Post-Recurrence Treatment Patterns and Outcomes After Curative-Intent Multimodality Strategy in Patients with Pleural Mesothelioma: A Retrospective Cohort Study

Our plain-English summary of Post-Recurrence Treatment Patterns and Outcomes After Curative-Intent Multimodality Strategy in Patients with Pleural Mesothelioma: A Retrospective Cohort Study, by O. Illini, H. Fabikan, I. Berghammer, et al (Journal of Clinical Medicine, 2026).

The study

• Authors: O. Illini, H. Fabikan, I. Berghammer, J. Krainer-Jacobs, A. Schneeweiss-Worel, L. Ay, D. Moser, C. Weinlinger, A. Lang-Stöberl, M.J. Hochmair, M. Benej, T. Krajc, T. Klikovits, A. Valipour, S. Watzka
• Journal: Journal of Clinical Medicine
• Published: 2026;15(20)
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Disease recurrence is common after surgery for pleural mesothelioma (PM), and the evidence guiding post-recurrence management remains limited. Methods: We conducted a retrospective, single-center cohort study including patients with PM treated within a curative-intent multimodality treatment pathway including surgery aiming for a macroscopic complete resection when feasible between 2001 and 2024. Post-recurrence treatments were categorized as best supportive care only (BSC), systemic therapy alone, or local with or without systemic therapy. Survival and disease-free outcomes were analyzed in relation to treatment patterns and clinical prognostic factors. Results: Among 67 patients with a median follow-up time of 107 months from surgery, 58 (86.6%) developed disease recurrence. At first recurrence, 21 patients (36%) received local with or without systemic therapy, 26 (45%) systemic therapy alone, and 11 (19%) BSC. The median post-recurrence survival was 21.7 months for patients receiving local with or without systemic therapy, 10.8 months for systemic therapy alone, and 1.6 months for BSC. Lung-sparing surgery and a disease-free interval of at least 12 months were associated with improved post-recurrence survival and post-recurrence progression-free survival. Conclusions: In this real-world cohort of patients with PM and extended follow-up, active post-recurrence treatment was associated with longer post-recurrence survival in selected patients. However, conclusions regarding their comparative effectiveness are limited by the retrospective design, incomplete recurrence-related data, and patient selection at recurrence.

In plain English

The authors reviewed records of patients with pleural mesothelioma treated at one referral center in Vienna, Austria, between 2001 and 2024. They included 67 patients whose treatment, aimed at cure, included surgery, mostly with chemotherapy and sometimes radiotherapy. Asbestos exposure was not studied. Over a median follow-up of 107 months after surgery, 58 of the 67 patients (86.6%) had a recurrence. At first recurrence, 21 received local treatment (surgery and/or radiotherapy) with or without drug therapy, 26 received drug therapy alone, and 11 received supportive care only. Their median survival after recurrence was 21.7 months (95% confidence interval 13.7 to 47.8), 10.8 months (6.6 to 20.9) and 1.6 months (0.9 to not estimable) respectively. Two factors were associated with longer survival after recurrence: lung-sparing surgery, compared with extrapleural pneumonectomy (which removes the whole lung), and a disease-free period of at least 12 months. The authors concluded that active treatment at recurrence was associated with longer survival in selected patients. They cautioned that group differences should not be read as evidence that one treatment works better, because treatment choice depended on each patient's condition.

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, single-center cohort study (review of medical records)
• Who was studied: Patients with pleural mesothelioma treated at a referral center in Vienna, Austria, from 2001 to 2024 (data cutoff February 2025). Of 172 patients, the study included the 67 who had surgery within a curative-intent multimodality treatment pathway. Their mean age was 62 years, 30% were female, and 89.6% had epithelioid histology.
• Exposure: The study did not examine asbestos exposure. It compared treatments. The initial surgery was either lung-sparing pleurectomy/decortication or extrapleural pneumonectomy, given with chemotherapy and/or radiotherapy. Treatment at recurrence was grouped as best supportive care only, local therapy (surgery and/or radiotherapy) with or without systemic therapy, or systemic therapy only.
• Main results:
  • Median follow-up from surgery was 107 months. By data cutoff, 58 of the 67 curative-intent surgical patients (86.6%) had developed recurrence.
  • Treatment at first recurrence among the 58 patients with recurrence:
• local therapy with or without systemic therapy: 21 (36%)
• systemic therapy alone: 26 (45%)
• best supportive care: 11 (19%)
  • Median post-recurrence survival by group:
• best supportive care: 1.6 months (95% CI 0.9 to not estimable)
• local therapy with or without systemic therapy: 21.7 months (95% CI 13.7 to 47.8)
• systemic therapy alone: 10.8 months (95% CI 6.6 to 20.9)
  • In multivariable analysis, local therapy with or without systemic therapy was associated with longer post-recurrence survival than best supportive care (HR 0.05, 95% CI 0.02 to 0.15, p less than 0.001). The comparison with systemic therapy alone was of borderline significance (HR 0.51, 95% CI 0.26 to 1.00, p = 0.051).
  • Lung-sparing surgery was associated with longer post-recurrence survival than extrapleural pneumonectomy (HR 0.28, 95% CI 0.12 to 0.68, p = 0.005).
  • Patients with a disease-free survival of 12 months or more had longer post-recurrence survival (HR 0.40, 95% CI 0.20 to 0.78, p = 0.007). They also had longer post-recurrence progression-free survival (HR 0.51, 95% CI 0.27 to 0.96, p = 0.038).
  • Median overall survival after surgery for the 67 patients was 19.8 months (95% CI 16.1 to 28.2).
  • Median overall survival was 25 months for patients who had lung-sparing surgery and 11 months for those who had extrapleural pneumonectomy (HR 0.36, 95% CI 0.17 to 0.74, p = 0.006).
  • Median disease-free survival for the 67 patients was 9.7 months (95% CI 7.4 to 14.0).
• The authors' conclusion: The authors concluded that active treatment after recurrence was associated with longer post-recurrence survival, particularly in patients with longer disease-free intervals. They stated that the survival differences between treatment groups should not be interpreted as evidence of comparative treatment efficacy.
• Limitations the authors state:
  • The study was retrospective. There was selection bias in who had surgery and in who received which treatment at recurrence. Practice also changed over the long study period.
  • Key factors that determined treatment choice were not recorded in a usable form, so the analysis could not adjust for treatment-selection bias.
  • Clinical (pre-surgery) stage was not systematically available, so only pathological stage was analyzed.
  • Where recurrences occurred in the body was not systematically recorded.
  • Patients without macroscopic complete resection were not excluded, so some 'recurrences' may be progression of disease that remained after surgery.
  • The link between lung-sparing surgery and survival may be confounded by calendar time and patient selection.
  • Too few patients received immunotherapy to assess its effect.
  • No correction was made for multiple statistical tests, so p-values are exploratory.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Cohort Study, Systemic Therapy, Progression-Free Survival.

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