Pleural thickness after neoadjuvant chemotherapy is a prognostic factor in malignant pleural mesothelioma Masaki Hashimoto, MD, PhD, Jiro Takeuchi, MD,

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Presentation transcript:

Pleural thickness after neoadjuvant chemotherapy is a prognostic factor in malignant pleural mesothelioma Masaki Hashimoto, MD, PhD, Jiro Takeuchi, MD, PhD, Teruhisa Takuwa, MD, PhD, Ayumi Kuroda, MD, Akifumi Nakamura, MD, Toru Nakamichi, MD, Seiji Matsumoto, MD, PhD, Nobuyuki Kondo, MD, PhD, Takashi Nakano, MD, PhD, Takeshi Morimoto, MD, PhD, Seiki Hasegawa, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 157, Issue 1, Pages 404-413 (January 2019) DOI: 10.1016/j.jtcvs.2018.09.106 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The thoracic cavity was divided into 3 levels (upper, middle, and lower). Each level was defined as follows. The upper level was defined as from the apex of the lung to the inferior margin of the aortic arch; the middle level as between the upper and lower levels; and the lower level from an inferior to the first image on which the left atrium is seen (A). Pleural thickness was measured perpendicular to the chest wall or mediastinum for each of the 3 levels on axial imaging (B). Double-headed arrow indicates the measurement of pleural thickness. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 404-413DOI: (10.1016/j.jtcvs.2018.09.106) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The correlation between maximum pleural thickness (max) and sum (A) pre and (B) post neoadjuvant chemotherapy. pre max, Maximum pleural thickness before neoadjuvant chemotherapy; pre sum, sum of pleural thickness in 3 levels before neoadjuvant chemotherapy; post max, maximum pleural thickness after neoadjuvant chemotherapy; post sum, sum of pleural thickness in 3 levels after neoadjuvant chemotherapy. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 404-413DOI: (10.1016/j.jtcvs.2018.09.106) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Survival curves for recurrence-free survival according to pleural thickness before neoadjuvant chemotherapy. A, Maximum pleural thickness before neoadjuvant chemotherapy (pre max). B, pre sum. pre sum, Sum of pleural thickness in 3 levels before neoadjuvant chemotherapy. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 404-413DOI: (10.1016/j.jtcvs.2018.09.106) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Survival curves for recurrence-free survival according to (A) maximum pleural thickness after neoadjuvant chemotherapy (post max) and (B) post sum. post sum, Sum of pleural thickness in 3 levels after neoadjuvant chemotherapy. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 404-413DOI: (10.1016/j.jtcvs.2018.09.106) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Survival curves for overall survival according to (A) maximum pleural thickness before neoadjuvant chemotherapy (pre max) and (B) pre sum. pre sum, Sum of pleural thickness in 3 levels before neoadjuvant chemotherapy. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 404-413DOI: (10.1016/j.jtcvs.2018.09.106) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Survival curves for overall survival according to (A) maximum pleural thickness after neoadjuvant chemotherapy (post max) and (B) post sum. post sum, Sum of pleural thickness in 3 levels after neoadjuvant chemotherapy. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 404-413DOI: (10.1016/j.jtcvs.2018.09.106) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Pleural thickness correlated with oncological outcomes in malignant pleural mesothelioma. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 404-413DOI: (10.1016/j.jtcvs.2018.09.106) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Video 1 We propose pleural thickness as a novel prognostic factor in malignant pleural mesothelioma. It is well known that the current T-component is not satisfactory to predict the clinical outcome in malignant pleural mesothelioma. In this cohort, we clarified that the efficacy of measurement of pleural thickness after neoadjuvant chemotherapy was a better prognosticator than the current T-component. Our measurement procedure is quite simple, and could be used throughout the world. I am going to introduce our measurement procedure. As you can see, we divided the thoracic cavity into 3 zones as upper, middle, and lower. Then, using axial imaging, the maximum pleural thickness was measured perpendicular from the chest wall or mediastinum in each zone. In our cohort the sum of pleural thickness in 3 zones was a novel prognostic factor. Because this procedure does not require any specific device or software, it has potential as a new T-component. Video available at: https://www.jtcvs.org/article/S0022-5223(18)32615-1/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 404-413DOI: (10.1016/j.jtcvs.2018.09.106) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions