• Juuso Paajanen, William G Richards, Yue Xie, Emanuele Mazzola, Kristina Sidopoulos, John Kuckelman, Ritu R Gill, and Raphael Bueno.
• The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program (www.impmeso.org), Division of Thoracic Surgery and the Lung Center, Brigham, and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
• Ann. Surg. 2025 Jan 15.

ObjectiveWe hypothesize that recurrence following pleurectomy decortication (PD) is primarily local. We explored factors associated with tumor recurrence patterns, disease-free interval (DFI), and post-recurrence survival (PRS).Summary Background DataTumor recurrence is a major barrier for long-term survival after pleural mesothelioma (PM) surgery.MethodsAll patients who underwent PD between 1998 and 2022 were identified. Patients with diffuse PM who achieved macroscopic complete resection and had sufficient information on tumor relapse were included. Postoperative scans were reviewed to determine the timing and sites of the first recurrence.ResultsA total of 436 patients had tumor recurrence during follow-up. Local recurrences occurred most frequently (N=370, 85%) and represented the only recurrence site in 29% (N=129) of cases. Patients with sarcomatoid tumors relapsed earlier than other subtypes (P=0.003) with more frequent distant spread compared to other subtypes (P<0.001). Multivariable analysis revealed that age (P=0.015), preoperative tumor volume (P<0.001), epithelioid histology (P<0.001), intraoperative chemotherapy (P<0.001), and TNM stage IV (P=0.003) were associated with DFI. Similarly, age (P=0.042), performance status (P<0.001), epithelioid histology (P<0.001), intraoperative chemotherapy (P<0.001), TNM stages III and IV (P=0.003 and 0.010 respectively), type of surgery (P=0.019), and number of recurrent lesions (P=0.024) were associated with PRS. Recurrence surgery (HR 0.46, 95% CI 0.29-0.74) and chemotherapy (HR 0.69, 95% CI 0.54-0.92) were independently associated with PRS in patients with distant with or without local recurrences.ConclusionsPM is frequently associated with local recurrence. Repeat surgical resection is feasible and can achieve good local control in selected cases.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

6 keywords...

hide…