Effectiveness of Surgical Treatment on Survival of Patients with Malignant Pleural Mesothelioma

Our plain-English summary of Effectiveness of Surgical Treatment on Survival of Patients with Malignant Pleural Mesothelioma, by R. Báez-Saldaña, M.E. Marmolejo-Torres, M.A. Iñiguez-García, et al (Cancers, 2025).

The study

• Authors: R. Báez-Saldaña, M.E. Marmolejo-Torres, M.A. Iñiguez-García, A. Jiménez-Corona, J.A. Berrios-Mejía
• Journal: Cancers
• Published: 2025;17(14)
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The benefit of surgery for malignant pleural mesothelioma is highly debated, as few robust clinical trials show its effectiveness. Objective: To examine the long-term survival of patients with malignant pleural mesothelioma who underwent surgical treatment combined with neoadjuvant chemotherapy versus those who received chemotherapy alone. Methods: We analyzed a historical cohort of 122 patients diagnosed with mesothelioma, confirmed through histopathological examination. We compared the clinical and laboratory characteristics of the surgery and chemotherapy groups at baseline. We calculated Kaplan-Meier survival curves and used Cox's proportional hazards model to evaluate the relationship between surgery and mortality. Results: Surgery was performed in 16 out of 122 cases. Pleurectomy/decortication (PD) represented 8 cases, while extrapleural pneumonectomy (EPP) accounted for the remaining 8 cases. At five years, survival rates for those who underwent surgery compared to chemotherapy alone were 53% (95% CI 15-81%) versus 23% (95% CI 10-40%), respectively. Survival among those who had PD was 67%, compared to 40% for those who had EPP. Surgical treatment was associated with improved survival, with a hazard ratio (HR) of 0.34 (95% CI 0.19-0.61) after adjusting for factors such as age over 65, the duration from symptom onset to diagnosis, hemoglobin levels below 10 g, a neutrophil-to-lymphocyte ratio over 6, and ECOG scores greater than 2. Conclusions: Mesothelioma surgery, whether it be PD or EPP, enhances patients' survival compared to chemotherapy. PD produces better outcomes than EPP.

In plain English

This study reviewed the medical records of 122 patients with malignant pleural mesothelioma. Diagnoses were confirmed by tissue examination between January 2012 and May 2015 at the National Institute of Respiratory Diseases, Mexico City. The study compared treatments, not asbestos exposure, although 85 patients (69.7%) had recorded asbestos exposure. Sixteen had surgery with chemotherapy (8 pleurectomy/decortication, PD; 8 extrapleural pneumonectomy, EPP); the rest received chemotherapy or supportive care. Five-year survival was 53% (95% CI 15–81%) with surgery versus 23% (95% CI 10–40) with chemotherapy. It was 67% (95% CI 19–90%) after PD versus 40% (95% CI 1–83%) after EPP, each based on eight patients. After adjustment for age, diagnostic delay, anemia, neutrophil-to-lymphocyte ratio and functional status, surgery was associated with lower risk of death (hazard ratio 0.34, 95% CI 0.19–0.61). For EPP alone, the adjusted result was not statistically significant. The authors concluded that surgery, especially PD, was linked to a survival benefit in selected patients. They noted the single-center design and few surgical cases. They also noted that early-stage disease and good functional status among surgical candidates may have influenced the survival advantage.

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 cohort study: a secondary analysis of an existing dataset plus a review of clinical records, drawn from a biomarkers study in mesothelioma
• Who was studied: 122 patients with malignant pleural mesothelioma confirmed by histopathology between January 2012 and May 2015. They were treated at the National Institute of Respiratory Diseases in Mexico City, a referral center mainly serving low-income patients. 16 had surgery and 106 received chemotherapy or supportive care.
• Exposure: The study compared treatments. One group had surgery (8 pleurectomy/decortication, 8 extrapleural pneumonectomy), all with chemotherapy. The other group had chemotherapy or supportive care without surgery. Asbestos exposure at work and at home was recorded as a patient characteristic, and no fiber types are reported.
• Main results:
  • Any type of asbestos exposure was recorded in 85 of 122 patients (69.7%): 9 (56.3%) in the surgery group and 76 (71.7%) in the chemotherapy or supportive care group (p = 0.210)
  • An ECOG score of 2 or higher was recorded in 14 surgical patients (87.5%) and 93 patients in the chemotherapy or supportive care group (87.7%) (p = 0.979)
  • Five-year survival was 53% (95% CI 15–81%) in the surgery group versus 23% (95% CI 10–40) in the chemotherapy group
  • Five-year survival was 67% (95% CI 19–90%) after pleurectomy/decortication versus 40% (95% CI 1–83%) after extrapleural pneumonectomy, with 8 patients in each group
  • Median survival was 24.2 months in the surgery group versus 7.7 months in the non-surgery group
  • Median survival was 33 (16–49) months after PD versus 14 (10–37) months after EPP (p = 0.0031)
  • The model adjusted for age over 65, time from symptom onset to diagnosis, hemoglobin below 10 g/dL, a neutrophil-to-lymphocyte ratio of 6 or more, and an ECOG score of 2 or more. With these adjustments, surgery of either type was associated with lower mortality among all 122 patients: HR 0.34 (95% CI 0.19–0.61). Among the 62 patients in clinical stages I, II and III, the HR was 0.37 (95% CI 0.19–0.72).
  • By surgery type, the adjusted HR was 0.26 (95% CI 0.12–0.57, p = 0.001) for PD and 0.48 (95% CI 0.22–1.06, p = 0.070) for EPP. The EPP confidence interval included 1, so that result was not statistically significant.
  • Postoperative complications occurred in 5 of 8 patients (62.5%) in both the PD group and the EPP group
  • Radiotherapy appeared protective without adjustment (HR 0.35) but not in the adjusted model (HR 0.96, 95% CI 0.36–2.57). The authors considered the apparent benefit likely due to confounding and patient selection.
• The authors' conclusion: The authors concluded that surgical treatment, especially PD, was linked to a significant survival benefit in selected patients with malignant pleural mesothelioma.
• Limitations the authors state:
  • The retrospective, single-center design and the small number of surgical cases limit how widely the findings apply
  • No data were available on surgical margins or quality of life
  • The dataset did not distinguish standard PD from extended PD
  • The survival advantage may have been influenced by early-stage disease and good functional status among the patients chosen for surgery

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Clinical Trial, Neoadjuvant Therapy, Chemotherapy, Mesothelioma, Pleurectomy/Decortication (P/D), Extrapleural Pneumonectomy (EPP), Hazard Ratio.

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