What is the survival after surgery for localized malignant pleural mesothelioma?

Our plain-English summary of What is the survival after surgery for localized malignant pleural mesothelioma?, by S.M. Gelvez-Zapata, D. Gaffney, M. Scarci, et al (Interactive Cardiovascular and Thoracic Surgery, 2013).

The study

• Authors: S.M. Gelvez-Zapata, D. Gaffney, M. Scarci, A.S. Coonar
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2013;16(4):533-7
• Type of article: Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A best evidence topic in thoracic surgery was written according to a structured protocol. This was with the purpose of assisting our management of patients with localized malignant mesothelioma of the pleura (LMM). Although the terminology is used inconsistently, this variant has been formally defined by the WHO as a distinct entity defined as localized disease histologically identical to the diffuse form but without any evidence of pleural spread. Treatments for LMM include different combinations of surgery, chemotherapy and radiotherapy. There is an impression that LMM may have a better outcome than the commoner diffuse form of malignant mesothelioma that has been reported to have a survival between 8 and 14 months. In order to advise our patients on prognosis, we studied the duration of survival after surgical resection of LMM. A total of 150 papers were found, of which 16 represented the best evidence to answer the question. The authors, journal, date, country of publication, study type, relevant outcomes and results of these papers are tabulated. It is difficult to combine the results of these 16 papers because both treatments and results are reported differently. Some report median survival (range: 11.6-36 months) and others disease-free survival (range: 0 months to 11 years). Median survival to the longest follow-up was 29 months when calculated by pooling data from informative papers using the Kaplan-Meier method. Our review suggests that survival in LMM is longer than that generally quoted for the more common diffuse form of malignant mesothelioma. Hence, aggressive treatment of LMM may be reasonable in appropriate patients.

In plain English

This article was a structured literature review (a "best evidence topic") of survival after surgery for localized malignant mesothelioma of the pleura. This form looks like the common diffuse form under the microscope but has not spread along the pleura. The authors searched Medline (1978 to November 2011) and chose 16 of 150 papers, all case reports or case series. From 15 papers that gave individual patient outcomes, they identified 48 patients treated with surgery, sometimes with chemotherapy or radiotherapy; 26 were followed until death. Survival ranged from 0 to 132 months; the 132 months was time to the end of follow-up, not to death. They reported an overall median survival of 36 months and overall disease-free survival of 24 months. A Kaplan–Meier analysis, which allows for patients not followed to death, gave a median survival of 29 months. The authors concluded that this form is associated with longer survival than generally reported for the diffuse form, and that multimodality treatment seems reasonable in appropriate patients. They noted that papers described treatments and survival differently. The article did not examine asbestos exposure.

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: Structured literature review (best evidence topic) of published case reports and case series, with pooled individual patient survival analysis
• Who was studied: 48 patients with localized malignant mesothelioma of the pleura who underwent surgery. They were identified from the 15 of 16 selected papers that allowed individual patient data extraction. The 16 papers came from 150 found in a Medline search covering 1978 to November 2011. A 10-patient series (Nakas et al.) was not included in the survival analysis.
• Exposure: No asbestos exposure was studied. The 'exposure' was treatment: surgery with or without chemotherapy or radiotherapy. Operations included extrapleural pneumonectomy, chest wall resection, lobectomy and wedge resections, and most also included partial or total pleurectomy/decortication.
• Main results:
  • All 16 papers were level V evidence (case reports or case series)
  • 48 patients with localized malignant mesothelioma of the pleura who underwent surgery were identified for the survival analysis; 26 of the 48 were followed to death
  • The 10 patients in the Nakas et al. series were not included in the survival analysis, because individual patients could not be identified in that paper
  • Survival among the 48 patients ranged from 0 to 132 months, including one death on the first postoperative day. The 132-month maximum was survival to the end of follow-up, not to death.
  • For the pooled patients, overall median survival was 36 months and overall disease-free survival was 24 months
  • Median survival calculated by the Kaplan–Meier method was 29 months
• The authors' conclusion: The authors concluded that localized malignant mesothelioma of the pleura is associated with longer survival than generally reported for the diffuse form. They also concluded that multimodality treatment, such as local excision with pleurectomy/decortication and adjuvant chemotherapy, seems reasonable in appropriate patients.
• Limitations the authors state:
  • Survival was reported differently across the papers, and adjuvant treatments or extent of surgery were not always clearly described
  • All the evidence came from case reports and case series
  • Not all patients were followed to death

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, Thoracic Surgery, Localized Malignant Mesothelioma, Pleura, Chemotherapy, Malignant Mesothelioma, Prognosis, Surgical Resection.

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