Aim:

To report the outcomes and prognosis of patients with malignant pleural mesothelioma (MPM) who present with or develop metastases during treatment.

Methods:

This is a retrospective observational study of patients diagnosed with MPM over 7 years. Metastases at presentation or during follow-up were recorded. Multivariate Cox regression was used to evaluate the relationship of clinicopathologic variables and overall survival (OS). Logistic regression was used for propensity score matching of patients to assess chemotherapy treatment effect.

Results:

There were 367 patients included with a median age of 71 years (range, 29–91). A total of 69 patients (18%) had metastases: 14 at presentation and 55 during follow-up. Patients presenting with metastases had significantly worse median and 2-year OS compared to those developing metastases during follow-up: 13.3 months (95% confidence interval [CI], 2–24.6 months) and 0% versus 20.2 months (95% CI, 16.7–23.3 months) and 33%, respectively (p = 0.029). Female sex, age >70 years, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors. There was no difference in OS of patients with locally advanced (T4) disease compared to metastatic disease (M1): median OS 10.7 months (95% CI, 5.9–15.6) versus 13.3 months (95% CI, 2–24.6) (p = 0.18), respectively. Following propensity matching, sarcomatoid histology (hazard ratio, 7.86 [95% CI, 3.64–16.95]; p < 0.001) and multiple lines of chemotherapy (hazard ratio, 0.38 [95% CI, 0.19–0.84]; p = 0.015) were significant independent prognostic factors for OS.

Conclusions:

T4 disease carries a similar OS as metastatic MPM. Female sex, advanced age, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors.

中文翻译：

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转移性恶性胸膜间皮瘤患者生存情况分析。

目标：

报告治疗期间出现或发生转移的恶性胸膜间皮瘤 (MPM) 患者的结局和预后。

方法：

这是一项对诊断为 MPM 的患者超过 7 年的回顾性观察研究。记录就诊时或随访期间的转移情况。多变量 Cox 回归用于评估临床病理变量与总生存期 (OS) 的关系。采用逻辑回归对患者进行倾向评分匹配，以评估化疗效果。

结果：

包括 367 名患者，中位年龄为 71 岁（范围，29-91）。共有 69 名患者 (18%) 发生转移：14 人在就诊时，55 人在随访期间。与随访期间发生转移的患者相比，出现转移的患者的中位和 2 年 OS 显着更差：13.3 个月（95% 置信区间 [CI]，2-24.6 个月）和 0% 与 20.2 个月（95% CI， 16.7-23.3 个月）和 33%，分别为（p = 0.029）。女性、年龄 > 70 岁、非上皮样组织学和未接受化疗是独立的不良预后因素。与转移性疾病 (M1) 相比，局部晚期 (T4) 患者的 OS 没有差异：中位 OS 10.7 个月 (95% CI, 5.9-15.6) 与 13.3 个月 (95% CI, 2-24.6) ( p= 0.18），分别。倾向匹配后，肉瘤样组织学（风险比，7.86 [95% CI，3.64–16.95]；p < 0.001）和多线化疗（风险比，0.38 [95% CI，0.19–0.84]；p = 0.015） OS 的重要独立预后因素。

结论：

T4 疾病的 OS 与转移性 MPM 相似。女性、高龄、非上皮样组织学和未接受化疗是独立的不良预后因素。