Invited commentary

Our plain-English summary of Invited commentary, by R.M. Flores (The Annals of Thoracic Surgery, 2014).

The study

• Author: R.M. Flores
• Journal: The Annals of Thoracic Surgery
• Published: 2014;97(6):1865-6
• Type of article: Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is an invited commentary, not a research study. The author commented on a separate article by Spaggiari and colleagues, a multicenter retrospective study from Italy of extrapleural pneumonectomy (EPP), an operation for malignant pleural mesothelioma used with other treatments. The commentary reported no new patient data and did not discuss asbestos exposure. The author noted that the Italian study reported excellent 90-day operative mortality and confirmed that epithelioid histology, female sex and negative nodal status were good prognostic signs. The author questioned the study's claim to follow the intent-to-treat principle, because 41 patients who had exploratory surgery intended to lead to EPP were left out of the survival analysis. The author wrote that the study's 5-year survival with surgery appeared similar to the 15% 5-year survival without surgery in 6000 patients in the SEER database. The author also wrote that better outcomes from treatment cannot be concluded from this or other retrospective studies, and asked whether apparent benefits reflect selection and lead-time bias or biology.

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: invited commentary on another published study (no new data)
• Who was studied: No population of its own. The commentary discusses a multicenter retrospective study from Italy (Spaggiari et al., Ann Thorac Surg 2014;97:1859–66) of extrapleural pneumonectomy for mesothelioma.
• Main results:
  • According to the author, the Spaggiari study reported excellent 90-day operative mortality and confirmed prior reports that epithelioid histology, female sex and negative nodal status are good prognosticators.
  • The author pointed out that 41 patients who underwent exploratory thoracotomy with the intention to perform EPP were excluded from the Spaggiari study's survival analysis. The author stated that a proper intent-to-treat analysis should include them.
  • The author wrote that the 5-year survival with surgical resection in the Spaggiari study appears similar to the 5-year survival of 15% without surgical resection in 6000 patients in the SEER database. The SEER figure comes from that database, not from either study.
  • The author stated that better outcomes as a result of treatment in mesothelioma cannot be concluded from this or the numerous other retrospective studies.
• The authors' conclusion: The author asked whether patients' perceived better outcome after intensive treatment is due to selection and lead-time bias or to biology. Describing themselves as a biased surgeon, the author wrote that they believe surgical resection changes the course of the disease in some patients, but that the data suggest otherwise.

Topics

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

Related studies

• Invited commentary — B.C. Tong (2014)
• Invited commentary — L. Lang-Lazdunski (2015)
• Invited commentary — V.W. Rusch (2015)
• Invited commentary — C.P. Clarke (2011)
• Invited commentary — D. Rice (2010)
• Invited commentary: Is it possible to investigate the quantitative relation between asbestos and mesothelioma in a community-based study? — J. Siemiatycki, P. Boffetta (1998)

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