Clinicopathological features of radiological early malignant pleural mesothelioma with no apparent tumor or pleural thic
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ORIGINAL ARTICLE
Clinicopathological features of radiological early malignant pleural mesothelioma with no apparent tumor or pleural thickening Akifumi Nakamura1 · Masaki Hashimoto1 · Hiroshi Kodama2 · Michiko Yuki3 · Nobuyuki Kondo1 · Koichiro Yamakado2 · Tohru Tsujimura3 · Takashi Kijima4 · Seiki Hasegawa1 Received: 17 July 2020 / Accepted: 27 August 2020 © Japan Society of Clinical Oncology 2020
Abstract Background We occasionally encounter malignant pleural mesothelioma (MPM) of no apparent tumor or pleural thickening that is radiological early MPM. This study aimed to examine the clinicopathological outcomes of radiological early MPM. Methods Patients with MPM treated with neoadjuvant chemotherapy and planned surgery at the time of diagnosis between July 2004 and December 2019 were retrospectively examined. Pretreatment maximal pleural thickness of all patients was measured on chest computed tomography. We extracted and investigated the patients who exhibited a lack of pleural thickening or visible tumor, which was defined as radiological early MPM. Survival was analyzed by the Kaplan–Meier method. Results Of 296treated patients, 16 (5.4%) exhibited radiological early MPM. Fourteen (87.5%) of these patients underwent pleurectomy/decortication and 2 (12.5%) underwent extrapleural pneumonectomy. Pathological stage T1 disease was diagnosed in 14 (87.5%) patients; 2 (12.5%) exhibited pulmonary parenchymal invasion (pathological stage T2). Lymphatic invasion was detected in only 1 patient. Lymph node metastases and vascular invasion were not detected. Median follow-up was 42 months. Median progression-free survival and median overall survival were 40.7 and 56.1 months, respectively. The 3-year progression-free survival and overall survival rates were 84.8% and 83.6%, respectively. Conclusions Radiological early MPM occurs in approximately 1 of every 20 patients treated with neoadjuvant chemotherapy and surgery planned at the time of diagnosis in an experienced center. Radiological early MPM was associated with early pathological stage and long-term survival. Keywords Radiological early mesothelioma · Pleural thickness · Pathological findings Abbreviations MPM Malignant pleural mesothelioma IASLC International Association for the Study of Lung Cancer IMIG International Mesothelioma Interest Group CT Computed tomography * Akifumi Nakamura [email protected] 1
Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, 1‑1 Mukogawa‑cho, Nishinomiya, Hyogo 663‑8501, Japan
2
Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
3
Department of Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
4
Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
PS Performance status NAC Neoadjuvant chemotherapy EPP Extrapleural pneumonectomy P/D Pleurectomy/decortication CE Contrast-enhanced FDG-PET Fluorodeoxy-d-glucose positron emission tomography OS Overall surviva
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