Updated post-recurrence survival outcomes in patients undergoing pleurectomy/decortication for pleural mesothelioma: A retrospective study.

Background: Pleural mesothelioma remains a challenging disease with a high recurrence rate despite multimodality treatment. We previously described clinical outcomes associated with post-pleurectomy/decortication recurrence in pleural mesothelioma. In this study, we aimed to update these results using data from a larger, more recent cohort and to identify prognostic factors influencing post-recurrence survival after pleurectomy/decortication.

Methods: We conducted a retrospective cohort study involving 251 patients who underwent neoadjuvant chemotherapy with platinum plus pemetrexed, followed by pleurectomy/decortication from January 2012 to December 2022. We calculated survival and recurrence rates using the Kaplan-Meier method and the log-rank test, respectively. Multivariable analysis with the Cox proportional hazards model was used to assess clinical factors related to post-recurrence survival.

Results: Of the 251 patients, 190 (75.7%) experienced recurrence (median follow-up, 30.9 months). The 2-year recurrence-free and overall survival rates were 37.3% (median, 21.1 months) and 72.3% (median, 44.1 months), respectively. The 1-year post-recurrence survival rate was 60.6% (median, 18.0 months). Multivariable analysis revealed that post-recurrence treatment (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.071-0.22; P < 0.0001), local recurrence (HR, 0.45; 95% CI, 0.31-0.66; P < 0.0001), age at recurrence < 70 years (HR, 0.53; 95% CI, 0.37-0.76; P = 0.0007), and disease-free interval > 12 months (HR, 0.43; 95% CI, 0.28-0.65; P < 0.0001) were independent, favorable, and significant prognostic factors of post-recurrence survival.

Conclusions: Post-recurrence treatment, recurrence pattern, age at recurrence, and disease-free interval significantly influence post-recurrence survival, indicating favorable outcomes in patients undergoing pleurectomy/decortication.