Clinical Outcomes With Recurrence After Pleurectomy/Decortication for Malignant Pleural Mesothelioma

Our plain-English summary of Clinical Outcomes With Recurrence After Pleurectomy/Decortication for Malignant Pleural Mesothelioma, by A. Nakamura, T. Takuwa, M. Hashimoto, et al (The Annals of Thoracic Surgery, 2020).

The study

• Authors: A. Nakamura, T. Takuwa, M. Hashimoto, A. Kuroda, T. Nakamichi, S. Matsumoto, N. Kondo, T. Kijima, K. Yamakado, S. Hasegawa
• Journal: The Annals of Thoracic Surgery
• Published: 2020;109(5):1537-1543
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Most patients with malignant pleural mesothelioma experience recurrence after treatment. However no clinical studies have evaluated postrecurrence survival after pleurectomy/decortication for malignant pleural mesothelioma. This study aimed to clarify postrecurrence survival, treatment, prognostic factors, and recurrence pattern after pleurectomy/decortication.

Methods: We conducted a retrospective cohort study of 90 patients who underwent neoadjuvant chemotherapy followed by pleurectomy/decortication at our hospital between September 2012 and December 2017. Survival and recurrence were calculated using the Kaplan-Meier method with the log-rank test. Clinical factors related to postrecurrence survival were assessed using multivariate analysis with the Cox proportional hazards model.

Results: Of 90 patients, 57 (63.3%) developed recurrence. The 1- and 3-year recurrence-free survival rates were 69.7% and 34.0%, respectively (median recurrence-free survival time, 19.0 months). With regard to initial recurrence, 39 patients (68.4%) developed local recurrence, 6 (10.5%) developed distant recurrence, and 12 (21.1%) developed both local and distant recurrences. The 1-year postrecurrence survival rate was 59.5% (median post-recurrence survival time, 14.4 months). Forty-three patients (75.4%) underwent a postrecurrence treatment. Multivariate analysis revealed that postrecurrence treatment (hazard ratio, 0.2; 95% confidence interval, 0.07-0.55; P = .002), performance status 0 to 1 (hazard ratio, 0.24; 95% confidence interval, 0.08-0.76; P = .01), and disease-free interval more than 12 months (hazard ratio, 0.4; 95% confidence interval, 0.16-0.99; P = .04) were the independent, favorable, and significant prognostic factors of postrecurrence survival.

Conclusions: Postrecurrence survival after pleurectomy/decortication is acceptable, and postrecurrence treatment, performance status, and disease-free interval are important prognostic factors of postrecurrence survival.

Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This retrospective cohort study from a single hospital in Hyogo, Japan, followed 90 patients with malignant pleural mesothelioma. Between September 2012 and December 2017 they had chemotherapy and then pleurectomy/decortication, a lung-sparing operation. The article does not discuss asbestos exposure. Of the 90 patients, 57 (63.3%) had a recurrence. The 3-year recurrence-free survival rate was 34.0%, and the median time without recurrence was 19.0 months. In the 57 patients, the first recurrence was local (same side of the chest or mediastinum) in 39, distant in 6, and both in 12. After recurrence, 1-year survival was 59.5% and median survival was 14.4 months. Forty-three of the 57 received further treatment, mostly chemotherapy; 14 received best supportive care. In multivariate analysis, three factors were each linked with longer survival after recurrence: receiving treatment, a performance status of 0 to 1 measured after recurrence, and a disease-free interval of 12 months or more. The authors concluded that survival after recurrence was acceptable. They noted the single-center design, possible differences from North American and European patients, and that 32 recurrences were diagnosed by imaging alone.

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 cohort study at a single hospital
• Who was studied: Of 140 consecutive patients with malignant pleural mesothelioma eligible for multimodality treatment at Hyogo College of Medicine, Japan, between September 2012 and December 2017, 90 underwent pleurectomy/decortication. Their median age was 66 years and 78 were men. Of these 90, 57 had recurrence and were analysed for survival after recurrence.
• Exposure: The article does not report asbestos exposure. What it studied was treatment: neoadjuvant chemotherapy with pemetrexed plus cisplatin or carboplatin, followed by pleurectomy/decortication and, where possible, adjuvant chemotherapy. It then looked at treatment given after recurrence.
• Main results:
  • Of the 90 patients who had pleurectomy/decortication, 57 (63.3%) had a recurrence.
  • In all 90 patients, the 1- and 3-year recurrence-free survival rates were 69.7% and 34.0%, with a median of 19.0 months.
  • In all 90 patients, the 1- and 3-year overall survival rates were 93.3% and 65.3%, with a median survival of 57.0 months.
  • In the 57 patients with recurrence, the first recurrence was local in 39 (68.4%), distant in 6 (10.5%), and both local and distant in 12 (21.1%).
  • In the 57 patients with recurrence, the 1-year survival rate after recurrence was 59.5%, and median survival after recurrence was 14.4 months.
  • Of the 57 patients with recurrence, 43 (75.4%) received treatment after recurrence and 14 (24.6%) received best supportive care.
  • In the univariate analysis, median survival after recurrence was 24.1 months in the treated group and 4.2 months in the best supportive care group (P less than .001).
  • In the univariate analysis, median survival after recurrence was 24.1 months for a disease-free interval of 12 months or more and 7.8 months for under 12 months (P less than .001).
  • In the univariate analysis, median survival after recurrence was 22.2 months for performance status 0 to 1 and 4.4 months for performance status 2 to 4 (P less than .001).
  • In the multivariate analysis, survival after recurrence was independently associated with two factors. Receiving treatment after recurrence had a hazard ratio of 0.2 (95% CI 0.07-0.55; P = .002). Performance status 0 to 1 measured after recurrence had a hazard ratio of 0.24 (95% CI 0.08-0.76; P = .01).
  • In the multivariate analysis, a disease-free interval of 12 months or more had a hazard ratio of 0.4 (95% CI 0.16-0.99; P = .04).
  • In the multivariate analysis, having only local recurrence was not statistically significant (hazard ratio 0.85, 95% CI 0.31-2.28; P = .70).
• The authors' conclusion: The authors concluded that most patients with recurrence after pleurectomy/decortication received treatment for it. They identified post-recurrence treatment, performance status and disease-free interval as prognostic factors, and judged survival after recurrence to be an acceptable outcome.
• Limitations the authors state:
  • The single-center design carries a risk of bias, and the results should be interpreted carefully.
  • The patients may not be comparable with North American and European populations.
  • Recurrence is hard to diagnose on chest imaging after surgery, and 32 patients (56.1%) were diagnosed by imaging alone, without biopsy.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Cohort Study, Neoadjuvant Chemotherapy, Multivariate Analysis, Recurrence-Free Survival, Hazard Ratio, confidence interval.

Related studies

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• Complications and Predictive Factors for Air Leak > 10 Days with Neoadjuvant Chemotherapy Followed by Pleurectomy/Decortication for Malignant Pleural Mesothelioma — A. Nakamura, N. Kondo, et al. (2021)
• Patterns of disease progression on 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients with malignant pleural mesothelioma undergoing multimodality therapy with pleurectomy/decortication — A. Bille, S. Chicklore, et al. (2013)
• A Clinical Trial of TumorGlow to Identify Residual Disease During Pleurectomy and Decortication — J.D. Predina, A.D. Newton, et al. (2019)
• Radiofrequency Ablation Effectively Treated Focal Recurrence of Mesothelioma — A. Nakamura, T. Takuwa, et al. (2018)
• Short-term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma — M. van Gerwen, A. Wolf, et al. (2018)

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