Mesothelioma: Live to fight another day

Our plain-English summary of Mesothelioma: Live to fight another day, by A.S. Wolf, R.M. Flores (The Journal of Thoracic and Cardiovascular Surgery, 2018).

The study

• Authors: A.S. Wolf, R.M. Flores
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2018;155(4):1855-1856
• Type of article: Editorial
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this editorial commentary, two thoracic surgeons from the Icahn School of Medicine at Mount Sinai, New York, discussed a retrospective single-center 10-year study by Ambrogi and colleagues. That study reported pleurectomy/decortication (P/D) followed by heated intraoperative chemotherapy (HIOC) for malignant pleural mesothelioma (MPM), leaving the pericardium and diaphragm intact. The commentators listed as strengths the inclusion of a full cohort, comprehensive data, long-term follow-up (median more than 5 years), low mortality and morbidity, and adjuvant therapy for all patients. They identified as weaknesses the small study size, multivariable models that suggested overfitting, and an unusual HIOC protocol. That protocol used a lower cisplatin dose (80 mg/m2) and epirubicin, which had not been investigated in prospective trials of HIOC in MPM. The authors noted growing consensus that lung-preserving surgery is paramount in MPM. Older studies favoring extrapleural pneumonectomy (EPP) had excluded perioperative deaths or evaluated only patients with favorable features. More recent studies showed similar overall survival but lower operative, short-term and one-year mortality with P/D. The authors suggested that less extensive surgery may allow quicker recovery and better tolerance of adjuvant therapy and later treatment. It may also prevent contamination of unaffected cavities: only 2% of Ambrogi's patients recurred in the abdomen, compared with 39% of 169 patients after EPP in another series. They concluded that the study was too small for definitive conclusions but supported the message that in MPM surgery, less is more.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This is an editorial commentary, not a new study. The authors commented on a separate report by Ambrogi and colleagues. That report was a retrospective, single-center, 10-year experience with pleurectomy/decortication, a lung-preserving operation, followed by heated intraoperative chemotherapy for malignant pleural mesothelioma. The commentary gives no new patient data and does not discuss asbestos exposure. The authors noted strengths of the report, including inclusion of a full cohort and long-term follow-up. They wrote that its weaknesses were largely due to small size and that its statistical models suggested overfitting. They also called its chemotherapy protocol unusual, citing a lower cisplatin dose (80 mg/m2) and the use of epirubicin. They pointed out that only 2% of Ambrogi's patients recurred in the abdomen (and 8% in the diaphragm). An earlier report by Baldini, of 169 patients after extrapleural pneumonectomy, had found 39% recurring in the abdomen. The authors said Ambrogi's study was too small to draw definitive conclusions. They concluded that in surgery for pleural mesothelioma, less is more, and that preserving the lung, diaphragm and pericardium when possible facilitates recovery and survival.

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 commentary on another group's retrospective single-center study; no original data
• Who was studied: No study population of its own. The commentary discusses Ambrogi and colleagues' retrospective, single-center, 10-year series of patients with malignant pleural mesothelioma; the commentary does not give the number of patients in that series.
• Exposure: Not an asbestos exposure study. The subject is surgical treatment: pleurectomy/decortication (P/D) followed by heated intraoperative chemotherapy (HIOC) for malignant pleural mesothelioma.
• Main results:
  • The commentators' assessment of Ambrogi's study: its strengths included inclusion of a full cohort (not only patients with favorable features), comprehensive data and long-term follow-up (median more than 5 years).
  • The commentators' assessment: the multivariable regression in Ambrogi's study suggested overfitting of models with too many predictors and too few events.
  • The commentators' assessment: the chemotherapy protocol in Ambrogi's study was unusual, using a lower dose of cisplatin (80 mg/m2) than doses that showed more efficacy in cisplatin-only regimens.
  • The commentators' assessment: Ambrogi's study used epirubicin as the second chemotherapy agent, which has not been investigated in prospective trials of this treatment in malignant pleural mesothelioma.
  • As reported from Ambrogi's study: 2% of patients recurred in the abdomen and 8% in the diaphragm.
  • For comparison, the commentators cited an earlier report by Baldini on patients after extrapleural pneumonectomy: 54% of 169 patients recurred in the chest on the same side or in the mediastinum, and 39% in the abdomen.
  • The commentators wrote that earlier work by Batirel and Marulli showed that leaving small amounts of mesothelioma behind did not reduce long-term survival, and that Ambrogi's study supports this too.
  • The commentators proposed that less extensive surgery may help because patients recover more quickly, tolerate further treatment better, and have more reserve for additional treatment when the disease recurs.
• The authors' conclusion: The authors concluded that in surgery for pleural mesothelioma, less is more, and that preserving the lung, diaphragm and pericardium when possible facilitates recovery and survival.
• Limitations the authors state:
  • The commentators stated that Ambrogi's study is too small to draw definitive conclusions.
  • The commentators stated that, as in many retrospective cohort studies, the weaknesses of Ambrogi's study are largely due to small size.
  • The commentators noted there is still debate over the actual benefit of surgery in malignant pleural mesothelioma.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleurectomy/Decortication (P/D), Chemotherapy, Pleural Mesothelioma, Pericardium, Diaphragm, Adjuvant Therapy, Cisplatin.

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