Analysis Finds No Survival Advantage from Mesothelioma Surgery, According to Surviving Mesothelioma

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An Italian study of more than 1,300 patients finds those with good prognostic factors fair about the same, regardless of their treatment.

Our data suggest that patients with good prognostic factors had a similar survival...

A new article in the Journal of Thoracic Surgery says a certain subset of mesothelioma patients is unlikely to see much of a survival benefit from surgery. As Surviving Mesothelioma reports, researchers from six different Italian institutions analyzed survival data on 1,365 consecutive mesothelioma patients treated between 1982 and 2012.

In the study group, 172 mesothelioma patients received only chemotherapy, 690 had best supportive care to manage their symptoms, 202 underwent lung-sparing pleurectomy/decortication (P/D) surgery, and 301 had a lung removed during extrapleural pneumonectomy (EPP) surgery.

After a median follow-up of 6.7 years, 16.6% (230) of the mesothelioma patients were still living. Among all the mesothelioma patients studied, median survival for those who had only palliative treatment or chemotherapy was 11.7 months. Patients who underwent P/D had a median overall survival of 20.5 months and the EPP patients survived for a median of 18.8 months.

But when the data was adjusted to consider only those patients who had the best chances of survival anyway, the numbers tell a different story. Although mesothelioma is an aggressive and deadly cancer, certain patients have been found to have a survival edge. These are those who are younger than 70, have the epithelioid variety of mesothelioma, and have undergone chemotherapy. Among the 313 patients who fit this criteria (25.5% of patients in the study), median survival was 18.6 months after medical therapy alone, 24.5 months after P/D, and 20.9 months after EPP.

Summarizing their findings in the Journal of Thoracic Oncology, the authors conclude, “Our data suggest that patients with good prognostic factors had a similar survival whether they received medical therapy only, P/D, or EPP.” They recommend that the “modest benefit” seen from surgery in the mesothelioma patients with good prognostic factors be investigated further in a larger clinical trial.

Surgery for mesothelioma is a controversial topic. Studies on the advantages of one surgical approach over the other have produced mixed results. The new study is published in the March issue of the Journal of Thoracic Oncology. (Bovolato, P, et al, “Does surgery improve survival of patients with malignant pleural mesothelioma? A multicenter retrospective analysis of 1365 consecutive patients”, March 2014, Journal of Thoracic Oncology, pp. 390-396,

For nearly ten years, Surviving Mesothelioma has brought readers the most important and ground-breaking news on the causes, diagnosis and treatment of mesothelioma. All Surviving Mesothelioma news is gathered and reported directly from the peer-reviewed medical literature. Written for patients and their loved ones, Surviving Mesothelioma news helps families make more informed decisions.

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Michael Ellis
Cancer Monthy
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