Comparison of prognostic impact between metabolic and radiologic response after induction chemotherapy for resectable malignant pleural mesothelioma: A multicenter study.
7031 Background: Induction chemotherapy followed by extrapleural pneumonectomy (EPP) for resectable malignant pleural mesothelioma (MPM) is controversial. To select optimal candidates for EPP, we evaluates the usefulness of metabolic response on fluorodeoxyglucose-positron emission tomography (FDG-PET) compared with radiologic response on high-resolution computed tomography (HRCT) after induction chemotherapy to predict prognosis for patients with resectable MPM who underwent EPP in the setting of multicenter study. Methods: We performed HRCT and FDG-PET before and after induction platinum-based chemotherapy on 50 patients with clinical T1-3 N0-2 M0 MPM who underwent EPP ± postoperative hemithoracic radiation. A decrease of more than 30% in tumor maximum standardized uptake value (SUVmax) was defined as a metabolic responder. Radiologic response using modified RECIST or metabolic response and surgical results were analyzed. Results: In all cohort patients, median overall survival (OS) from diagnosis was 20.5 month (95% confidence interval [CI], 15.0-26.0 month). Fourteen patients were classified as metabolic responders (28%) and 36 as non-responders (72%). Metabolic responders significantly correlated to OS with median OS for metabolic responders of not reached (3-year OS of 60.0%) versus 18.7 month (95% CI, 13.3-24.2 month, 3-year OS of 26.5%) for non-responders (P = .025). No correlation was observed between OS and radiologic response with median OS for radiologic responders of 25.7 month (n = 20, 95% CI, 14.5-37.0 month, 3-year OS of 35.8%) versus 17.7 month (n = 30, 95% CI, 12.8-22.6 month, 3-year OS of 35.1%) for non-responder (p = .216). Based on the multivariate Cox analyses, decreased SUVmax (%) (p = .010) was a significantly independent factor for OS as well as epithelioid subtype (p = .044). Conclusions: Metabolic response on FDG-PET has higher predictive value of prognosis than radiologic response on HRCT after induction chemotherapy for patients with resectable MPM. Patients with metabolic responder and/or epithelioid subtype can be good candidates for EPP after induction chemotherapy.