Survival was not affected by gross residual tumor in the specimen, age, gender, cigarette smoking, asbestos exposure, length of operation, side of tumor, microscopically compromised margins (Fig 3), or neoplasia involving (but not fully penetrating the full thickness of) either the pericardium or diaphragm. Microscopic invasion of tumor through the diaphragm was significantly associated with poorer survival (median, 11 months; n = 14), regardless of cell type or node status.
A revised mesothelioma staging system based on an earlier analysis of a subset of these patients (n=52) has been published. Stage I indicates disease that is resectable by pleurectomy or extrapleural pneumonectomy. Stage II includes patients with involved lymph nodes detected on MRI, at mediastinoscopy, or at thoracotomy. Stage III (combines Butchart stages II and III) tumors extend into the mediastinum or across the diaphragm and are therefore considered unresectable. Stage IV includes patients presenting with evidence of extrathoracic metastasis.
Survival in the entire cohort (n=120) was significantly stratified by stage using this revised system (Fig 4). Median survival rates for patients classified as having stage I (n=57), II (n=43), or stage III (n=14) disease by this system were 22, 17, and 11 months, respectively (p=0.04). canadian-familypharmacy.com

Discussion
In appropriately selected patients, extrapleural pneumonectomy with adjuvant chemotherapy and radiotherapy is safe and effective treatment for malignant pleural mesothelioma. Overall median survival (21 months, Fig 1) of patients receiving this trimodality therapy is superior to that obtained with single-modality therapy. Nodal involvement, cell type, and transdiaphragmatic invasion are prognostic factors that stratify survival of patients treated in this manner. The results described herein validate a revised staging system that is based on resectability and nodal involvement.

Figure 3. Kaplan-Meier survival curve for all patients with positive vs negative surgical resection margins. Survival did not depend on margin status (p=not significant). Reprinted with permission from Sugarbaker et al.

Figure 3. Kaplan-Meier survival curve for all patients with positive vs negative surgical resection margins. Survival did not depend on margin status (p=not significant). Reprinted with permission from Sugarbaker et al.

Figure 4. Kaplan-Meier survival curve demonstrating significant stratification of survival when all patients are classified as having stage I, II, or III disease according to our previously proposed staging system. Reprinted with permission from Sugarbaker et al.

Figure 4. Kaplan-Meier survival curve demonstrating significant stratification of survival when all patients are classified as having stage I, II, or III disease according to our previously proposed staging system.’ Reprinted with permission from Sugarbaker et al.