Impact of Multimodal Surgical Resection and Personalized Targeted Therapy on Survival Outcomes in Early-Stage Malignant Pleural Mesothelioma: A Meta-Analysis

Our plain-English summary of Impact of Multimodal Surgical Resection and Personalized Targeted Therapy on Survival Outcomes in Early-Stage Malignant Pleural Mesothelioma: A Meta-Analysis, by A.Q. Vega Morales, J.L. Rivera Gastelum, A.J. Massé Ponce, et al (Curēus, 2025).

The study

• Authors: A.Q. Vega Morales, J.L. Rivera Gastelum, A.J. Massé Ponce, A.A.A. Dunay Silva, E. Banda Dávila, A.V. Rivera Aguirre, O.B. Villares Santillán, M.D. Naranjo Venegas
• Journal: Curēus
• Published: 2025;17(5):e84640
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive malignancy with limited evaluates the efficacy and safety of these treatments. A systematic review and meta-analysis were conducted, including 14 studies that compared multimodal therapies for early-stage MPM. Continuous variables were analyzed using random-effects modeling, with heterogeneity assessed using I² statistics. The primary outcomes included physical function, social function, and lethargy. The meta-analysis found no statistically significant differences between experimental and control groups in terms of physical function (standardized mean difference [SMD]: -0.34, 95% confidence interval [CI]: -1.14 to 0.45), social function (SMD: 0.01, 95% CI: -0.52 to 0.53), or lethargy (SMD: -0.34, 95% CI: -0.96 to 0.27). Heterogeneity across studies was moderate to high (I²: 47%-76%). These findings suggest limited improvements in quality-of-life domains with experimental approaches compared to controls. This systematic review and meta-analysis highlights the need for individualized, multimodal treatment strategies in MPM management. While extrapleural pneumonectomy and extended pleurectomy/decortication offer specific benefits, their impact on quality of life varies and may not consistently provide significant improvements. Future research should focus on large-scale, randomized trials with standardized protocols to optimize treatment outcomes.

Copyright © 2025, Vega Morales et al.

In plain English

This systematic review and meta-analysis pooled studies of multimodal treatment for early-stage malignant pleural mesothelioma. Eligible studies combined surgery (extrapleural pneumonectomy, EPP, or extended pleurectomy/decortication, P/D) with heated chest chemotherapy, chemotherapy before surgery or targeted therapy, but the table of included studies identified no study of targeted therapy. The authors included 14 studies, which they reported as covering 564 patients. Despite the title's mention of survival, the pooled analyses covered complications, lethargy, physical function and social function. None showed a statistically significant difference between the experimental and control groups. For grade 3 complications across five studies, the pooled odds ratio was 1.00 (95% confidence interval 0.69 to 1.47). For lethargy across four studies it was 1.39 (0.42 to 4.52). For physical function across three studies, the pooled standardized mean difference was -0.34 (-1.14 to 0.45). For social function across three studies it was 0.01 (-0.52 to 0.53). The authors concluded that EPP can relieve symptoms but carries significant risks, while lung-sparing extended P/D may better preserve lung function. They listed small samples, mostly observational designs and varying definitions among their limitations.

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: Systematic review and meta-analysis of published studies
• Who was studied: 14 published studies of patients with early-stage (stages I to III) malignant pleural mesothelioma, reported as 564 patients in total. The studies came from Canada, the UK, Switzerland, Italy, the USA, Germany, Japan and Turkey and were published 2007 to 2023.
• Exposure: Not an asbestos exposure study. The eligible interventions were multimodal treatments: surgery (extrapleural pneumonectomy or extended pleurectomy and decortication) combined with hyperthermic intrathoracic chemotherapy, neoadjuvant chemotherapy or targeted therapy. The table of included studies lists surgical and multimodal interventions and does not identify any study testing a targeted therapy.
• Main results:
  • Grade 3 complications (five studies): pooled odds ratio 1.00 (95% CI 0.69 to 1.47), with no significant difference between experimental and control groups. Heterogeneity I-squared was 45%.
  • Lethargy (four studies): pooled odds ratio 1.39 (95% CI 0.42 to 4.52), with no statistically significant difference. Heterogeneity was high (I-squared 88%).
  • Physical function (three studies): pooled standardized mean difference -0.34 (-1.14 to 0.45), a non-significant trend favoring the control group. Heterogeneity I-squared was 76%.
  • Social function (three studies): pooled standardized mean difference 0.01 (95% CI -0.52 to 0.53), with no statistically significant difference. Heterogeneity I-squared was 47%.
• The authors' conclusion: The authors concluded that EPP can alleviate symptoms and improve some aspects of quality of life but carries significant risks, including complications and declines in lung function. They concluded that lung-sparing extended P/D better preserves lung function and may give better quality-of-life outcomes, especially in patients with baseline symptoms.
• Limitations the authors state:
  • Moderate to high heterogeneity in patient populations, treatment protocols and outcome measures
  • Most included studies were observational or retrospective, so selection bias and confounding are possible
  • Small sample sizes in several studies reduced statistical power
  • Definitions of complications and quality-of-life measures differed between studies
  • Follow-up times varied, limiting assessment of long-term survival and quality of life
  • Publication bias cannot be excluded, and there are no large randomized trials

Topics

Medical terms in this study, explained in our Lexicon: Surgical Resection, Targeted Therapy, Pleural Mesothelioma, Meta-Analysis, Systematic Review, confidence interval, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D).

Related studies

• Survival by Histologic Subtype of Malignant Pleural Mesothelioma and the Impact of Surgical Resection on Overall Survival — V. Verma, C.A. Ahern, et al. (2018)
• Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach — L.V. Klotz, H. Hoffmann, et al. (2022)
• Impact of guideline therapy on survival of patients with stage I-III epithelioid mesothelioma — D.Z. Liou, Y. Wang, et al. (2023)
• Impact of induction therapy on postoperative outcome after extrapleural pneumonectomy for malignant pleural mesothelioma: does induction-accelerated hemithoracic radiation increase the surgical risk? — P. Mordant, K. McRae, et al. (2016)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• CRS/HIPEC with Major Organ Resection in Peritoneal Mesothelioma Does not Impact Major Complications or Overall Survival: A Retrospective Cohort Study of the US HIPEC Collaborative — D. Roife, B.D. Powers, et al. (2020)

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