Diagnostic and therapeutic strategy in malignant pleural mesothelioma

Our plain-English summary of Diagnostic and therapeutic strategy in malignant pleural mesothelioma, by D. Branscheid, S. Krysa, E. Bauer, et al (European Journal of Cardio-thoracic Surgery, 1991).

The study

• Authors: D. Branscheid, S. Krysa, E. Bauer, H. Bülzebruck, J. Schirren
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 1991;5(9):466-72; discussion 473
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We retrospectively analysed 301 patients with diffuse malignant pleural mesothelioma (235 male, 66 female; median age 59 years). Prognosis depended significantly on patient age, evidence of pain, loss of weight, tumour cell type, stage, local and distant metastasis, involvement of peritoneum and surgical treatment. The overall median survival rate was 238 days, after extended pleuropneumonectomy 284 days, and after decortication 315 days - significantly better than the prognosis in patients without surgical treatment or exploratory thoracotomy. Pleuropneumonectomy should only be considered in young patients with an epithelial cell-type tumour (possibly with adjuvant chemotherapy). Decortication seems nowadays to be the treatment of choice.

In plain English

This article reported a retrospective analysis of the cases of 301 patients with diffuse malignant pleural mesothelioma, covering 1978 to 1989, at a department of thoracic surgery in Heidelberg, Germany. Work-related exposure was described in retrospect for 44% of patients. Lung tissue was tested in 112 patients, and needle-shaped particles were increased in 69 of them, which the authors took to indicate work-related asbestos exposure. Median survival for all patients was 238 days, and 4% were alive after 5 years. Shorter survival was associated with age over 40, chest wall pain, weight loss, the sarcomatous tumour type (median 91 days, against 298 days for the epithelial type), tumour spread and higher stage. Median survival was 284 days after extended pleuropneumonectomy (76 patients), 315 days after decortication (82 patients) and 149 days after exploratory thoracotomy. Deaths within 30 days were 11.8% after pleuropneumonectomy and 2.4% after decortication. The authors concluded that decortication seems superior because of its lower complication rate. They judged extended pleuropneumonectomy probably justified only in patients under 45 with epithelial-type tumours.

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 analysis of patient records from one surgical department, with survival calculated by the Kaplan-Meier method
• Who was studied: 301 patients with diffuse malignant pleural mesothelioma seen between 1978 and 1989 at the Department of Thoracic Surgery, Rohrbach Hospital, Heidelberg, Germany. Median age was 59 years (range 22 to 87). The article gives inconsistent numbers of men and women. 118 patients had no surgery, and some of them received no treatment at all.
• Exposure: Asbestos exposure was not measured directly. Work-related exposure was described in retrospect for 44% of patients. In 69 of 112 patients whose lung tissue was analysed (62%), needle-shaped particles were increased, which the authors took as indicating work-related asbestos exposure. No fiber types were named.
• Main results:
  • All patients: median survival 238 days; 30% alive after 1 year, 8% after 3 years and 4% after 5 years
  • Patients under 40 years (19 patients): 42% alive after 1 year and 30% after 2 years
  • Patients over 40 years: 29% survived 1 year, 11% 2 years and 7% 3 years. The authors reported the age difference as significant.
  • Median survival was 177 days in patients with chest wall pain versus 305 days in patients without pain (p less than 0.01)
  • Median survival was 185 days in patients with weight loss versus 273 days in those without
  • Median survival by tumour type: epithelial 298 days, sarcomatous 91 days, mixed biphasic 176 days
  • Patients without metastases (256 patients): median survival 265 days
  • Patients with distant metastases (33 patients): median survival 76 days. Patients whose peritoneum or contralateral pleura was involved (12 patients): median survival 26 days.
  • Patients without lymph node involvement (145 patients): 35% alive at 1 year and 11% at 3 years. Patients with involved lymph nodes (72 patients): 24% and 2%.
  • Median survival by stage: stages I and II (39 patients) 389 days, stage III (168 patients) 250 days, stage IV (45 patients) 70 days
  • Thirty-day mortality: 11.8% (9 of 76) after extended pleuropneumonectomy, 2.4% (2 of 82) after decortication, and 8% (2 of 25) after exploratory thoracotomy
  • Median survival by operation: 284 days after extended pleuropneumonectomy, 315 days after decortication, and 149 days after exploratory thoracotomy
  • Chemotherapy as the first treatment (25 patients) showed no difference in survival compared with patients who received no treatment
  • Decortication with chemotherapy: median survival 354 days, versus 278 days for decortication without chemotherapy. The difference was not statistically significant (p = 0.07).
  • Peritoneal metastasis during follow-up: 20% after extended pleuropneumonectomy versus 5% after decortication
  • In a review of 215 patients, tumour spread into puncture channels or surgical wounds (implantation metastasis) was found in 26 (12%)
• The authors' conclusion: The authors concluded that decortication seems superior to pleuropneumonectomy because of its lower complication rate, and called it probably the treatment of choice at present. They considered extended pleuropneumonectomy probably justified in patients under 45 years with epithelial-type tumours.
• Limitations the authors state:
  • Because the study was retrospective, the palliative effect of treatment and the response rate could not be evaluated
  • 49 patients could not be assigned to a stage because the relevant data were missing
  • In the published discussion, the author stated that some patients had to be excluded after their findings were compared with the final pathological diagnosis

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, Prognosis, Metastasis, Peritoneum, Median Survival, Thoracotomy, Chemotherapy.

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