Survival results in biphasic malignant pleural mesothelioma patients: A multicentric analysis

Filippo Lococo, Federica Torricelli, Loic Lang-Lazdunski, Giulia Veronesi, Ottavio Rena, Massimiliano Paci, Caterina Casadio, Simonetta Piana, Pierluigi Novellis, Teresa Severina Di Stefano, Alessia Ciarrocchi, Andrea Billè

Research output: Contribution to journalArticlepeer-review


Objective: The best strategy of care for biphasic malignant pleural mesothelioma (Biph-MPM) is controversial. In this study, a large dataset of Biph-MPM cases was reviewed to identify prognostic factors and to evaluate the role of a multimodal approach, including cancer-directed surgery. Methods: A total of 213 patients with Biph-MPM treated at 4 tertiary centers who experienced MPM from January 2009 to December 2016 were selected, and clinical, pathologic, and surgical information was retrieved. A Cox regression model was used to identify predictors of survival, and the Kaplan–Meier method was used to summarize overall survival. Results: The mean age and the male/female ratio were 68.4 ± 9.5 years and 5:1, respectively. Tumors were assigned to stages I (127, 59.6%), II (3, 1.4%), III (76, 35.4%), and IV (7, 3.3%) according to the Eighth Tumor, Node, Metastasis (TNM) edition. A multimodal treatment including pleurectomy/decortication was performed in 58 patients (27.2%), chemotherapy alone in 99 patients (46.5%), and best supportive care in 56 (26.3%). The median overall survival was 11 months. A univariate analysis revealed that survival was significantly associated with the percentage forced expiratory volume in 1 second (P < .0001), performance status (P = .0002), multimodal treatment including surgery (P < .0001), and TNM stage (P = .011). A multivariable analysis confirmed performance status, percentage forced expiratory volume in 1 second, TNM, and a multimodal approach as independent variables affecting long-term survival. Conclusions: Despite the overall poor prognosis of biphasic histology, a multimodal approach, including cancer-directed surgery, is associated with improved long-term results in very selected patients with Biph-MPM.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
Publication statusE-pub ahead of print - Sep 9 2019


  • decortication
  • malignant pleural mesothelioma
  • pleural tumor
  • pleurectomy
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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