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Prognostic factors in malignant pleural mesothelioma: role of talc pleurodesis

Objective: To examine baseline characteristics associated with survival in patients with malignant pleural mesothelioma. Methods: 122 patients with histologically proven malignant pleural mesothelioma during the period 2000–2010 were studied. Survival was evaluated by the Kaplan-Meier method with the logrank test. Cox regression analysis was used to estimate the hazard ratios for possible prognostic factors. Results: 105 (86%) patients had complete survival follow-up; 91 died and 14 (13.3%) were alive at the end of the observation period starting from the day of diagnosis. The median survival was 286 days (95% confidence interval: 212–359). Talc pleurodesis was performed in 59 patients, and 17 had surgical interventions (2 chest wall resections, 2 extrapleural pneumonectomies, and 13 decortications). Chemotherapy was used in 41 patients, port-site radiation in 68, and combined therapy in 26. Cox regression analysis identified talc pleurodesis (p = 0.04), chemotherapy (p < 0.001), port-site radiation (p < 0.001), and combined chemotherapy and port-site radiation (p < 0.006) as favorable prognostic factors after adjusting for age, sex, histologic subtype, smoking, and performance status. Conclusions: Surgical intervention including decortications and extrapleural pneumonectomy had no effect on survival in this series. Chemotherapy and radiation to port sites independently and in combination were associated with improved overall survival in malignant pleural mesothelioma patients. Talc pleurodesis was an independent determinant of survival, but further studies are warranted.