In Response

Our plain-English summary of In Response, by A. Billè, L. Porcu (Journal of Thoracic Oncology, 2015).

The study

• Authors: A. Billè, L. Porcu
• Journal: Journal of Thoracic Oncology
• Published: 2015;10(9):e93-e94
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

In this letter to the editor, the authors replied to comments by Carbonelli and colleagues on their earlier study comparing extrapleural pneumonectomy (EPP) with pleurectomy decortication (PD) for malignant pleural mesothelioma. Clinical staging was missing for 854 of 1365 patients (62.6%), and for 634 of 862 (73.5%) patients not treated surgically. Citing both the missing data and the inaccuracy of clinical staging, the authors left clinical stage out of their univariate and multivariate analyses. They still reported survival rates stage by stage as descriptive results. They reported no correlations between clinical staging and overall survival. In nonstaged patients, the only reliable characteristics in the multivariate analysis were age, histology and chemotherapy treatment. Pathological staging was missing less often, for 75 of 503 (14.9%). The relative risk of death between the two operations was similar for stages I, II and III but drastically different for stage IV. The authors cautioned that the stage IV results should be considered very carefully because of missing data and small numbers. They stated that PD should be favored over EPP, and they concluded that prospective trials comparing different treatments are what is really needed.

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: letter to the editor (authors' reply to comments on their earlier retrospective study)
• Who was studied: Patients with malignant pleural mesothelioma in the authors' earlier study: 1365 patients, 862 of them not treated surgically. Most were treated before the MARS trial results were available.
• Exposure: No asbestos exposure was studied. The letter concerns surgical treatment: extrapleural pneumonectomy (EPP) versus pleurectomy decortication (PD).
• Main results:
  • Clinical staging was missing for 854 of 1365 patients (62.6%).
  • Among patients not treated surgically, clinical staging was missing for 634 of 862 (73.5%).
  • Because of missing data and the inaccuracy of clinical staging, clinical stage was not included in the univariate and multivariate analyses.
  • Survival rates were reported stage by stage as descriptive results, and there were no correlations between clinical staging and overall survival.
  • In nonstaged patients, the only reliable characteristics in the multivariate analysis were age, histology and chemotherapy treatment.
  • Pathological staging was missing for 75 of 503 patients (14.9%).
  • The relative risk of death between PD and EPP was similar for stages I, II and III, and drastically different for stage IV.
• The authors' conclusion: The authors stated that PD should be favored over EPP as the surgical treatment of choice. They concluded that what is really needed is prospective trials comparing different treatments.
• Limitations the authors state:
  • The stage IV results should be considered very carefully because of missing data and the small sample size of stage IV patients.
  • Clinical staging was missing for many patients and is unreliable.

Topics

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

Related studies

• Does surgery improve survival of patients with malignant pleural mesothelioma?: a multicenter retrospective analysis of 1365 consecutive patients — P. Bovolato, C. Casadio, et al. (2014)
• British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma — I. Woolhouse, L. Bishop, et al. (2018)
• Malignant pleural mesothelioma and the Society of Thoracic Surgeons Database: an analysis of surgical morbidity and mortality — B.M. Burt, R.B. Cameron, et al. (2014)
• Thirty-day mortality underestimates the risk of early death after major resections for thoracic malignancies — R.R. McMillan, A. Berger, et al. (2014)
• Intraoperative fluorescence imaging in thoracic surgery — A.D. Newton, J.D. Predina, et al. (2018)
• Surgery for malignant pleural mesothelioma — D.J. Sugarbaker, A.S. Wolf (2010)

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