Commentary: Biphasic malignant mesothelioma-Survival of the fittest

Our plain-English summary of Commentary: Biphasic malignant mesothelioma-Survival of the fittest, by L.M. Felmly, B.C. Gibney (The Journal of Thoracic and Cardiovascular Surgery, 2020).

The study

• Authors: L.M. Felmly, B.C. Gibney
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2020;159(4):1596-1597
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This is a short commentary, not an original study. The authors discussed a separate study by Lococo and colleagues that pooled the experience of 4 European centers in treating biphasic malignant pleural mesothelioma. According to the commentary, that study found improved survival for patients who had cancer-directed surgery compared with chemotherapy alone or best supportive care. It also found that survival was influenced by performance status, lung function and TNM stage. The commentators urged caution. They noted that comorbidities were grouped into a yes-or-no variable, that lung function was split only into 30% to 80% and greater than 80%, and that the series reported a 40% complete pathologic resection rate with no data on tumor volume or removal of the diaphragm. Surgical patients were younger and had better performance status and lung function, and macroscopic complete resection had no effect on survival. For these reasons the authors said they could not tell whether surgery itself or a better starting prognosis explained the survival difference. The authors concluded that surgery can be an acceptable strategy for selected patients, but that it remains unclear whether it improves survival. The commentary did not address asbestos exposure.

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: Commentary on another published study (no new data collected)
• Who was studied: No patients were studied by the commentary authors. The commentary discusses a multicenter series by Lococo and colleagues of patients with biphasic malignant pleural mesothelioma treated at 4 European centers.
• Exposure: Not asbestos exposure. The comparison discussed is treatment: cancer-directed surgery versus chemotherapy alone or best supportive care.
• Main results:
  • As reported in the commentary, Lococo and colleagues found improved survival for patients with biphasic malignant pleural mesothelioma who had cancer-directed surgery, compared with chemotherapy alone or best supportive care.
  • As reported in the commentary, survival in the Lococo series was influenced by performance status, percentage of expected forced expiratory volume in 1 second, and TNM stage.
  • The commentators criticized the data as lacking detail: comorbidities were grouped into a binary variable rather than a comorbidity index.
  • The commentators noted that lung function was divided into 30% to 80% and greater than 80% of expected, which they said likely selected for patients with less severe disease.
  • The commentators noted that the Lococo series reported a 40% complete pathologic resection rate, lower than in a series by Batirel and associates, with no data on tumor volume or the need to remove the diaphragm.
  • The commentators said they could not determine whether the improved survival with surgery was due to the treatment or to better baseline prognosis. They pointed out that surgical patients were younger with better performance status and lung function, and that macroscopic complete resection had no effect on survival.
• The authors' conclusion: The authors concluded that cancer-directed surgery can be an acceptable strategy for selected patients with biphasic mesothelioma, but that it remains unclear whether surgery improves survival. They hoped the upcoming MARS 2 randomised trial would provide clarity.

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: Biphasic Mesothelioma, Mesothelioma.

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• Survival results in biphasic malignant pleural mesothelioma patients: A multicentric analysis — F. Lococo, F. Torricelli, et al. (2020)
• Biphasic malignant mesothelioma cases with osseous differentiation and long survival: a review of the literature — F. Demirag, E. Unsal, et al. (2007)
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