Surgery and Survival of Patients with Diagnosis of Malignant Pleural Mesothelioma

Our plain-English summary of Surgery and Survival of Patients with Diagnosis of Malignant Pleural Mesothelioma, by C. Carbonelli, C. Rapicetta, A. Cesario (Journal of Thoracic Oncology, 2015).

The study

• Authors: C. Carbonelli, C. Rapicetta, A. Cesario
• Journal: Journal of Thoracic Oncology
• Published: 2015;10(9):e92-e93
• Type of article: Letter, Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This item is a letter to the editor, not a new study. The authors commented on an earlier multicenter retrospective analysis by Bovolato and colleagues of 1365 consecutive patients with malignant pleural mesothelioma. That study compared extrapleural pneumonectomy (EPP) with a less invasive operation the letter calls extrapleural decortication (EP/D). The letter noted that the earlier study reported longer survival after EPP only in pathological stage IV patients (28 months versus 10.9 months after EP/D). It also noted that the earlier study did not show a statistically significant survival advantage for surgery overall compared with non-surgical treatment. The authors pointed out that in that study 51% of EP/D patients and 38.9% of EPP patients had an unknown clinical stage. They called this a strong methodological bias that could undermine the study's multivariate analysis, and they asked the earlier authors to analyse the unstaged or understaged cases separately. The authors concluded that the role of EPP should be further and carefully discussed, and that dialogue among experts is still the best way to resolve the uncertainty. The letter reported no patient data of its own.

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 commenting on a previously published study (Bovolato et al.). No new data were collected or analysed.
• Who was studied: The letter studied no patients of its own. It discussed the Bovolato et al. multicenter retrospective analysis of 1365 consecutive patients with malignant pleural mesothelioma.
• Exposure: No asbestos exposure was discussed. The subject was the type of surgery for malignant pleural mesothelioma: extrapleural pneumonectomy (EPP) versus extrapleural decortication (EP/D), as these terms appear in the letter.
• Main results:
  • The letter cited the Bovolato et al. study as reporting a survival advantage for EPP only in pathological stage IV patients: 28 months after EPP versus 10.9 months after EP/D. No such advantage was reported in earlier stages.
  • The letter's authors speculated that this stage IV difference might arise because less invasive surgery in advanced stages leaves more residual tumor. They described this as an assumption needing further investigation.
  • The letter noted that in the Bovolato et al. study, the best prognosis was seen in patients younger than 70 years, with epithelioid malignant pleural mesothelioma, who had received chemotherapy.
  • The letter noted that the Bovolato et al. study did not show a statistically significant survival advantage for surgery overall compared with non-surgical treatment.
  • The letter pointed out that, in the Bovolato et al. study's Table 1, clinical stage was unknown for 51% of EP/D patients and 38.9% of EPP patients.
  • The letter's authors suggested that, given this, the extent of surgery was likely decided during the operation.
  • In the letter's authors' opinion, the missing or understated staging was a strong methodological bias that could hamper the earlier study's multivariate analysis.
  • The letter's authors asked for the unstaged and understaged cases to be analysed separately.
  • The letter's authors stated that the role of EPP should be further and carefully discussed.
• The authors' conclusion: The authors invited Bovolato et al. to deepen their analysis. They concluded that dialogue among experts is still the best way to resolve the large areas of uncertainty about surgical management of 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: Pleural Mesothelioma.

Related studies

• 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)
• Intraoperative fluorescence imaging in thoracic surgery — A.D. Newton, J.D. Predina, et al. (2018)
• Surgery for malignant pleural mesothelioma — D.J. Sugarbaker, A.S. Wolf (2010)
• The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence — P. Bertoglio, D.A. Waller (2016)
• A survey of opinions and beliefs concerning surgery for malignant pleural mesothelioma amongst 802 members of the European Association for Cardio-Thoracic Surgery (EACTS), the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS) — T. Treasure, E. Internullo, et al. (2011)
• Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery — T. Tokunaga, N. Sawabata, et al. (2010)

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