Clinical and pathological features of three-year survivors of malignant pleural mesothelioma following extrapleural pneumonectomy

Our plain-English summary of Clinical and pathological features of three-year survivors of malignant pleural mesothelioma following extrapleural pneumonectomy, by D.J. Sugarbaker, A.S. Wolf, L.R. Chirieac, et al (European Journal of Cardio-thoracic Surgery, 2011).

The study

• Authors: D.J. Sugarbaker, A.S. Wolf, L.R. Chirieac, J.J. Godleski, T.R. Tilleman, M.T. Jaklitsch, R. Bueno, W.G. Richards
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2011;40(2):298-303
• Cited by: 66 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Surgery-based multimodality therapy is associated with long-term survival in a significant number of pleural mesothelioma patients. We explored factors associated with 3-year survival in patients with malignant pleural mesothelioma, who underwent extrapleural pneumonectomy, to help refine patient selection criteria for surgery and other therapies.

Methods: With Institutional Review Board approval, we reviewed records in the International Mesothelioma Program Patient Data Registry to identify all patients, who underwent extrapleural pneumonectomy for malignant pleural mesothelioma between 1 January 1988 and 31 May 2007. Vital status as of 31 May 2010 was confirmed. Fisher's exact test was used to compare dichotomous variables for patients who survived at least 3 years with those who did not. Kaplan-Meier analysis was used to estimate the cumulative survival probability for all 3-year survivors.

Results: Among 636 patients who underwent extrapleural pneumonectomy, 117 (18%) survived at least 3 years following surgery, including 26 remaining alive and four lost to follow-up. Of the 3-year survivors, 39 (33%) were female, 61 (52%) had left-sided disease, and the median age was 56 years (range 27-77). Relatively more 3-year survivors were younger than, or at the median age (p=0.0005), or female (p=0.0007), had epithelial tumor histology (p<0.0001) and/or had normal white blood cell count (p=0.0001), hemoglobin (p<0.0001), or platelet count (p<0.0001) preoperatively. The median survival of the 117 patients who survived 3-years was 59 months. Among these patients, a significant association between age and survival was found only for women.

Conclusions: A significant proportion of patients undergoing extrapleural pneumonectomy for pleural mesothelioma experienced extended survival. Although favorable prognostic features were more common, the cohort of 3-year survivors included a substantial number of patients with late-stage disease. The longest survival (median greater than 7 years) was experienced by women under the median age of 56 years. These data support the role of macroscopic cytoreduction through extrapleural pneumonectomy in the context of multimodality therapy to extend survival for malignant pleural mesothelioma. Further efforts to treat micrometastatic disease and improve patient selection are warranted.

Copyright © 2011. Published by Elsevier B.V.

In plain English

This retrospective study reviewed registry records of all patients who had extrapleural pneumonectomy for malignant pleural mesothelioma at Brigham and Women's Hospital in Boston between 1 January 1988 and 31 May 2007. Vital status was checked as of 31 May 2010. The study did not examine asbestos exposure. Of 636 patients, 117 (18%) survived at least 3 years after surgery. These 3-year survivors were compared with the 519 patients who died within 3 years. Higher proportions of the survivors were at or below the median age (67% vs 49%), were female (33% vs 18%), had epithelial tumors (91% vs 60%), and had normal white blood cell count, hemoglobin and platelet count before surgery. Among the 3-year survivors, median survival was 59 months. By AJCC/UICC criteria, 67% had Stage III and 7% had Stage IV disease. Women under the median age of 56 years had the longest survival, a median greater than 7 years. The authors concluded that a significant proportion of patients experienced extended survival. They noted that the study was retrospective and that the survivor group was selected for favorable prognosis.

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: Retrospective review of patient registry records (single-institution surgical series), comparing patients who survived at least 3 years after surgery with those who did not
• Who was studied: 636 patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy at Brigham and Women's Hospital, Boston, MA, USA, between 1 January 1988 and 31 May 2007, with vital status confirmed as of 31 May 2010. The 117 who survived at least 3 years were compared with 519 who survived less than 3 years.
• Exposure: Not an asbestos exposure study: asbestos exposure was not assessed. The treatment studied was extrapleural pneumonectomy, given within various multimodality regimens (intra-operative heated chemotherapy, adjuvant radiation and/or chemotherapy).
• Main results:
  • Of 636 patients who underwent extrapleural pneumonectomy, 117 (18%) survived at least 3 years after surgery. At the time of analysis, 87 of these were deceased, 26 were alive and 4 were lost to follow-up.
  • The 3-year survivors (n = 117) were compared with patients who survived less than 3 years (n = 519). Relatively more 3-year survivors were at or below the median age (67% vs 49%, p = 0.0005), female (33% vs 18%, p = 0.0007), had epithelial histology (91% vs 60%, p less than 0.0001), and had normal preoperative white blood cell count (93% vs 78%, p = 0.0001), hemoglobin (76% vs 47%, p less than 0.0001) and platelet count (91% vs 72%, p less than 0.0001). Percentages are from Table 4.
  • Among the 117 three-year survivors, median survival was 59 months. The 5-year survival rate was 43.8% and the 10-year rate was 13.6%.
  • The 3-year survivors were not mainly early-stage cases: 67% were Stage III and another 7% were Stage IV by AJCC/UICC criteria.
  • Among the 3-year survivors, a significant association between age and survival was found only for women. Women under the median age of 56 years had the longest survival, a median greater than 7 years.
  • Of the 26 three-year survivors still alive and in follow-up, 13 (50%) had experienced recurrent mesothelioma.
  • The 3-year survivors had perioperative hospitalization and complications similar to all patients undergoing extrapleural pneumonectomy in the authors' prior series.
• The authors' conclusion: The authors concluded that a significant proportion of patients undergoing extrapleural pneumonectomy for pleural mesothelioma experienced extended survival. They also concluded that the 3-year survivors included a substantial number of patients with late-stage disease, and that tumor biology appeared to be a major determinant of extended survival.
• Limitations the authors state:
  • The study was retrospective and covered a heterogeneous group of patients operated on over 19 years at a referral center.
  • Patients received intracavitary chemotherapy and/or adjuvant treatment with variable consistency, often at outside institutions. Adjuvant therapy status was not available for 31 patients (27%).
  • The 3-year survivor cohort was a group selected for their favorable prognosis.
  • The study was limited to patients who underwent extrapleural pneumonectomy.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Extrapleural Pneumonectomy (EPP), Multimodal Therapy, International Mesothelioma Program, Histology, Median Survival, Cytoreductive Surgery.

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