Therapeutic surgery for nonepithelioid malignant pleural mesothelioma: is it really worthwhile?

Our plain-English summary of Therapeutic surgery for nonepithelioid malignant pleural mesothelioma: is it really worthwhile?, by B. Balduyck, D. Trousse, A. Nakas, et al (The Annals of Thoracic Surgery, 2010).

The study

• Authors: B. Balduyck, D. Trousse, A. Nakas, A.E. Martin-Ucar, J. Edwards, D.A. Waller
• Journal: The Annals of Thoracic Surgery
• Published: 2010;89(3):907-11
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Debate remains about the relative prognostic importance of the histologic subtype of malignant pleural mesothelioma.

Methods: From a prospective database, the details of 312 malignant pleural mesothelioma surgical patients were reviewed. A comparison was made of the survival from the three major cell types.

Results: One hundred ninety-five patients underwent radical surgery, and 117 underwent nonradical surgery. Final histologic subtype was epithelioid in 218 patients, biphasic in 66 patients, and sarcomatoid in 28 patients. The median survival was 15.3 months in the epithelioid group, 10.1 months in the biphasic group, and 5.0 months in the sarcomatoid group. On univariate analysis in the epithelioid group, age (p = 0.005), International Mesothelioma Interest Group stage (p = 0.001), radicality of the procedure (p = 0.001), leukocytosis (p = 0.016), and preoperative or postoperative chemotherapy (p = 0.012) were significant prognostic factors influencing postoperative survival. In the biphasic group, preoperative anemia was the only significant factor (p = 0.007). In sarcomatoid patients, International Mesothelioma Interest Group stage and radicality of the surgical procedure were significant prognostic variables (p = 0.012 and p = 0.015, respectively). Multivariate analysis in the epithelioid group identified International Mesothelioma Interest Group stage (p = 0.001), radicality of the procedure (p = 0.008), and preoperative or postoperative chemotherapy (p = 0.007) as significant prognostic factors, whereas in the sarcomatoid group, only the International Mesothelioma Interest Group stage (p = 0.012) was significant and the radicality of surgery had no effect.

Conclusions: The extremely poor prognosis of sarcomatoid malignant pleural mesothelioma is independent of the extent of surgery unlike other cell types. Patients with sarcomatoid histology should therefore be considered separately in trials evaluating radical procedures and adjuvant treatment. The treatment of biphasic pleural mesothelioma remains debatable.

2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This retrospective study reviewed a prospective surgical database at Glenfield Hospital in Leicester, United Kingdom. Of 329 consecutive patients operated on for malignant pleural mesothelioma from 1998 to 2008, the 17 who died within 30 days of surgery were excluded, leaving 312. Tumors were epithelioid in 218, biphasic in 66 and sarcomatoid in 28. Of the 312, 195 patients had radical surgery and 117 had nonradical surgery. Asbestos exposure was not reported. Median survival was 15.3 months for epithelioid, 10.1 months for biphasic and 5.0 months for sarcomatoid patients. No sarcomatoid patient survived beyond 2 years. In multivariate analysis, stage, radical surgery and chemotherapy before or after surgery were significant prognostic factors in the epithelioid group. In the sarcomatoid group only stage was significant, and the extent of surgery had no effect. The authors concluded that the extremely poor prognosis of sarcomatoid mesothelioma is independent of the extent of surgery and that these patients should be considered separately in trials. They wrote that the treatment of biphasic disease remains debatable. They noted the analysis was retrospective and that selection for surgery may have been biased.

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: Retrospective analysis of a prospective single-institution surgical database, comparing survival by histologic subtype
• Who was studied: 329 consecutive patients who had surgery for malignant pleural mesothelioma at one institution (Glenfield Hospital, Leicester, UK) between January 1998 and December 2008. The 17 who died within 30 days of surgery were excluded, leaving 312 patients (273 men, 39 women; median age 61.0 years, range 14.0 to 80.0)
• Exposure: The article does not report asbestos exposure. It compared histologic subtypes (epithelioid, biphasic, sarcomatoid) and radical surgery (extrapleural pneumonectomy, radical pleurectomy or decortication) versus nonradical surgery
• Main results:
  • Of the 312 patients, 195 had radical surgery and 117 had a nonradical procedure
  • Epithelioid group (218 patients): median survival 15.3 months; 1-year survival 63.3% and 2-year survival 31.7%
  • Biphasic group (66 patients): median survival 10.1 months; 1-year survival 40.9% and 2-year survival 7.6%
  • Sarcomatoid group (28 patients): median survival 5.0 months and 1-year survival 3.6%; no sarcomatoid patient survived more than 2 years
  • After nonradical surgery, survival did not differ significantly between the epithelioid and biphasic groups, but survival in the sarcomatoid group was significantly lower than in the biphasic group
  • In univariate analysis of the biphasic group, preoperative anemia was the only significant factor
  • In multivariate analysis of the sarcomatoid group, only IMIG stage was significant and the radicality of surgery had no effect. (In the epithelioid group, IMIG stage, radicality of the procedure and preoperative or postoperative chemotherapy were significant.)
• The authors' conclusion: The authors concluded that the extremely poor prognosis of sarcomatoid malignant pleural mesothelioma is independent of the extent of surgery, unlike other cell types. They concluded that sarcomatoid patients should be considered separately in trials of radical procedures and adjuvant treatment, and that the treatment of biphasic disease remains debatable
• Limitations the authors state:
  • The analysis was retrospective
  • Data were collected over an extended period during which treatment evolved and was not uniform
  • Patients selected for radical surgery may have had a good prognosis even without treatment
  • No patients were treated as part of a prospective protocol
  • The decision to operate may have been biased by a preconceived belief that sarcomatoid disease has a poor outlook

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Histological Subtype, Epithelioid, Biphasic Mesothelioma, Sarcomatoid, Median Survival, Mesothelioma, Chemotherapy.

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