摘要： Our study population presented a median age of 60 years (53 -71 yrs), most were male 64.8 %, with asbestos exposure in 57.2% of cases and epithelioid histology in 85.7%. Almost half of the patients received gemcitabine as ?rst-line treatment (n?43; 47.3%). Overall PFS was 14.1 months (95% CI 9.8e18.4 months,) while PFS in patients receiving gemcitabine treatment was 6.8 months (95% CI 5.4e8.2 months). Several factors were associated to an improved PFS, including female vs. male sex (7.2 vs 6.6 months, p?0.062) and epithelial vs. sarcomatoid histology (7.2 vs 3.8 months, p?0.035) after gemcitabine treatment in univariate analysis. In the multivariate analysis, sex (HR 3.06, p?0.085) and no wood-smoke exposure (HR 2.55, p?0.092) were independently associated to gemcitabine treatment. Patients with high expression levels of RRM1 showed better PFS compared to patients with low expression levels (7.6 vs 5.5 months, p?0.049) in univariate analysis; with a HR of 0.204 (0.050e0.831) p?0.026 in multivariate analysis. Conversely, the M2 subunit (RRM2) did not show any significant associations (7.6 vs 6.6 months, p?0.363). Conclusion: Our results suggest that high protein expression levels of RRM1 could potentially serve as a biomarker of response to gemcitabine treatment in patients with advanced stage MPM.