P-183PERSISTENT LUNG EXPANSION AFTER PLEURAL TALC POUDRAGE IN MALIGNANT PLEURAL MESOTHELIOMA NOT ELIGIBLE FOR SURGICAL RESECTION: AN INDEPENDENT PROGNOSTIC FACTOR

Objectives To investigate the prognostic effect of persistent lung expansion (no pleural fluid recurrence) after pleural talcage and other variables in non-surgically treated malignant pleural mesothelioma (MPM). Methods All consecutive patients submitted to video-assisted thoracoscopic (VAT) pleural biopsy and pleurodesis by talc poudrage for MPM between 2007 and 2011 were studied. The following parameters were prospectively recorded: age, sex, smoking history, asbestos exposure, preoperative C-reactive protein (CRP) levels, platelets (PLT) count, ECOG performance status (PS), histological subtype, clinical stage (c-Stage), chemotherapy, persistence of lung expansion at 3 months follow-up. Survival was assessed on December 2012. Results A total of 172 patients were considered; 26 patients were excluded because of incomplete lung expansion at discharge; the remaining 146 patients were the objective of the present study. Median survival was 14 months (95% confidence interval [CI], 13-16). Two- and 5-year disease-specific survival was 15% (95% CI, 8-26%) and 7% (95% CI, 3-16%), respectively. Age, ECOG PS, non-epithelioid histology, CRP level >5 mg/l, PLT count >400 000/dl, c-Stage >II and pleural fluid recurrence at 3 months follow-up influenced the outcome at univariate analysis. Multivariate analysis showed that non-epithelioid histology (hazard ratio [HR], 2.78; 95% CI, 1.80–5.08), pleural fluid recurrence (HR 2.56; 95% CI, 1.75–4.41), c-Stage >II (HR 2.38; 95% CI, 1.52–4.34), PS >1 (HR 2.23; 95% CI, 1.29-4.28), CRP >5 mg/l (HR 2.01; 95% CI, 1.18–4.12) and PLT count >400 000 (HR 1.80; 95% CI 1.19–3.98) were independent worse survival predictors. Conclusions Persistent lung expansion after pleural talc poudrage and absence of fluid recurrence is demonstrated to be a stronger factor rather than clinical stage and other clinical variables in non-surgically treated MPM patients. Further studies are needed to evaluate its utility in the clinical staging of MPM. Disclosure All authors have declared no conflicts of interest.