Prognostic factors after multimodality treatment for pleural mesothelioma

OBJECTIVES: To investigate prognostic factors associated with overall survival (OS) in patients with pleural mesothelioma (PM) undergoing curative-intent surgery as part of multimodality treatment (MMT). METHODS: This retrospective two-centre cohort included 255 patients treated between 2006 and 2019. OS was measured from the date of histological diagnosis and analyzed using Cox proportional hazards regression as the primary analysis. A secondary logistic regression analysis evaluated 5-year survival among patients with ascertainable 5-year vital status. A sensitivity Cox analysis used the date of surgery as the time origin. RESULTS: Among 255 patients, 77 (30.2%) survived ≥5 years after diagnosis. All 255 patients and 192 deaths were included in the primary Cox analysis. Age ≥70 years (HR 1.49, 95% CI 1.04-2.14; P=.029), non-epithelioid histology (HR 2.22, 95% CI 1.33-3.72; P=.002), preoperative T2-4 disease according to the 9th edition TNM classification (HR 2.47, 95% CI 1.78-3.43; P<.001), severe postoperative complications (HR 2.62, 95% CI 1.85-3.70; P<.001), and blood loss >1465 mL (HR 1.39, 95% CI 1.03-1.87; P=.030) were independently associated with poorer OS. Fifteen patients alive at last contact but censored before 5 years were excluded from the secondary 5-year analysis, leaving 240 patients (77 surviving ≥5 years and 163 dying before 5 years). Results were materially unchanged when OS was measured from surgery. CONCLUSIONS: Advanced age, non-epithelioid histology, higher preoperative T category according to the 9th edition TNM classification, severe postoperative complications, and greater intraoperative blood loss were independently associated with poorer OS in this highly selected surgically treated cohort.