Sarcomatoid mesothelioma: future advances in diagnosis, biomolecular assessment, and therapeutic options in a poor-outcome disease

Our plain-English summary of Sarcomatoid mesothelioma: future advances in diagnosis, biomolecular assessment, and therapeutic options in a poor-outcome disease, by D. Galetta, A. Catino, A. Misino, et al (Tumori, 2016).

The study

• Authors: D. Galetta, A. Catino, A. Misino, A. Logroscino, M. Fico
• Journal: Tumori
• Published: 2016;102(2):127-30
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is the most frequent pleural neoplasm, with asbestos exposure as one of the recognized carcinogen agents, causative in 80% of cases. The prognosis is poor; median survival of untreated cases is 6-9 months, with fewer than 5% of patients surviving 5 years. Sarcomatoid mesothelioma (SM) represents the subtype with the worst outcome and median survival ranging from 3.5 to 8 months. In the last few years, an accurate differentiation between the subtypes of MPM has become a crucial issue, due to differences in chemosensitivity and clinical outcome, and several studies have evaluated different immunohistochemical markers to better define the diagnosis. The different and worse outcome of patients with SM and, in general, nonepithelioid subtypes makes it intriguing to select these cases to better study the biomolecular profile in order to find factors linked to prognosis and/or predictive of therapeutic response. Considering recent studies on miRNA and genetic mapping, further investigation of this rare subtype might represent a field for basic and clinical-translational research providing for more tailored therapies.

In plain English

This article was a narrative review of sarcomatoid mesothelioma, the least common subtype of malignant pleural mesothelioma. It reported no new patient data. Instead it summarized published studies on diagnosis, outlook and treatment. The review stated that asbestos causes about 80% of malignant pleural mesothelioma cases. It cited earlier studies giving median survival for sarcomatoid mesothelioma of 3.5 to 8 months. One cited study, by Neumann and colleagues, reported median survival of 4 months for sarcomatoid and 8 months for biphasic subtypes, compared with 26 months for the epithelioid subtype. The review also described a systematic review by Mansfield and colleagues. In it, 137 of 1475 trial patients (9.3%) had sarcomatoid histology, and their response rate to chemotherapy was 13.9%, against an overall response rate of 21.9%. The review discussed tissue-staining markers and molecules such as miRNAs and CD26 as possible signs of outlook or treatment response. It noted that sarcomatoid patients are generally excluded from surgical trials. The authors concluded that this subtype is an attractive field for basic and clinical-translational research.

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: Narrative review of published studies (no original patient data)
• Who was studied: No patients were studied directly. The review discussed published research on sarcomatoid malignant pleural mesothelioma, described as accounting for about 10%-20% of primary pleural neoplasms.
• Exposure: Asbestos was mentioned only as background: the review stated that asbestos is the cause of about 80% of malignant pleural mesothelioma cases. No fiber types were specified.
• Main results:
  • Citing earlier studies, the review reported median survival for sarcomatoid mesothelioma ranging from 3.5 to 8 months.
  • Citing Neumann et al, the review reported median survival of 4 months (sarcomatoid) and 8 months (biphasic), compared with 26 months for the epithelioid subtype (log-rank test, p less than 0.05).
  • Citing earlier studies, the review reported that calretinin and WT1 staining was present in 31% and 33% of sarcomatoid mesothelioma samples, respectively.
  • Citing a systematic review by Mansfield and colleagues: of 1475 patients in 30 trials with sarcomatoid data, 137 (9.3%) had sarcomatoid histology. Their response rate was 13.9% (19 patients), against an overall response rate of 21.9%.
  • Citing Aoe et al: CD26 expression was associated with longer survival in patients receiving chemotherapy (median 18.6 vs 10.7 months, p = 0.0083). Sarcomatoid subtypes were reported to lack surface CD26.
  • Citing Matsumoto and colleagues: upregulation of miRNA-31 was associated with poor prognosis of malignant pleural mesothelioma with a sarcomatoid component.
  • The review stated that patients with sarcomatoid and biphasic histology are generally excluded from surgical trials because of poor outcome.
• The authors' conclusion: The authors concluded that patients with sarcomatoid mesothelioma are a subgroup with different prognosis and chemosensitivity. They considered it an attractive field for basic and clinical-translational research that might lead to tailored treatments.

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: Sarcomatoid, Mesothelioma, Pleural Mesothelioma, Neoplasm, Asbestos Exposure, Prognosis, Median Survival.

Related studies

• Upregulation of microRNA-31 associates with a poor prognosis of malignant pleural mesothelioma with sarcomatoid component — S. Matsumoto, K. Nabeshima, et al. (2014)
• Preoperative assessment and therapeutic options for patients with malignant pleural mesothelioma — S. Paul, S. Neragi-Miandoab, et al. (2004)
• Malignant peritoneal mesothelioma: prognostic factors and oncologic outcome analysis — D. Magge, M.S. Zenati, et al. (2014)
• Outcomes of Cytoreductive Surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients older than 70 years; survival benefit at considerable morbidity and mortality — K.I. Votanopoulos, N.A. Newman, et al. (2013)
• Soluble mesothelin, megakaryocyte potentiating factor, and osteopontin as markers of patient response and outcome in mesothelioma — K. Hollevoet, K. Nackaerts, et al. (2011)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)

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