How Old is Too Old to Operate for Mesothelioma?

Our plain-English summary of How Old is Too Old to Operate for Mesothelioma?, by J.M. Karush (Annals of Surgical Oncology, 2019).

The study

• Author: J.M. Karush
• Journal: Annals of Surgical Oncology
• Published: 2019;26(8):2311-2312
• Type of article: Editorial
• Read it: PubMed · Publisher

In plain English

This is an editorial, not an original study. The author, from Rush University Medical Center in Chicago, commented on a separate study by Verma and colleagues in the same journal issue. That study used the National Cancer Database to examine treatment and outcomes in 4526 geriatric patients with malignant pleural mesothelioma. The age cutoff is printed as 80 years, but the symbol before it is garbled. As the editorial reports, 63% of these patients received no treatment, 22% chemotherapy alone, 13% surgery alone and 2% both. Death within 30 and 90 days after surgery was 11% and 28.5%. In a propensity-matched comparison, survival was 13.4 months with surgery plus chemotherapy versus 6.5 months with chemotherapy alone (p = 0.002). Of 663 surgical patients, 85% (566) received no follow-up (adjuvant) treatment. The author noted that missing information on patients' fitness, nutrition and other illnesses likely biased the survival figures. The author concluded that when selecting patients for surgery, it is paramount to consider whether adjuvant treatment can be offered. The editorial does not discuss 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: Editorial commenting on another published study (Verma et al., a National Cancer Database analysis); no new data
• Who was studied: Not studied by this author. The commented study (Verma et al.) included 4526 geriatric patients with malignant pleural mesothelioma from the US National Cancer Database. The age threshold is given as 80 years, but the symbol before it is garbled in the text.
• Exposure: Treatment approaches for malignant pleural mesothelioma (surgery, chemotherapy, both, or no treatment) in the commented study. Asbestos exposure is not discussed.
• Main results:
  • As reported from Verma et al.: among the 4526 geriatric patients, 63% were observed without treatment, 22% received chemotherapy alone, 13% received surgery alone, and 2% received both surgery and chemotherapy
  • As reported from Verma et al.: postoperative 30-day mortality was 11% and 90-day mortality was 28.5%
  • As reported from Verma et al.: in a propensity-matched analysis, survival was 13.4 months with surgery plus chemotherapy versus 6.5 months with chemotherapy alone (p = 0.002), favoring the combined approach
  • As reported from Verma et al.: of the 663 patients who received surgery, 85% (n = 566) did not receive adjuvant treatment
• The authors' conclusion: The author concluded that when selecting patients with mesothelioma for surgery, it is paramount to consider the ability to offer adjuvant treatment. The author considered the Verma study informative for managing geriatric patients with malignant pleural mesothelioma, and wrote that the eventual role of surgery remains uncertain.
• Limitations the authors state:
  • Limitation of the commented study, as stated by the editorial's author: it lacks detail on the 'functional age' of the patients selected for different treatments
  • Limitation of the commented study, as stated by the editorial's author: unknown clinical factors (performance status, nutrition status, other comorbidities) likely bias the survival statistics and may account for the high postoperative mortality
  • Limitation of the commented study, as stated by the editorial's author: the possible negative effect on survival in patients who could not receive or tolerate adjuvant therapy because of the surgery itself is not known

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma.

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