Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary Review of 103 Published Cases

Our plain-English summary of Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary Review of 103 Published Cases, by E. McGehee, D.E. Gerber, J. Reisch, et al (Clinical Lung Cancer, 2019).

The study

• Authors: E. McGehee, D.E. Gerber, J. Reisch, J.E. Dowell
• Journal: Clinical Lung Cancer
• Published: 2019;20(2):e152-e157
• Type of article: Systematic review
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary pericardial mesothelioma (PPM) is a rare cancer for which there is no consensus on treatment. We evaluated and summarized a large contemporary population of published PPM cases to characterize risk factors, treatment patterns, and clinical outcomes. Using Ovid and PubMed, literature published from 2000 through 2016 was searched using the terms "primary pericardial mesothelioma," "pericardial mesothelioma," and "malignant pericardial mesothelioma." We identified 6 case series and 84 case reports for a total of 103 PPM cases published from 2000 through 2016. The median age at diagnosis was 55 years, and the median overall survival was 6 months. In univariate analyses of clinical characteristics including gender, asbestos exposure, tobacco use, prior radiation exposure, histologic subtype, and metastasis and/or mediastinal spread, only the presence of metastasis and/or mediastinal spread was a significant predictor of decreased survival (P = .015). Surgery did not provide a statistically significant survival benefit (P = .12). A survival benefit was noted in those who received chemotherapy (median survival, 13 months vs. 0.5 months, P = .002), specifically chemotherapy with a platinum agent with or without pemetrexed. In multivariate analysis, only the receipt of chemotherapy was associated with improved survival. PPM remains a rare and poorly understood malignancy with unclear etiology and a poor prognosis. In this retrospective systematic review, a survival benefit was seen in patients who received chemotherapy.

Copyright © 2018 Elsevier Inc. All rights reserved.

In plain English

This article was a review of published medical reports of primary pericardial mesothelioma, a rare cancer of the lining around the heart. The authors searched Ovid and PubMed for reports published from 2000 through 2016 and pooled 103 cases from 6 case series and 84 case reports. Median age at diagnosis was 55 years, and 61% of cases were men. Asbestos exposure was suspected or confirmed in 20% of cases and did not predict survival; the authors wrote that this suggested another cause accounts for most cases. The median time from diagnosis to death was 6 months. Patients given chemotherapy had a median survival of 13 months versus 0.5 months without it (HR 0.31; 95% CI, 0.17-0.57), and chemotherapy remained linked with survival in a multivariate analysis of 66 cases. Surgery overall showed no statistically significant survival benefit, though removal of a pericardial mass was linked with longer survival. The authors concluded that mass resection and platinum-based chemotherapy may be beneficial, noting the small number of cases and possible publication and selection bias.

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 review of published case reports and case series, with pooled statistical analysis of the cases
• Who was studied: 103 cases of primary pericardial mesothelioma from 6 case series and 84 case reports published from 2000 through 2016, found in Ovid and PubMed. Median age at diagnosis was 55 years (range 19 to 87). 61% were male and 39% female.
• Exposure: Asbestos exposure was suspected or confirmed in 20% of cases. No fiber types were reported. Tobacco use was reported in 15% and radiation exposure in 6%. The treatments compared were surgery, chemotherapy and radiation.
• Main results:
  • In univariate analyses of gender, asbestos exposure, tobacco use, prior radiation exposure, histologic subtype and metastasis and/or mediastinal spread, only metastasis and/or mediastinal spread significantly predicted decreased survival (P=0.015).
  • Asbestos exposure, reported in one-fifth of cases, was not predictive of mortality. The authors interpreted this as suggesting that another cause accounts for most cases.
  • Overall, the median time from diagnosis to death was 6 months.
  • Surgery overall did not give a statistically significant survival benefit (HR 0.82; 95% CI, 0.46-1.45; P=0.45).
  • Patients who had a mass resection, with or without pericardiectomy, had a median survival of 27 months. This was a statistically significant benefit compared with no surgery (HR 0.40; 95% CI, 0.17-0.96; P=0.03).
  • Patients who received chemotherapy had a median survival of 13 months, compared with 0.5 months for those who did not (HR 0.31; 95% CI, 0.17-0.57; P=0.001).
  • The multivariate analysis used the 66 of 103 cases with complete information. In it, chemotherapy was a statistically significant positive predictor of survival (OR 0.10; 95% CI, 0.024-0.45; P=0.002).
  • In the same multivariate analysis, metastasis and/or mediastinal spread showed a trend toward worse outcomes that was not statistically significant (OR 4.51; 95% CI, 0.96-21.09; P=0.056).
  • Pericardial fluid sampling was done in 49 cases and revealed the diagnosis in 9 of them (18%).
• The authors' conclusion: The authors concluded that primary pericardial mesothelioma remains a rare and poorly understood cancer with unclear cause. They concluded that pericardial mass resection and platinum-based chemotherapy (with or without pemetrexed) may be beneficial.
• Limitations the authors state:
  • The small number of cases and possible publication bias limit how widely the findings apply.
  • Clinical management and data reporting varied widely across the included cases. Data on performance status and underlying comorbidities were not available.
  • Selection bias may account for some of the survival benefit seen with chemotherapy, and for the better results with more than one type of treatment.
  • Radiation was given in only 8 cases, so the authors could not draw firm conclusions about it.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Median Overall Survival, Asbestos Exposure, Histological Subtype, Metastasis, Chemotherapy, Pemetrexed (Alimta), Multivariate Analysis.

Related studies

• Surgical treatment of a primary malignant pericardial mesothelioma: case report — G. Apicella, A. Boulemden, et al. (2022)
• Three-year survival after surgery for primary malignant pericardial mesothelioma: report of a case — K. Fujita, M. Hata, et al. (2014)
• Primary pericardial mesothelioma: a case report of a patient treated with an immune checkpoint inhibitor as the second-line treatment — O. Arponen, V. Salo, et al. (2021)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Primary pericardial tumors — C.S. Restrepo, D. Vargas, et al. (2013)
• Primary pericardial mesothelioma: report of two cases and review of the literature — A.L. Sytman, R.N. MacAlpin (1971)

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