Two thoracic surgeons from Glenfield Hospital in Leicester, England have come up with a list of factors they say can be used to predict long term survival in mesothelioma patients who undergo radical surgery.
Noting that the factors predicting poor outcomes from mesothelioma surgery have already been determined, Drs. Apostolos Nakas and David Waller say their goal was to determine the predictors of positive surgical outcomes. The two retrospectively reviewed the records of 252 patients diagnosed with malignant pleural mesothelioma, a virulent form of cancer caused by asbestos inhalation. The epithelioid variety of mesothelioma was identified in 193 of the tested patients. The rest had the rarer biphasic type.
There are two major types of radical surgery for pleural mesothelioma – one which involves removing a lung and the other which leaves both lungs intact. Both involve removal of the pleural lining around the lungs, all or part of the diaphragm, and other diseased tissue. In the current study, 140 patients underwent the lung-sparing surgery called extended pleurectomy with decortication (EPD) while 112 patients underwent lung-removing extrapleural pneumonectomy (EPP). One hundred and twenty-eight of the patients had received some amount of chemotherapy, either before or after surgery. To be included in the study, the patient had to have survived for at least 90 days after surgery.
Although there is great worldwide disagreement over the risks and value of the different types of mesothelioma surgery, the Leicester researchers found no survival difference between the two patient groups. The overall median survival was 18.2 months. Just over 30% of patients met the study’s definition of ‘long term’ survival, which was a minimum of 24 months.
By focusing on these longer-surviving patients, Nakas and Waller were able to make a list of surgery survival predictors. They found that mesothelioma patients were most likely to survive for at least 24 months if they were under age 60, had the epithelioid variety of mesothelioma, had some level of chemotherapy, and had no cancer in their lymph nodes.
Summarizing their results in the European Journal of Cardiothoracic Surgery, the authors concluded, “These results support a policy of accurate preoperative tissue diagnosis, nodal staging, and induction chemotherapy prior to radical surgery for malignant pleural mesothelioma, which can result in long-term survival. Trials investigating the role of surgery should be focused on confirming and refining these selection criteria.”
Nakas, A & Waller, D, “Predictors of long-term survival following radical surgery for malignant pleural mesothelioma”, January 30, 2014, European Journal of Cardiothoracic Surgery, Epub ahead of print.