ASO Author Reflections: Management of Malignant Peritoneal Mesothelioma

Our plain-English summary of ASO Author Reflections: Management of Malignant Peritoneal Mesothelioma, by T.R. Cushman, V. Verma, C.B. Simone (Annals of Surgical Oncology, 2018).

The study

• Authors: T.R. Cushman, V. Verma, C.B. Simone
• Journal: Annals of Surgical Oncology
• Published: 2018;25(Suppl 3):767-768
• Type of article: Comment
• Read it: PubMed · Publisher

In plain English

This was a brief invited commentary in which the authors reflected on their own earlier National Cancer Data Base study of malignant peritoneal mesothelioma, published separately in the same journal in 2018. It did not study asbestos exposure. The authors restated that observation alone was the most common approach (25%), followed by chemotherapy only, cytoreductive surgery (CRS) alone, CRS with chemotherapy, and CRS with hyperthermic intraperitoneal chemotherapy (HIPEC). Treatment use did not change between 2004 and 2013. Younger age, female sex, insurance status, living in more highly educated areas, living farther from the treating institution and treatment at academic centers predicted having CRS. Patients with sarcomatoid or biphasic tumors were less likely than those with epithelioid tumors to have it. CRS appeared safe, with low postoperative death rates. Patients given both chemotherapy and CRS had numerically better overall survival than those given any single treatment, and observed patients had the lowest. The authors noted that this retrospective analysis cannot show causation. They concluded that results must be interpreted with caution and that prospective studies are needed to compare treatments.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Invited commentary (author reflection) on the authors' own retrospective National Cancer Data Base study
• Who was studied: Patients with malignant peritoneal mesothelioma in a US national database (National Cancer Data Base), 2004 to 2013, as studied in the original article. No patient count is given in this commentary.
• Exposure: No asbestos exposure was studied. The commentary concerns treatments: observation, chemotherapy, cytoreductive surgery (CRS), CRS with chemotherapy, and CRS with hyperthermic intraperitoneal chemotherapy (HIPEC).
• Main results:
  • Observation alone was the most common treatment approach (25% of patients), followed by chemotherapy only, CRS alone, CRS with chemotherapy, and CRS with HIPEC.
  • Treatment use did not change between 2004 and 2013.
  • Younger age, female sex, insurance status, residence in higher educated areas, living farther from treating institutions and treatment at academic centers predicted undergoing CRS.
  • Patients with sarcomatoid and biphasic histologies were less likely to undergo CRS than those with epithelioid histology.
  • CRS appeared to be safe, with low postoperative mortality rates.
  • Patients who had combined chemotherapy and CRS had numerically improved overall survival compared with any single treatment. Observed patients had the lowest overall survival. The authors stated that this retrospective analysis cannot imply causation.
• The authors' conclusion: The authors concluded that their results must be interpreted with caution and that prospective studies, likely requiring national or multinational collaboration, are needed to compare the effectiveness of treatment strategies and differences between histologies.
• Limitations the authors state:
  • The study was retrospective and cannot show that any treatment caused the survival differences.
  • Despite controlling for biases, the results must be interpreted with caution.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma.

Related studies

• ASO Author Reflections: Long-Term Survival Is Feasible After Complete CRS/HIPEC for Biphasic Peritoneal Mesothelioma — K. Chouliaras, K.I. Votanopoulos (2018)
• ASO Author Reflections: Improving Outcomes in Diffuse Malignant Peritoneal Mesothelioma: Challenges and Opportunities — J.C. Leinwand, M.D. Kluger (2020)
• ASO Author Reflections: Expert Surgical Evaluation is Critical for Patients with Diffuse Malignant Peritoneal Mesothelioma: Lessons Learned from Assessing Outcomes of 2000 Patients — L. Bijelic, T. Cannon (2020)
• ASO Author Reflections: C-Reactive Protein/Albumin Ratio as a Prognostic Factor in Patients with Malignant Pleural Mesothelioma: What Does the Novel Index Represent? — S. Takamori, M. Takenoyama (2018)
• ASO Author Reflections: Postoperative Radiotherapy for Patients with Mesothelioma-Past, Present, and Future — G.D. Lewis, B.S. Teh (2019)
• Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases — D. Elias, D. Goéré, et al. (2014)

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