Dr. Giovanni Leuzzi, MD, from Regina Elena National Cancer Institute in Rome, Italy has developed a new statistical model that may help predict which mesothelioma patients are most likely to benefit from surgery.
“The therapy for malignant pleural mesothelioma (MPM) is still somewhat controversial and the optimal surgical approach is still a matter of debate,” said Dr. Leuzzi. “Our study found clinic-surgical factors that can indicate which patients will benefit most from surgery so that patients and their physicians can better decide the optimal course of therapy.”
Participants in the study included 468 malignant pleural mesothelioma patients—all of whom had undergone extrapleural pneumonectomy, or EPP; a surgical treatment in which the affected areas of lung, chest lining, diaphragm, and heart lining are removed. It’s a serious operation typically performed only on those patients whose cancer is confined to the chest cavity and are deemed to be sufficiently healthy.
Due to the nature of mesothelioma and the fact that by the time a diagnosis is made, the disease has usually reached an advanced stage, a surgical cure isn’t a likely option. However, in some cases, surgery is recommended in order to remove as much of the cancer as possible. Treatment decisions are usually based on the stage of the disease, as well as overall health and age of the patient.
EPP can be used in addition to radiation and chemotherapy, but as Dr. Leuzzi mentioned, it’s controversial and often dangerous with hemorrhages, respiratory failure, pneumonia, empyema, blood clotting and death as risks.
The procedure is extremely technical and complications caused by air leaks can reduce quality of life and occur even after the surgery is complete. Plus, the recovery period can last up to a year and a half or longer.
All prior research resulted in a ten-month average survival for patients given EPP solely. A different surgery called pleurectomy/decortication (P/D) has actually shown lower death rates than EPP. But in Dr. Luezzi’s study, 107 EPP patients (22.9%) survived for three or more years post-surgery.
Younger age, no history of asbestos exposure, an epitheliod subtype of mesothelioma, and a low amount of lymph nodes affected were the most linked factors to a longer term of survival.
“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, MPM still has a poor prognosis, even after surgery.”
Future studies will be necessary to validate the statistical scoring model and assess its utilization in clinical practice.