Clinical outcomes with recurrence after pleurectomy/decortication for malignant pleural mesothelioma

Abstract Background Most patients with malignant pleural mesothelioma experience recurrence following treatment. However, no clinical studies have evaluated post-recurrence survival after pleurectomy/decortication for malignant pleural mesothelioma. This study aimed to clarify the post-recurrence survival, treatment, prognostic factors, and recurrence pattern after pleurectomy/decortication. Methods We conducted a retrospective cohort study of 90 patients who underwent neoadjuvant chemotherapy followed by pleurectomy/decortication at our hospital between September 2012 and December 2017. Survival and recurrence were calculated using the Kaplan–Meier method with the log-rank test. Clinical factors related to post-recurrence survival were assessed using multivariate analysis with the Cox proportional hazards model. Results Of the 90 patients, 57 (63.3%) developed recurrence. The 1- and 3-year recurrence-free survival rates were 69.7% and 34.0%, respectively (median recurrence-free survival time, 19.0 months). With regard to initial recurrence, 39 patients (68.4%) developed local recurrence, 6 (10.5%) developed distant recurrence, and 12 (21.1%) developed both local and distant recurrences. The 1-year post-recurrence survival rate was 59.5% (median post-recurrence survival time, 14.4 months). Total 43 patients (75.4%) underwent a post-recurrence treatment. Multivariate analysis revealed that post-recurrence treatment [hazard ratio: 0.2, 95% confidence interval (CI): 0.07–0.55; P=0.002], performance status 0–1 (hazard ratio: 0.24, 95%CI: 0.08–0.76; P=0.01) and disease-free interval of >12 months (hazard ratio: 0.4, 95%CI: 0.16–0.99; P=0.04) were the independent, favorable, and significant prognostic factors of post-recurrence survival. Conclusions Post-recurrence survival after pleurectomy/decortication is acceptable, and post-recurrence treatment, performance status, and disease-free interval are important prognostic factors of post-recurrence survival.