Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma--institutional review and current update

Our plain-English summary of Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma--institutional review and current update, by C. Cao, S.K. Krog Andvik, T.D. Yan, et al (Interactive Cardiovascular and Thoracic Surgery, 2011).

The study

• Authors: C. Cao, S.K. Krog Andvik, T.D. Yan, C. Kennedy, P.G. Bannon, B.C. McCaughan
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2011;12(5):754-7
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Extrapleural pneumonectomy (EPP) has been established as a viable surgical option in the treatment of malignant pleural mesothelioma (MPM) for selected patients. A number of pathological staging systems have been developed to prognosticate survival outcomes. We assessed 91 patients with MPM who underwent EPP in our institution and evaluated the applicability of the most updated staging systems in the current literature. After a mean follow-up of 20 months, the median overall survival was 27.6 months. Postoperative pathological staging according to the International Mesothelioma Interest Group criteria (P = 0.026) and the Brigham and Women's Hospital criteria (P = 0.039) were both found to be significant prognostic factors. Adjuvant chemotherapy (P = 0.022) and radiotherapy (P = 0.008) were associated with improved survival outcomes. These findings are consistent with previous reports that demonstrated the usefulness of pathological staging systems as a prognostic tool in patients with MPM after undergoing EPP. However, preoperative clinical staging systems need to be developed to facilitate the patient selection process prior to surgery.

In plain English

This study reviewed 91 patients with malignant pleural mesothelioma who had extrapleural pneumonectomy (EPP), an operation removing the pleura, lung and diaphragm on one side. The patients were treated by one surgeon's team at the authors' institution in Sydney between 1994 and 2010. The authors tested whether two staging systems predicted survival: one from the International Mesothelioma Interest Group (IMIG) and one from Brigham and Women's Hospital (BWH). Median overall survival was 27.6 months. One-year survival was 71.9% and three-year survival was 55.9%. Four patients died around the time of surgery (4.4%), and 34 (37.4%) had complications. Stage under both systems was significantly linked to survival (IMIG p = 0.026; BWH p = 0.039). So were adjuvant chemotherapy (p = 0.022) and adjuvant radiotherapy (p = 0.008). Sixty-one patients (67%) reported prior asbestos exposure, but this was not a statistically significant factor (p = 0.074). The authors described a trend toward better survival in those without reported exposure. The authors concluded that stage was a significant prognostic factor. They noted that the study was retrospective, had no control group, and that treatment changed over 16 years.

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: Single-institution retrospective review (institutional case series) of patients operated on by one surgical team
• Who was studied: 91 patients with malignant pleural mesothelioma (MPM) who underwent extrapleural pneumonectomy between 1994 and 2010 at the authors' institution (Royal Prince Alfred Hospital, Sydney, Australia); median age 59.4 years; 75 had epithelial-type disease
• Exposure: Asbestos was not the focus. Prior asbestos exposure was one of several factors examined: 61 patients (67%) were recorded as exposed and 30 (33%) as not exposed. No fiber types, jobs or doses were given. The main factors studied were pathological stage (IMIG and BWH systems) and treatments such as adjuvant chemotherapy and radiotherapy.
• Main results:
  • In all 91 patients, median overall survival was 27.6 months, with one- and three-year survival rates of 71.9% and 55.9%
  • Four patients died within 30 days of surgery or during the same hospital stay, a perioperative mortality rate of 4.4%
  • 34 patients (37.4%) had one or more complications around the time of surgery
  • Stage according to both the IMIG criteria (P = 0.026) and the BWH criteria (P = 0.039) was a significant prognostic factor for overall survival
  • Adjuvant chemotherapy (P = 0.022) and adjuvant radiotherapy (P = 0.008) were reported by the authors to improve survival outcomes
  • Prior asbestos exposure was not statistically significant (P = 0.074). The authors described a trend toward better survival in patients who did not report previous asbestos exposure.
  • Histologic subtype and nodal status were not found to be significant prognostic factors in this cohort
• The authors' conclusion: The authors concluded that disease stage, by both the IMIG and BWH criteria, was a significant prognostic factor after EPP
• Limitations the authors state:
  • The study was retrospective and had no control group
  • Changes in adjuvant therapy over the 16-year study period may have affected survival and were a potential source of bias
  • Relatively few patients had nodal disease or non-epithelial subtypes, which the authors offered as a possible reason these factors were not significant

Topics

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

Medical terms in this study, explained in our Lexicon: Staging, Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Median Overall Survival, Mesothelioma, Brigham and Women's Hospital, Chemotherapy.

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• Induction chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy for malignant pleural mesothelioma: experience of Guy's and St Thomas' hospitals — A. Bille, E. Belcher, et al. (2012)
• Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors — T.D. Yan, M. Boyer, et al. (2009)
• Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma — M. de Perrot, R. Feld, et al. (2016)
• Clinical and pathological features of three-year survivors of malignant pleural mesothelioma following extrapleural pneumonectomy — D.J. Sugarbaker, A.S. Wolf, et al. (2011)
• Impact of induction therapy on postoperative outcome after extrapleural pneumonectomy for malignant pleural mesothelioma: does induction-accelerated hemithoracic radiation increase the surgical risk? — P. Mordant, K. McRae, et al. (2016)

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