Recurrence Patterns and Management after Pleurectomy Decortication for Pleural Mesothelioma

To hypothesize that recurrence after pleurectomy decortication is primarily local. We explored factors associated with tumor recurrence patterns, disease-free interval, and postrecurrence survival (PRS).

Tumor recurrence is a major barrier to long-term survival after pleural mesothelioma (PM) surgery.

All patients who underwent pleurectomy decortication 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.

A 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 with 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 disease-free interval. 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 (hazard ratio: 0.46, 95% CI: 0.29-0.74) and chemotherapy (hazard ratio: 0.69, 95% CI: 0.54-0.92) were independently associated with PRS in patients with distant with or without local recurrences.

PM is frequently associated with local recurrence. Repeat surgical resection is feasible and can achieve good local control in selected cases.