Clinical characteristics of long-term survivors of pleural mesothelioma

Objective To identify the clinical characteristics of long-term survivors (> 5 years) with pleural mesothelioma (PM) who had previously undergone curative-intent surgery. Methods A total of 121 patients with PM undergone curative-intent surgery following neoadjuvant chemotherapy between January 2006 and June 2016were enrolled in this study. Long-term survivors were defined as patients survived > 5 years from the date of diagnosis. We determined the incidence and clinical characteristics of long-term survivors. Results Of 121, 41 (33.9%) survived > 5 years from the date of diagnosis. The median age was 62 years. There were 35 males, 23 right-sided, the performance status (PS) was 0 in 40, and all were epithelioid subtype. Nine had partial responses to neoadjuvant chemotherapy, and 32 had stable disease. The median sum of pleural thickness at three levels was 8.2 mm, 25 patients underwent pleurectomy/decortication, 14 were pathological T1, 33 were pathological node-negative, and 2 had severe postoperative complications (Clavien–Dindo classification grade ≥ 3). Tumor relapse was observed in 31, and the relapse pattern was local only in 21, distant only in 2, and both in 8. Of 31 patients with tumor relapse, chemotherapy was performed in 30. Of the 41 long-term survivors, 24 died from PM, and 3 died from other causes. The median relapse-free survival was 51.4months, and the median post-relapse survival was 45.0 months. Conclusion In our cohort, 33.9% survived > 5 years after diagnosis. The clinical characteristics of long-term survivors were a good candidate (< 70-year-old, PS0), epithelioid subtype, tinner pleural thickness and an uneventful postoperative course.