Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: Results in 183 patients

Abstract

(1) Multimodality therapy including extrapleural pneumonectomy is feasible in selected patients with malignant pleural mesotheliomas, (2) pre-resectional evaluation of extrapleural nodes may select patients for radical therapy, (3) microscopic resection margins affect long-term survival, highlighting the need for further investigation of locoregional control, and (4) patients with epithelial, margin-negative, extrapleural node-negative resection had extended survival.

Angiogenesis is an independent prognostic factor in malignant mesothelioma

“…Accurate TNM staging is difficult to achieve in the majority of patients with MM. Only a small proportion of patients are suitable for radical surgery, which does allow accurate pathological TNM staging, but even the validity of the International Mesothelioma Interest Group TNM staging system has been questioned (Sugarbaker et al, 1999). Therefore, biological markers may have an important role in providing prognostic information, which is not only of use in individual cases, but also crucial to the design and interpretation of clinical trials.…”

“…Pathological tumour, nodes and metastasis (TNM) staging is difficult to achieve. In a large series of patients undergoing extrapleural pneumonectomy and adjuvant chemoradiotherapy, International Mesothelioma Interest Group (IMIG) TNM staging (Rusch, 1995) failed to stratify survival (Sugarbaker et al, 1999), questioning the value of this approach in predicting outcome. Biological markers of prognosis have attracted interest in other solid tumours and may provide prognostic information independent from TNM stage (Cox et al, 2000a(Cox et al, , 2001.…”

The Value of Occult Disease in Resection Margin and Lymph Node After Extrapleural Pneumonectomy for Malignant Mesothelioma

“…In fact, the surface to be examined is so extended that even the most accurate pathologic examination cannot be considered totally reliable. According to Sugarbaker and colleagues [4], we have already adopted a compromise solution by selecting areas with obvious macroscopic infiltration, with a high infiltration risk (ie, bronchus, pericardium, diaphragm), and some specific areas of the parietal pleura for classic microscopic studies. The same paraffin-embedded specimens were reassessed with immunohistochemistry for the present study.…”

“…Despite extensive surgical removal provided by extrapleural pneumonectomy, patients relapsed rapidly. Therefore, most treatment regimens have focused on radiation therapy, chemotherapy and immunotherapy multimodality treatment [4], or neoadjuvant chemotherapy [5].…”

“…These tumoral nests are likely located in proximity of resection margins or in mediastinal nodes not adequately assessed at the time of thoracotomy. Indeed, positive resection margins and mediastinal lymph node metastases have been identified as poor prognostic factors in many published series [3][4][5][6][7][8][9][10][11][12]. However, some patients experience a poor outcome despite a histologically proven complete surgical resection.…”