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Mesothelioom: wat voorspelt de levensverwachting?

21-11-2007 00:00

Factoren die een aanwijzing kunnen geven over de levensverwachting van mesothelioompatiënten zijn: het soort mesothelioom, de locatie van de tumor in het lichaam, sekse, rookgedrag en de conditie en symptomen van de patiënt. Een Behandeling met een combinatie van chemo-, radiotherapie en operatieve verwijdering van de tumor lijkt het best te werken, hoewel meer onderzoek nodig is. Dit concluderen Amerikaanse onderzoekers na analyse van medische gegevens van 945 patiënten die tussen 1990 en 2005 in een New Yorks ziekenhuis voor mesothelioom waren behandeld. Flores, R.M. et al., (2007). Prognostic Factors in the Treatment of Malignant Pleural Mesothelioma at a Large Tertiary Referral Center. Journal of Thoracic Oncology, 2, oct. 2007, p. 957-965.

Flores, R.M. et al., (2007). Prognostic Factors in the Treatment of Malignant Pleural Mesothelioma at a Large Tertiary Referral Center. Journal of Thoracic Oncology, 2, oct. 2007, p. 957-965.
Abstract:
Introduction:
Most studies describing the natural history and prognostic factors for malignant pleural mesothelioma antedate accurate pathologic diagnosis, staging by computed tomography, and a universal staging system. We conducted a large single-institution analysis to identify prognostic factors and assess the association of resection with outcome in a contemporary patient population.
Methods: Patients with biopsy-proven malignant pleural mesothelioma at our institution were identified and clinical data were obtained from an institutional database. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. A p value <. 0.05 was considered statistically significant.
Results: From 1990 to 2005, 945 patients were identified: 755 men, 190 women. median age, 66 years (range, 26&ndash.93). Extrapleural pneumonectomy was performed in 208 (22%), pleurectomy/decortication in 176 (19%). Operative mortality was 4% (16/384). Multimodality therapy including surgery was associated with a median survival of 20.1 months. Significant predictors of overall survival included histology, gender, smoking, asbestos exposure, laterality, surgical resection by extrapleural pneumonectomy or pleurectomy/decortication, American Joint Committee on Cancer stage, and symptoms. A Cox model demonstrated a hazard ratio of 1.4 without surgical resection when controlling for histology, stage, gender, asbestos exposure, smoking history, symptoms, and laterality (p = 0.003).
Conclusions: In addition to tumor histology and pathologic stage,
predictors of survival include gender, asbestos exposure, smoking,
symptoms, laterality, and clinical stage. Surgical resection in a
multimodality setting was associated with improved survival.