Updated Postrecurrence Survival Outcomes in Patients Undergoing Pleurectomy/Decortication for Pleural Mesothelioma: A Retrospective Study.

Abstract

Pleural mesothelioma remains a challenging disease with a high recurrence rate despite multimodality treatment. We previously described clinical outcomes associated with recurrence after pleurectomy/decortication in pleural mesothelioma. In this study, we updated these results using data from a larger, more recent cohort and identified prognostic factors influencing postrecurrence survival after pleurectomy/decortication. We conducted a retrospective cohort study involving 251 patients who underwent neoadjuvant chemotherapy with platinum plus pemetrexed, followed by pleurectomy/decortication from January 2012 to December 2022. We calculated survival and recurrence rates using the Kaplan-Meier method and the log-rank test, respectively. Multivariable analysis with the Cox proportional hazards model was used to assess clinical factors related to postrecurrence survival. Of the 251 patients, 190 (75.7%) experienced recurrence (median follow-up, 30.9 months). The 2-year recurrence-free and overall survival rates were 37.3% (median, 21.1 months) and 72.3% (median, 44.1 months), respectively. The 1-year postrecurrence survival rate was 60.6% (median, 18.0 months). Multivariable analysis revealed that postrecurrence treatment (hazard ratio [HR], 0.12; 95% CI, 0.071-0.22; P < .0001), local recurrence (HR, 0.45; 95% CI, 0.31-0.66; P < .0001), age at recurrence <70 years (HR, 0.53; 95% CI, 0.37-0.76; P = .0007), and disease-free interval >12 months (HR, 0.43; 95% CI, 0.28-0.65; P < .0001) were independent, favorable, and significant prognostic factors of postrecurrence survival. Postrecurrence treatment, recurrence pattern, age at recurrence, and disease-free interval significantly influence postrecurrence survival, indicating favorable outcomes in patients undergoing pleurectomy/decortication.