Commentary: Picking the winners-Leaning into selection bias

Our plain-English summary of Commentary: Picking the winners-Leaning into selection bias, by E. Wakeam, B. Kidane (The Journal of Thoracic and Cardiovascular Surgery, 2020).

The study

• Authors: E. Wakeam, B. Kidane
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2020;159(4):1594-1595
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This was a commentary with no data of its own, and it did not discuss asbestos exposure. The authors commented on a separate multicenter analysis by Lococo and colleagues of survival in biphasic malignant pleural mesothelioma at 4 specialist centers. In that study, 27.2% of patients had pleurectomy and decortication, 46.5% were treated without surgery (usually chemotherapy), and 26.3% received only best supportive care. Among the surgical patients, complete resection was achieved in only 40%, and the commentators questioned how surgeons chose between an "aggressive" pleurectomy and a debulking. Lococo and colleagues concluded that surgery was indicated because survival was better. The commentators said the study gave minimal information on how patients were selected. They suggested such details could help explain why complete resection and TNM stage did not predict outcomes. They said the data are not likely to be useful in centers offering extrapleural pneumonectomy, and that unclear selection criteria made it difficult to know whether the results apply. The authors concluded that surgeons have always "picked the winners" but must describe that selection better. They also proposed disease-specific regional networks for mesothelioma care.

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 article (Lococo and colleagues) published in the same journal issue
• Who was studied: No study population of its own; the commentary discusses the Lococo and colleagues study of mesothelioma patients at 4 specialist mesothelioma centers
• Main results:
  • In the Lococo study (not this commentary), 27.2% of patients received pleurectomy and decortication and 46.5% were treated without surgery, usually with systemic chemotherapy; Lococo and colleagues concluded surgery was indicated because survival was better
  • The commentators said the Lococo study gave minimal information on how patients were selected for treatment
  • Among patients who had surgery in the Lococo study, complete resection was achieved in only 40%; the commentators questioned how surgeons chose an aggressive pleurectomy versus what amounted to a debulking (no more precise denominator is given)
  • In the Lococo study, 26.3% received only best supportive care; the commentators said it was unclear how no-treatment decisions were made
  • The commentators noted that in the Lococo study, complete resection and TNM stage did not predict outcomes, and suggested that selection details could help explain this
  • The commentators said the Lococo data are not likely to be useful in centers offering aggressive approaches such as complete resection through extrapleural pneumonectomy
  • The commentators said that because Lococo and colleagues did not fully describe their selection criteria, it is difficult to know whether the new results apply
  • The commentators suggested mesothelioma may suit a disease-specific regionalization approach to care
• The authors' conclusion: The authors concluded that surgeons have always selected favorable patients but need to describe this selection process better so that results can be understood and compared

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: Selection Bias.

Related studies

• Evaluation of Confounding and Selection Bias in Epidemiological Studies of Populations Exposed to Low-Dose, High-Energy Photon Radiation — M.K. Schubauer-Berigan, A. Berrington de Gonzalez, et al. (2020)
• Evaluation of selection bias in a cross-sectional survey — I.J. Selikoff, H. Seidman (1991)
• Commentary: Know your enemy-Understanding futility in the battle against malignant pleural mesothelioma — A.E. Giles, B. Kidane (2020)
• Estimating the effect of cumulative occupational asbestos exposure on time to lung cancer mortality: using structural nested failure-time models to account for healthy-worker survivor bias — A.I. Naimi, S.R. Cole, et al. (2014)
• Assessing the component associations of the healthy worker survivor bias: occupational asbestos exposure and lung cancer mortality — A.I. Naimi, S.R. Cole, et al. (2013)
• Bias in the proportionate mortality ratio analysis of small study populations: a case on analyses of radiation and mesothelioma — J.Y. Zhou (2014)

Browse more research in The Journal of Thoracic and Cardiovascular Surgery, or return to medical research.