Reply: To PMID 25534527

Our plain-English summary of Reply: To PMID 25534527, by R.M. Flores, E. Taioli, A.S. Wolf (The Annals of Thoracic Surgery, 2015).

The study

• Authors: R.M. Flores, E. Taioli, A.S. Wolf
• Journal: The Annals of Thoracic Surgery
• Published: 2015;100(3):1133-4
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

This item is a letter, not a new study. The authors wrote it in reply to a letter by Cao and colleagues that criticized the authors' earlier meta-analysis. That meta-analysis compared survival after pleurectomy decortication with survival after extrapleural pneumonectomy in mesothelioma. The reply reports no new data. The authors said the main result still stood: overall outcome favored pleurectomy, even when residual tumor was left behind and even though different types of pleurectomy were grouped together. They said that their main analysis, of short-term survival, did not show statistically significant heterogeneity between studies. They said the secondary analysis of 2-year survival did show heterogeneity, which they presumed was because only 7 studies were included. They explained that their median-survival figure was only a visual aid, not a statistical comparison. They described the Allen study cited by Cao and colleagues as outdated. They also said it was an invited paper that was not part of a rigorous peer-reviewed journal process. The authors concluded that extrapleural pneumonectomy showed no advantage over pleurectomy. The letter 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: Letter to the editor (reply to correspondence about the authors' own published meta-analysis); no new data
• Who was studied: No new population. The letter discusses the studies pooled in the authors' earlier meta-analysis of surgery for mesothelioma; the 2-year survival subgroup included 7 studies
• Exposure: Not an asbestos exposure. The comparison is between two operations for mesothelioma: pleurectomy (with decortication) and extrapleural pneumonectomy
• Main results:
  • The authors said the overall outcome in their meta-analysis favored pleurectomy, even when residual tumor was left and different pleurectomy types were grouped together
  • The authors said the main analysis of short-term survival showed no statistically significant heterogeneity (p values for the Quick test of 1 and 0.5; I-squared heterogeneity of 0%)
  • The authors said the 2-year survival subgroup analysis did show statistical heterogeneity, which they presumed was because few studies (7) were included. They said 2 years was chosen because most included studies reported that time frame
  • The authors said their median-survival figure made no statistical comparison and was only a visual aid showing how many studies favored each procedure
  • The authors argued that which type of pleurectomy can be done depends on the invasiveness of the patient's tumor, not usually on the surgeon's skill
  • The authors described the Allen study cited by Cao and colleagues as outdated. They said it was an invited paper and not part of a rigorous peer-reviewed journal process. They recommended comparing results with current studies that use immunohistochemistry, TNM staging, computed tomography and modern surgical techniques
• The authors' conclusion: The authors concluded that, despite its perceived better oncologic result, extrapleural pneumonectomy had no advantage over pleurectomy in their study
• Limitations the authors state:
  • The authors acknowledged statistical heterogeneity in the 2-year survival subgroup analysis, which they attributed to the small number of studies included

Topics

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

Related studies

• Reply: To PMID 25534527 — E. Taioli, A.S. Wolf, et al. (2015)
• Reply: To PMID 24726598 — L. Spaggiari, G. Marulli, et al. (2015)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• The use of surgery in mesothelioma — J.Y. Lim, A.S. Wolf, et al. (2013)
• Short-term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma — M. van Gerwen, A. Wolf, et al. (2018)

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