surgery for malignant pleural mesothelioma : A multicenter analysis. / Leuzzi, Giovanni; Rea, Federico; Spaggiari, Lorenzo; Marulli, Giuseppe; Sperduti, Isabella; Alessandrini, Gabriele; Casiraghi, Monica; Bovolato, Pietro; Pariscenti, Gianluca; Alloisio, Marco; Infante, Maurizio; Pagan, Vittore; Fontana, Paolo; Oliaro, Alberto; Ruffini, Enrico; Ratto, Giovanni Battista; Leoncini, Giacomo; Sacco, Rocco; Mucilli, Felice; Facciolo, Francesco.

In: Annals of Thoracic Surgery, Vol. 100, No. 3, 01.09.2015, p. 890-897.

Research output: Contribution to journalArticle

Leuzzi, G, Rea, F, Spaggiari, L, Marulli, G, Sperduti, I, Alessandrini, G, Casiraghi, M, Bovolato, P, Pariscenti, G, Alloisio, M, Infante, M, Pagan, V, Fontana, P, Oliaro, A, Ruffini, E, Ratto, GB, Leoncini, G, Sacco, R, Mucilli, F & Facciolo, F 2015, 'Prognostic score of long-term survival after surgery for malignant pleural mesothelioma: A multicenter analysis', Annals of Thoracic Surgery, vol. 100, no. 3, pp. 890-897. https://doi.org/10.1016/j.athoracsur.2015.04.087
Leuzzi, Giovanni ; Rea, Federico ; Spaggiari, Lorenzo ; Marulli, Giuseppe ; Sperduti, Isabella ; Alessandrini, Gabriele ; Casiraghi, Monica ; Bovolato, Pietro ; Pariscenti, Gianluca ; Alloisio, Marco ; Infante, Maurizio ; Pagan, Vittore ; Fontana, Paolo ; Oliaro, Alberto ; Ruffini, Enrico ; Ratto, Giovanni Battista ; Leoncini, Giacomo ; Sacco, Rocco ; Mucilli, Felice ; Facciolo, Francesco. / Prognostic score of long-term survival after surgery for malignant pleural mesothelioma : A multicenter analysis. In: Annals of Thoracic Surgery. 2015 ; Vol. 100, No. 3. pp. 890-897.
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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 χ2, 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.",
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T1 - Prognostic score of long-term survival after surgery for malignant pleural mesothelioma

T2 - A multicenter analysis

AU - Leuzzi, Giovanni

AU - Rea, Federico

AU - Spaggiari, Lorenzo

AU - Marulli, Giuseppe

AU - Sperduti, Isabella

AU - Alessandrini, Gabriele

AU - Casiraghi, Monica

AU - Bovolato, Pietro

AU - Pariscenti, Gianluca

AU - Alloisio, Marco

AU - Infante, Maurizio

AU - Pagan, Vittore

AU - Fontana, Paolo

AU - Oliaro, Alberto

AU - Ruffini, Enrico

AU - Ratto, Giovanni Battista

AU - Leoncini, Giacomo

AU - Sacco, Rocco

AU - Mucilli, Felice

AU - Facciolo, Francesco

PY - 2015/9/1

Y1 - 2015/9/1

N2 - 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 χ2, 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.

AB - 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 χ2, 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.

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