Extrapleural Pneumonectomy in Malignant Pleural Mesothelioma Patients: A Case-Control Study

Mathieu Saint-Pierre, MD; Tinghua Zhang, MS; Garth Nicholas, MD; Scott Laurie, MD; Paul Wheatley-Price, MD

PURPOSE: The role of extrapleural pneumonectomy (EPP) in malignant pleural mesothelioma (MPM) is controversial. For patients presenting with limited disease, trimodality therapy consisting of induction chemotherapy, EPP and post-operative radiation may be offered at some institutions. The benefit of EPP remains questionable after a randomized feasibility trial failed to complete, but suggested no benefit. We completed a case-matched chart review to determine the frequency and outcomes of EPP at The Ottawa Hospital.

METHODS: All MPM patients from 1991 to June 2012 were identified. Data collected included age, gender, performance status (PS), histology, stage, laboratory values and therapies received. The primary outcome was overall survival. A case-control analysis involving EPP and comparable patients not undergoing surgery was subsequently performed. Matches were chosen by age, PS, histology and stage.

RESULTS: From 245 patients with MPM, only 20 (8%) underwent EPP. The mean age of EPP patients was of 60 years (range 21 to 68). Of these, 90% were men, 90% had a PS ECOG 0-1, and 75% were of epithelial histology. 19 patients had chemotherapy, and 11 received trimodality therapy. Median overall survival of patients having undergone EPP was 24.7 months versus 9.1 months in non-EPP patients (p=0.0001). The benefit of EPP was not statistically significant after multivariate analysis; HR 1.57, 95% CI 0.80-3.08 (p=0.19). 19/20 EPP patients had a suitable match. From the case-match analysis, there was also no statistically significant benefit from EPP, median overall survival of 23.9 months in EPP patients versus 20.8 months in matched subjects; HR 0.68, 95% CI 0.34-1.37 (p=0.28).

CONCLUSIONS: We did not find a statistically significant improvement in outcomes associated with EPP at our institution, suggesting that the longer overall survival seen in patients undergoing this procedure is mainly due to the selection of those with better baseline characteristics.

Chest. 2015;148(4_MeetingAbstracts):40A. doi:10.1378/chest.2215910