Prognostic Indicator for Pleural Mesothelioma.

Background: In malignant pleural mesothelioma), it is difficult to evaluate the degree of tumor progression using imaging findings. It is essential to develop an objective index that is independent of imaging findings and useful for assessing the degree of tumor progression and indications for surgery.

Methods: We retrospectively evaluated the data of 79 patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy or pleurectomy/decortication at our institution between 1999 and 2022. The postoperative prognosis was evaluated based on clinical factors.

Results: Of the 79 patients, extrapleural pneumonectomy was performed in 41 (51.9%), and pleurectomy/decortication was performed in 38 (48.1%). Univariate analyses identified that percent predicted forced vital capacity (FVC) < 80% ( < .01), rind-like growth pattern on computed tomography ( < .01), Glasgow Prognostic Score ≥ 1 ( < .01), and pathologic stage ≥ II ( < .01) were poor prognostic factors for overall survival. In the multivariate analysis, percent predicted FVC <80% (hazard ratio, 2.76; 95% CI, 1.23-6.18,  = .01) was found to be the only poor prognostic factor for overall survival after surgery. Pathologic stage was a less significant prognostic factor (hazard ratio, 1.83; 95% CI, 0.95-3.53,  = .07). Two-year overall survival in patients with percent predicted FVC ≥80% and <80% was 76.6% ± 6.6% and 16.6% ± 7.5%, respectively.

Conclusions: FVC is a strong predictor of postoperative survival in patients with malignant pleural mesothelioma independent of imaging findings. FVC is useful for assessing tumor invasion and would help determining surgical indication.