Outcomes of the Multimodal Treatment of Malignant Pleural Mesiothelioma: The Role of Surgery

Our plain-English summary of Outcomes of the Multimodal Treatment of Malignant Pleural Mesiothelioma: The Role of Surgery, by B.S. Na, J.S. Kim, K. Hyun, et al (The Korean Journal of Thoracic and Cardiovascular Surgery, 2018).

The study

• Authors: B.S. Na, J.S. Kim, K. Hyun, I.K. Park, C.H. Kang, Y.T. Kim
• Journal: The Korean Journal of Thoracic and Cardiovascular Surgery
• Published: 2018;51(1):35-40
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The treatment of malignant pleural mesothelioma (MPM) is challenging, and multimodal treatment including surgery is recommended; however, the role of surgery is debated. The treatment outcomes of MPM in Korea have not been reported. We analyzed the outcomes of MPM in the context of multimodal treatment, including surgery.

Methods: The records of 29 patients with pathologically proven MPM from April 1998 to July 2015 were retrospectively reviewed. The treatment outcomes of the surgery and non-surgery groups were compared.

Results: The overall median survival time was 10.6 months, and the overall 3-year survival rate was 25%. No postoperative 30-day or in-hospital mortality occurred in the surgery group. Postoperative complications included tachyarrhythmia (n=4), pulmonary thromboembolism (n=1), pneumonia (n=1), chylothorax (n=1), and wound complications (n=3). The treatment outcomes between the surgery and non-surgery groups were not significantly different (3-year survival rate: 31.3% vs. 16.7%, respectively; p=0.47). In a subgroup analysis, there was no significant difference in the treatment outcomes between the extrapleural pneumonectomy group and the non-surgery group (3-year survival rate: 45.5% vs. 16.7%, respectively; p=0.23).

Conclusion: Multimodal treatment incorporating surgery did not show better outcomes than non-surgical treatment. A nationwide multicenter data registry and prospective randomized controlled studies are necessary to optimize the treatment of MPM.

In plain English

This was a retrospective review of the records of 29 patients with pathologically proven malignant pleural mesothelioma treated from April 1998 to July 2015 at Seoul National University Hospital in Korea. One patient was excluded, so 28 were analyzed. Sixteen had surgery with curative intent. In 11 of them this was extrapleural pneumonectomy, an operation that removes the lung together with the pleura, pericardium and diaphragm. Twelve inoperable patients received chemotherapy. The groups were not alike: half of the surgery patients had stage I or II disease, while 10 of 12 non-surgery patients had stage IV. Overall median survival was 10.6 months and 3-year survival was 25%. Three-year survival was 31.3% in the surgery group and 16.7% in the non-surgery group. This difference was not statistically significant (p=0.47). In the extrapleural pneumonectomy group, 3-year survival was 45.5%, also not statistically significant compared with the non-surgery group. No surgery patient died within 30 days or in hospital. The authors concluded that multimodal treatment incorporating surgery did not show better outcomes than non-surgical treatment. They named the small number of patients and the long study period as 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: Retrospective review of medical records at a single hospital, comparing surgery and non-surgery groups
• Who was studied: 29 patients with pathologically proven malignant pleural mesothelioma treated April 1998 to July 2015 at Seoul National University Hospital, Korea. One patient who refused treatment after exploratory thoracotomy was excluded, leaving 28 analyzed: 16 in the surgery group and 12 in the non-surgery group.
• Exposure: The study compared treatments: surgery (mainly extrapleural pneumonectomy, also pleurectomy/decortication and lobectomy) within multimodal treatment, versus definitive chemotherapy. Table 1 lists 'Asbestosis exposure' (as printed) in 7 of 28 patients (25%): 2 of 12 (16.7%) in the non-surgery group and 5 of 16 (31.3%) in the surgery group. No fiber types or exposure details are given.
• Main results:
  • All 28 patients: median survival time 10.6 months; 3-year survival rate 25%
  • 3-year survival was 31.3% in the surgery group versus 16.7% in the non-surgery group; the difference was not statistically significant (p=0.47)
  • Median survival time was 10.6 months in the surgery group and 8.4 months in the non-surgery group
  • Extrapleural pneumonectomy subgroup versus non-surgery group: median survival 13.3 versus 8.4 months; 3-year survival 45.5% versus 16.7%; p=0.23, not statistically significant
  • There was no postoperative 30-day or in-hospital mortality in the surgery group
  • Postoperative complications in the surgery group included tachyarrhythmia (n=4), pulmonary thromboembolism (n=1), pneumonia (n=1), chylothorax (n=1) and wound complications (n=3 in abstract, n=1 in results)
  • The groups differed in stage: half of the surgery group had clinical stage I or II disease, while the non-surgery group had stage III (n=2) or stage IV (n=10) disease
  • In the surgery group, 11 underwent extrapleural pneumonectomy, 1 underwent pleurectomy/decortication, and 4 who were preoperatively misdiagnosed with non-small cell lung cancer underwent lobectomy with chest wall resection
• The authors' conclusion: The authors concluded that multimodal treatment incorporating surgery did not show better outcomes than non-surgical treatment. They also called for a nationwide multicenter registry and randomized controlled studies.
• Limitations the authors state:
  • Small number of patients and long study period
  • Limited experience with pleurectomy/decortication
  • No prognostic difference was found between the old and new chemotherapy regimens, possibly because the sample was too small

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Median Overall Survival, Extrapleural Pneumonectomy (EPP).

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