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Statistical Model May Identify Patients Most Likely to Benefit From Mesothelioma Surgery

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Key Points

  • Previous research has shown an average 10-month survival for patients treated with extrapleural pneumonectomy alone.
  • In this study, 107 patients (22.9%) treated with extrapleural pneumonectomy survived at least 3 years after surgery.
  • Characteristics most strongly associated with long-term survival included younger age, no history of asbestos exposure, an epithelioid subtype of mesothelioma, and a low number of affected lymph nodes.

A new statistical model may help predict which patients are most likely to receive life-extending benefits from surgical treatment for malignant pleural mesothelioma, according to a report published by Leuzzi et al in The Annals of Thoracic Surgery.

Malignant pleural mesothelioma is an aggressive cancer that affects the lining of the pleura. The main cause of mesothelioma is believed to be repeated exposure to asbestos. About 3,000 cases of mesothelioma are diagnosed in the United States each year, with many more worldwide. There is frequently a lag time of 20 years or more between exposure to asbestos and the development of the disease. Currently, there is no cure for advanced-stage mesothelioma, and the 5-year survival rate is only about 10%.

“The therapy for malignant pleural mesothelioma is still somewhat controversial, and the optimal surgical approach is still a matter of debate,” said Giovanni Leuzzi, MD, a thoracic surgeon at the Regina Elena National Cancer Institute in Rome, Italy. “Our study found clinicosurgical factors that can indicate which patients would benefit the most from surgery, so that patients and their physicians can better decide the optimal course of therapy.”

Characteristics of More Successful Surgeries

Dr. Leuzzi and colleagues studied 468 patients with malignant pleural mesothelioma who had undergone extrapleural pneumonectomy, a surgical treatment that involves removal of a lung, the affected chest lining, the diaphragm, and the heart lining. Previous research has shown an average 10-month survival for patients treated with extrapleural pneumonectomy alone. In this study, 107 patients (22.9%) treated with extrapleural pneumonectomy survived at least 3 years after surgery. Characteristics most strongly associated with long-term survival included younger age, no history of asbestos exposure, an epithelioid subtype of mesothelioma, and a low number of affected lymph nodes.

“Based on these findings, we have built a scoring system by combining the above-mentioned factors. This easy-to-use model could help physicians in stratifying the treatment outcome and, eventually, tailoring postoperative treatment by identifying those patients who require close surveillance or more aggressive cancer therapy,” said Dr. Leuzzi. “Unfortunately, malignant pleural mesothelioma still has a poor prognosis, even after surgery.”

He added that further studies would be needed to validate the statistical scoring model to assess its utility in clinical practice.

Dr. Leuzzi is the corresponding author of The Annals of Thoracic Surgery article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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