Malignant pleural mesothelioma: a survival study

Our plain-English summary of Malignant pleural mesothelioma: a survival study, by J.C. Harvey, E.H. Fleischman, A.R. Kagan, et al (Journal of Surgical Oncology, 1990).

The study

• Authors: J.C. Harvey, E.H. Fleischman, A.R. Kagan, O.E. Streeter
• Journal: Journal of Surgical Oncology
• Published: 1990;45(1):40-2
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003841).

Abstract

Ninety-four patients with malignant pleural mesothelioma were treated at Southern California Permanente Medical Group Facilities between 1965 and 1988. This retrospective analysis of survival in these patients is compared according to surgical and/or supportive management. Group I patients received supportive care only, including pleurodesis as needed. This group included the majority of patients. Group II patients were managed largely with debulking procedures including decortication and pleurectomy. Group III patients received extrapleural pneumonectomy. This group included the two long-term survivors of the entire group. This study of survival points out the need for a cooperative protocol as well as the consistent use of proper modern preoperative staging in an attempt to select patients who benefit from extrapleural pneumonectomy.

In plain English

This retrospective review covered 94 patients with malignant pleural mesothelioma in a Southern California Permanente Medical Group tumor registry, 1965 to 1988. The authors grouped patients by treatment. Group I was 76 patients whose surgery was limited to diagnostic procedures and supportive care, with no major debulking; 33 of them also had some form of nonsurgical treatment, such as chemotherapy or radiation. Group II was nine patients who had debulking surgery (decortication and pleurectomy). Group III was seven patients who had extrapleural pneumonectomy. Median survival was 231 days in Group I and 360 days in Group II, where no patient survived 2 years. In Group III, two men lived long term: one lived 7 years and one was alive 8 years after diagnosis. Four of those seven patients died within 6 months. Asbestos exposure was recorded for 50 Group I patients (66%), 4 Group II patients (44%) and 5 Group III patients (71%). The authors concluded that selected patients benefit from radical surgery and that the data suggest a survival benefit from debulking. They noted that the records were too incomplete for proper staging or for studying how patients were chosen for surgery.

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 review of survival by type of treatment, using tumor registry records from several hospitals
• Who was studied: 94 patients with malignant pleural mesothelioma enrolled in the regional tumor registry of hospitals served by the Southern California Permanente Medical Group, 1965 to 1988, drawn from seven hospitals
• Exposure: The study compared treatments. Group I (76 patients) had surgery limited to diagnostic procedures and supportive care, with no major debulking; 33 of them also had some form of nonsurgical treatment (chemotherapy and external beam irradiation in varied combinations and doses). Group II (9 patients) had debulking by decortication and pleurectomy. Group III (7 patients) had extrapleural pneumonectomy. Asbestos exposure was recorded for 50 (66%) of Group I, 4 (44%) of Group II and 5 (71%) of Group III. No fiber types were named.
• Main results:
  • Group I (76 patients, no debulking surgery): median survival was 231 days. Four patients survived more than 2 years, and one survived more than 5 years after chemotherapy and tangential field external beam irradiation.
  • Group II (debulking, 9 patients): all had died at the time of review, none survived 2 years, and median survival was 360 days.
  • Group III (extrapleural pneumonectomy, 7 patients): there were two long-term survivors. A 42-year-old man lived 7 years and died of pneumonia and cor pulmonale. A 36-year-old man was alive 8 years after diagnosis. Four of the seven died within 6 months.
  • Follow-up was complete, and all but three patients had died by the time of review.
  • There were no deaths from the operation in Group II.
• The authors' conclusion: The authors concluded that their data confirm that selected patients benefit from radical surgery and suggest a survival benefit from debulking. They said well-planned trials with modern staging are needed.
• Limitations the authors state:
  • There was not enough information for proper staging, or to investigate how patients were selected for more radical surgery.
  • The data came from seven hospitals over more than 20 years, with many physicians and no set treatment protocol.
  • Chemotherapy and radiation in Group I varied too much to analyze separately.

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, Pleurodesis, Extrapleural Pneumonectomy (EPP), Staging.

Related studies

• Prognostic factors for survival after surgical palliation of malignant pleural effusion — J.E. Pilling, M.E. Dusmet, et al. (2010)
• Patterns of care and survival of older patients with malignant pleural mesothelioma — A. Linton, P. Blinman, et al. (2019)
• Survival after conservative (palliative) management of pleural malignant mesothelioma — N. Merritt, C.J. Blewett, et al. (2001)
• Malignant pleural mesothelioma: a population-based study of survival — M.T. Milano, H. Zhang (2010)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• 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)

Browse more research in Journal of Surgical Oncology, or return to medical research.