Survival Effect of Complete Multimodal Therapy in Malignant Pleural Mesothelioma

Our plain-English summary of Survival Effect of Complete Multimodal Therapy in Malignant Pleural Mesothelioma, by M. Sayan, A. Bas, M.S. Turk, et al (Journal of Chest Surgery, 2022).

The study

• Authors: M. Sayan, A. Bas, M.S. Turk, D. Ozkan, A. Celik, İ.C. Kurul, A.I. Tastepe
• Journal: Journal of Chest Surgery
• Published: 2022;55(5):405-412
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive pleural malignancy, and despite all multimodal treatment modalities, the 5-year overall survival rate of patients with MPM is less than 20%. In the present study, we aimed to analyze the surgical and prognostic outcomes of patients with MPM who received multimodal treatment.

Methods: In this retrospective, single-center study, the records of patients who underwent surgery for MPM between January 2010 and December 2020 at our department were reviewed retrospectively.

Results: Sixty-four patients were included in the study, of whom 23 (35.9%) were women and 41 (64.1%) were men. Extrapleural pneumonectomy, pleurectomy/decortication, and extended pleurectomy/decortication procedures were performed in 34.4%, 45.3%, and 20.3% of patients, respectively. The median survival of patients was 21 months, and the 5-year survival rate was 20.2%. Advanced tumor stage (hazard ratio [HR], 1.8; p=0.04), right-sided extrapleural pneumonectomy (HR, 3.1; p=0.02), lymph node metastasis (HR, 1.8; p=0.04), and incomplete multimodal therapy (HR, 1.9; p=0.03) were poor prognostic factors. There was no significant survival difference according to surgical type or histopathological subtype.

Conclusion: Multimodal therapy can offer an acceptable survival rate in patients with MPM. Despite its poor reputation in the literature, the survival rate after extrapleural pneumonectomy, especially left-sided, was not as poor as might be expected.

In plain English

This retrospective study from Gazi University in Ankara, Turkey, reviewed the records of 64 patients (23 women, 41 men) who had surgery for malignant pleural mesothelioma between 2010 and 2020. The article did not report the patients' asbestos exposure. The operations were extrapleural pneumonectomy, pleurectomy/decortication, or extended pleurectomy/decortication, with or without chemotherapy beforehand. Median survival was 21 months (95% CI 11.3 to 30.6); estimated survival was 39.2% at 3 years and 20.2% at 5. One patient died within 30 days of surgery and 4 (6.25%) within 90 days. Shorter survival was statistically linked to more advanced tumor stage (hazard ratio 1.8, 95% CI 1.1 to 3.4), lymph node spread (1.8, 1.1 to 3.3), right-sided rather than left-sided extrapleural pneumonectomy (3.1, 1.1 to 9.6), and incomplete treatment in 10 patients (1.9, 1.1 to 4.2). Survival did not differ significantly by type of operation, chemotherapy before surgery, or tumor cell type. The authors concluded that multimodal therapy can offer an acceptable survival rate. They noted the study was retrospective, small, single-center, and covered a long period.

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 review of surgical patient records (survival analysis)
• Who was studied: 64 patients (23 women, 41 men; median age 58 years, range 32 to 76) who had surgery for malignant pleural mesothelioma at the Department of Thoracic Surgery, Gazi University, Ankara, Turkey, between January 2010 and December 2020
• Exposure: This is not an asbestos exposure study, and the patients' asbestos exposure was not reported. The 'exposure' was treatment: extrapleural pneumonectomy (22 patients; 10 right, 12 left), pleurectomy/decortication (29), or extended pleurectomy/decortication (13). Each was given with or without induction cisplatin-pemetrexed chemotherapy (32 patients), followed by adjuvant chemotherapy and/or radiotherapy (multimodal therapy).
• Main results:
  • For all 64 patients, median overall survival was 21 months (95% CI 11.3 to 30.6 months). Estimated (Kaplan-Meier) overall survival rates were 39.2% at 3 years and 20.2% at 5 years.
  • Early postoperative mortality (within 30 days) occurred in 1 patient, who had extended pleurectomy/decortication
  • 90-day mortality occurred in 4 patients (6.25%): 2 in the extended pleurectomy/decortication group, 1 in the extrapleural pneumonectomy group and 1 in the pleurectomy/decortication group
  • Among extrapleural pneumonectomy patients, right-sided surgery was associated with poorer survival than left-sided: median 10 vs 48 months; hazard ratio 3.1 (95% CI 1.1 to 9.6), p=0.02
  • Patients who did not complete multimodal therapy (10 of 64, 15.6%) had a median survival of 11 months, versus 24 months for those who completed it; hazard ratio 1.9 (95% CI 1.1 to 4.2), p=0.03
  • T category III tumors had a median survival of 15 months, versus 26 months for T I to II; hazard ratio 1.8 (95% CI 1.1 to 3.4), p=0.04
  • Lymph node metastasis (N1) was associated with a median survival of 16 months, versus 27 months for N0; hazard ratio 1.8 (95% CI 1.1 to 3.3), p=0.04
  • Survival did not differ significantly by type of surgery: median 16 months after extrapleural pneumonectomy, 24 after pleurectomy/decortication and 22 after extended pleurectomy/decortication (p=0.9)
  • Induction chemotherapy had no significant effect on survival: median 22 months with it and 18 months without (p=0.2)
  • Histopathological subtype showed no significant survival difference: median 26 months for epithelioid and 11 months for biphasic (p=0.5). Only 2 patients had the sarcomatoid type.
• The authors' conclusion: The authors concluded that multimodal therapy can offer an acceptable survival rate in patients with malignant pleural mesothelioma. They also concluded that survival after extrapleural pneumonectomy, especially left-sided, was not as poor as might be expected.
• Limitations the authors state:
  • The study was retrospective and included a small number of patients
  • It was a single-center study
  • Overall survival was used instead of disease-free survival
  • The study covered a long time span, and changes in treatment and perioperative care over that span could bias the outcomes
  • Because so few patients had each tumor subtype, the authors said it would not be realistic to claim that histopathological type does not affect survival
  • The authors could not explain the poorer survival after right-sided extrapleural pneumonectomy, because they could not fully demonstrate that the deaths were directly related to cancer

Topics

Medical terms in this study, explained in our Lexicon: Multimodal Therapy, Pleural Mesothelioma, Overall Survival, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Median Overall Survival, Hazard Ratio, Metastasis.

Related studies

• Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach — L.V. Klotz, H. Hoffmann, et al. (2022)
• Impact of Multimodal Surgical Resection and Personalized Targeted Therapy on Survival Outcomes in Early-Stage Malignant Pleural Mesothelioma: A Meta-Analysis — A.Q. Vega Morales, J.L. Rivera Gastelum, et al. (2025)
• Prolonged survival after multimodal therapy for pleural mesothelioma: Don't give up the follow-up. A case report — J. Guinde, B. Chollet, et al. (2020)
• Multimodal therapy of malignant pleural mesothelioma: is the replacement of radical surgery imminent? — J. Lindenmann, V. Matzi, et al. (2013)
• Case Report: A case of primary pericardial mesothelioma treated with multimodal combined therapy — J. Gong, X. Wu, et al. (2024)
• Biphasic pleural mesothelioma treated successfully with multimodal therapy: a case report — K. Omura, R. Fukai, et al. (2023)

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