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Bille A, Ripley RT, Giroux DJ, Gill RR, Kindler HL, Nowak AK, Opitz I, Pass HI, Wolf A, Rice D, Rusch VW. The International Association for the Study of Lung Cancer Mesothelioma Staging Project: Proposals for the "N" Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Pleural Mesothelioma. J Thorac Oncol 2024:S1556-0864(24)00208-9. [PMID: 38734073 DOI: 10.1016/j.jtho.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer developed an international database to inform potential revisions in the ninth edition of the TNM classification of diffuse pleural mesothelioma (PM). This study analyzed the clinical and pathologic N categories to determine whether revisions were indicated relative to the eighth edition staging system. METHODS Of 7338 PM cases diagnosed from 2013 to 2022 and 3598 met all inclusion criteria for planned analyses. Data on 2836 patients without metastases were included in this study. Overall survival (OS) was measured from date of diagnosis. Patients were included regardless of whether they received neoadjuvant treatment. For the pathologic N analysis, patients who underwent resection (extrapleural pneumonectomy or pleurectomy/decortication) were included. N subgroups were analyzed and OS assessed by the Kaplan-Meier method. RESULTS The existing eighth edition N categories were performed adequately in the ninth edition data set. A median OS advantage was noted for clinical and pathologic N0 versus N1 patients: 23.2 versus 18.5 and 33.8 versus 25.0 months, respectively. Patients with resected pN0 had a 3-year OS of 48%. No difference in OS was noted for single- versus multiple-station nodal metastases. The number of nodal stations sampled at the time of resection was not associated with a difference in OS. CONCLUSIONS Data regarding clinical and pathologic N categories corroborate those used in the eighth edition. No changes in the N categories are recommended in the ninth edition of PM staging system.
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Affiliation(s)
- Andrea Bille
- Thoracic Surgery Department, Guy's Hospital, London, United Kingdom.
| | - R Taylor Ripley
- Department of Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Anna K Nowak
- National Centre for Asbestos-Related Diseases, Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital, Zurich, Switzerland
| | - Harvey I Pass
- Department of Thoracic Surgery, NYU Langone Medical Center, New York, New York
| | - Andrea Wolf
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - David Rice
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Wolf AS, Eisele M, Giroux DJ, Gill R, Nowak AK, Bille A, Rice D, Ripley RT, Opitz I, Galateau-Salle F, Hasegawa S, Kindler HL, Pass HI, Rusch VW. The International Association for the Study of Lung Cancer Pleural Mesothelioma Staging Project: Expanded Database to Inform Revisions in the Ninth Edition of the TNM Classification of Pleural Mesothelioma. J Thorac Oncol 2024:S1556-0864(24)00059-5. [PMID: 38309456 DOI: 10.1016/j.jtho.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
The International Association for the Study of Lung Cancer collaborated with the International Mesothelioma Interest Group to propose the first TNM stage classification system for diffuse pleural mesothelioma in 1995, accepted by the Union for International Cancer Control and the American Joint Committee on Cancer for the sixth and seventh edition stage classification manuals. The International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee Mesothelioma Domain developed and analyzed an international registry of patients with pleural mesothelioma and updated TNM descriptors for the eighth edition of the stage classification system. To inform revisions for the forthcoming ninth edition of the TNM stage classification system, data submission was solicited for patients diagnosed between 2013 and 2022 with expanded data elements on the basis of the first project's exploratory analyses, including pleural thickness measurements, updated surgical nomenclature, and molecular markers. The resulting database consisted of a total of 3598 analyzable cases from Europe, Australia, Asia, North America, and South America, with a median age of 71 years (range: 18-99 y), 2775 (77.1%) of whom were men. With only 1310 patients (36.4%) undergoing curative-intent operations, this iteration of the database includes far more patients treated nonsurgically compared with prior. Four separate manuscripts on T, N, M, and stage groupings submitted to this journal will summarize analyses of these data and will serve collectively as the primary source of the proposed changes to the upcoming ninth edition of the pleural mesothelioma stage classification system.
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Affiliation(s)
- Andrea S Wolf
- Department of Thoracic Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Megan Eisele
- Cancer Research And Biostatistics, Seattle, Washington
| | | | - Ritu Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Anna K Nowak
- Medical School of the University of Western Australia, Crawley, Western Australia, Australia
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - David Rice
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Robert T Ripley
- Division of General Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Seiki Hasegawa
- Departments of Thoracic Surgery and Thoracic Oncology, Hyogo College of Medicine, Hyogo, Japan
| | - Hedy L Kindler
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, NYU-Langone Medical Center, New York, New York
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Hasegawa S, Shintani Y, Takuwa T, Aoe K, Kato K, Fujimoto N, Hida Y, Morise M, Moriya Y, Morohoshi T, Suzuki H, Chida M, Endo S, Kadokura M, Okumura M, Hattori S, Date H, Yoshino I. Nationwide prospective registry database of patients with newly diagnosed untreated pleural mesothelioma in Japan. Cancer Sci 2024; 115:507-528. [PMID: 38047872 PMCID: PMC10859622 DOI: 10.1111/cas.16021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Due to the scarcity of large-sized prospective databases, the Japanese Joint Committee for Lung Cancer Registry conducted a nationwide prospective registry for newly diagnosed and untreated pleural mesothelioma. All new cases diagnosed pathologically as any subtype of pleural mesothelioma in Japan during the period between April 1, 2017, to March 31, 2019, were included before treatment. Data on survival were collected in April 2021. The eligible 346 patients (285 men [82.3%]; 61 women [17.7%]; median age, 71.0 years [range, 44-88]) were included for analysis. Among these patients, 138 (39.9%) underwent surgery, 164 (47.4%) underwent non-surgical therapy, and the remaining 44 (12.7%) underwent best supportive care. The median overall survival for all 346 patients was 19.0 months. Survival rates at 1, 2, and 3 years for all patients were, 62.8%, 42.3%, and 26.5%, respectively. Median overall survival was significantly different among patients undergoing surgery, non-surgical treatment, and best supportive care (32.2 months vs. 14.0 months vs. 3.8 months, p < 0.001). The median overall survival of patients undergoing pleurectomy/decortication and extrapleural pneumonectomy was 41.8 months and 25.0 months, respectively. Macroscopic complete resection resulted in longer overall survival than R2 resection and partial pleurectomy/exploratory thoracotomy (41.8 months vs. 32.2 months vs. 16.8 months, p < 0.001). Tumor shape, maximum tumor thickness, and sum of three level thickness were significant prognostic factors. The data in the prospective database would serve as a valuable reference for clinical practice and further studies for pleural mesothelioma.
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Affiliation(s)
- Seiki Hasegawa
- Department of Thoracic SurgeryHyogo Medical UniversityHyogoJapan
| | - Yasushi Shintani
- Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Teruhisa Takuwa
- Department of Thoracic SurgeryHyogo Medical UniversityHyogoJapan
| | - Keisuke Aoe
- Department of Medical OncologyNational Hospital Organization Yamaguchi‐Ube Medical CenterYamaguchiJapan
| | - Katsuya Kato
- Department of Diagnostic Radiology 2Kawasaki Medical SchoolOkayamaJapan
| | | | - Yasuhiro Hida
- Department of Cardiovascular and Thoracic SurgeryHokkaido University Graduate School of MedicineHokkaidoJapan
| | - Masahiro Morise
- Department of Respiratory MedicineNagoya University Graduate School of MedicineAichiJapan
| | - Yasumitsu Moriya
- Division of General Thoracic SurgeryChiba Rosai HospitalChibaJapan
| | - Takao Morohoshi
- Division of General Thoracic SurgeryYokosuka‐Kyosai HospitalKanagawaJapan
| | - Hidemi Suzuki
- Department of General Thoracic SurgeryChiba University Graduate School of MedicineChibaJapan
| | - Masayuki Chida
- Department of General Thoracic SurgeryDokkyo Medical UniversityTochigiJapan
| | - Shunsuke Endo
- Department of Thoracic SurgeryJichi Medical UniversityShimotsukeJapan
| | - Mitsutaka Kadokura
- Division of Chest Surgery, Department of SurgeryShowa University School of MedicineTokyoJapan
| | - Meinoshin Okumura
- Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Satoshi Hattori
- Department of Biomedical StatisticsOsaka University Graduate School of MedicineOsakaJapan
| | - Hiroshi Date
- Department of Thoracic SurgeryKyoto University HospitalKyotoJapan
| | - Ichiro Yoshino
- Department of General Thoracic SurgeryChiba University Graduate School of MedicineChibaJapan
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Schulte JJ, Husain AN. Updates on grading mesothelioma. Histopathology 2024; 84:153-162. [PMID: 37872123 DOI: 10.1111/his.15065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/25/2023]
Abstract
Mesothelioma is a rare disease with an historically poor prognosis. Over the past decade, a grading system has been developed that is a powerful prognostic tool in epithelioid mesothelioma. Grading of epithelioid mesothelioma is now required or strongly recommended by expert consensus, the College of American Pathologists, the World Health Organization, and the International Mesothelioma Interest Group. The original nuclear grading system for epithelioid mesothelioma, developed in the United States, split epithelioid mesotheliomas into three prognostic groups with marked differences in survival. Now, this three-tiered nuclear grading system has been combined with the presence or absence of necrosis to form the currently recommended two-tiered grading system of low- and high-grade epithelioid mesothelioma. This review will focus on the development of this grading system in mesothelioma, the grading system's shortcomings, and the application of the grading system to cytology specimens and other extra-pleural sites. Lastly, this review will briefly discuss alternative grading systems and future considerations.
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Wolf AS, Rosenthal A, Giroux DJ, Nowak AK, Bille A, de Perrot M, Kindler HL, Rice D, Opitz I, Rusch VW, Pass HI. The International Association for the Study of Lung Cancer Pleural Mesothelioma Staging Project: Updated Modeling of Prognostic Factors in Pleural Mesothelioma. J Thorac Oncol 2023; 18:1689-1702. [PMID: 37567386 PMCID: PMC11168491 DOI: 10.1016/j.jtho.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer developed an international pleural mesothelioma database to improve staging. Data entered from 1995 to 2009 (training data set) were analyzed previously to evaluate supplemental prognostic factors. We evaluated these factors with new clinical data to determine whether the previous models could be improved. METHODS Patients entered into the database from 2009 to 2019 (validation cohort) were assessed for the association between previous prognosticators and overall survival using Cox proportional hazards regression with bidirectional stepwise selection. Additional variables were analyzed and models were compared using Harrell's C-index. RESULTS The training data set included 3101 patients and the validation cohort, 1733 patients. For the multivariable pathologic staging model applied to the training cohort, C-index was 0.68 (95% confidence interval [CI]: 0.656-0.705). For the validation data set (n = 497), C-index was 0.650 (95% CI: 0.614-0.685), and pathologic stage, histologic diagnosis, sex, adjuvant therapy, and platelet count were independently associated with survival. Adding anemia to the model increased the C-index to 0.652 (95% CI: 0.618-0.686). A basic presentation model including all parameters before staging yielded a C-index of 0.668 (95% CI: 0.641-0.695). In comparison, the European Organization for Research and Treatment of Cancer model yielded C-indices of 0.550 (95% CI: 0.511-0.589) and 0.577 (95% CI: 0.550-0.604) for pathologic staging and presentation models, respectively. CONCLUSIONS Although significant predictors differed slightly, the International Association for the Study of Lung Cancer training model performed well in the validation set and better than the model of the European Organization for Research and Treatment of Cancer. International collaboration is critical to improve outcomes in this rare disease.
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Affiliation(s)
- Andrea S Wolf
- Department of Thoracic Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | | | - Anna K Nowak
- Medical School of the University of Western Australia, Crawley, Western Australia, Australia
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, Ontario, Canada
| | - Hedy L Kindler
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - David Rice
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University (NYU) Langone Medical Center, New York, New York
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Medina CG, Xu Y, Ripley RT. International Prognostic Modeling: A Platform for Collaborative Approach for Patients With Mesothelioma. J Thorac Oncol 2023; 18:1618-1620. [PMID: 37993213 DOI: 10.1016/j.jtho.2023.09.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Cristian G Medina
- David J. Sugarbaker Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Yuan Xu
- David J. Sugarbaker Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - R Taylor Ripley
- David J. Sugarbaker Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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Martini K, Frauenfelder T. Old Borders and New Horizons in Multimodality Imaging of Malignant Pleural Mesothelioma. Thorac Cardiovasc Surg 2022; 70:677-683. [PMID: 34062600 DOI: 10.1055/s-0041-1728714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The purpose of this article is to describe the various imaging techniques involved in detection, staging, and preoperative planning in malignant pleural mesothelioma (MPM) focusing on new imaging modalities. METHODS For this purpose, first a brief summary of the etiology of MPM is given. Second, not only the commonly known, but also novel imaging modalities used in MPM will be discussed. RESULTS A wide range of imaging methods, from conventional chest radiography, through computed tomography and hybrid imaging to radiomics and artificial intelligence, can be used to evaluate MPM. CONCLUSION Nowadays multimodality imaging is considered the cornerstone in MPM diagnosis and staging.
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Affiliation(s)
- Katharina Martini
- University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich, ZH, Switzerland.,University of Zurich, Faculty of Medicine Zurich, ZH, Switzerland
| | - Thomas Frauenfelder
- University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich, ZH, Switzerland.,University of Zurich, Faculty of Medicine Zurich, ZH, Switzerland
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Lopci E, Castello A, Mansi L. FDG PET/CT for Staging and Restaging Malignant Mesothelioma. Semin Nucl Med 2022; 52:806-815. [PMID: 35965111 DOI: 10.1053/j.semnuclmed.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/11/2022]
Abstract
Malignant mesothelioma is an aggressive tumor originating from the mesothelial cells and presenting in general with a very poor prognosis. The pleural localization represents the prevailing disease site, while peritoneal involvement is commonly rare. The WHO classifies mesotheliomas into epithelioid, biphasic, and sarcomatoid histotypes, having diverse outcome with the sarcomatoid or biphasic forms showing the poorest prognosis. Given the peculiar rind-like pattern of growth, mesothelioma assessment is rather challenging for medical imagers. Conventional imaging is principally based on contrast-enhanced CT, while the role of functional and metabolic imaging is regarded as complementary. By focusing essentially on the staging and restaging role of [18F]FDG PET/CT in malignant mesotheliomas, the present review will summarize the available data present in literature and provide some hints on alternative imaging and future perspectives. Given the prevailing incidence of pleural disease, the majority of the information will be addressed on malignant pleural mesothelioma, although a summary of principal characteristics and imaging findings in patients with peritoneal mesothelioma will be also provided.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine Unit, IRCCS - Humanitas Research Hospital, Milan, Italy.
| | - Angelo Castello
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Luigi Mansi
- Interuniversity Research Center for the Sustainable Development (CIRPS), Rome, Italy
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Vivoda Tomšič M, Korošec P, Kovač V, Bisdas S, Šurlan Popovič K. Dynamic contrast-enhanced MRI in malignant pleural mesothelioma: prediction of outcome based on DCE-MRI measurements in patients undergoing cytotoxic chemotherapy. BMC Cancer 2022; 22:191. [PMID: 35184730 PMCID: PMC8859879 DOI: 10.1186/s12885-022-09277-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 02/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background The malignant pleural mesothelioma (MPM) response rate to chemotherapy is low. The identification of imaging biomarkers that could help guide the most effective therapy approach for individual patients is highly desirable. Our aim was to investigate the dynamic contrast-enhanced (DCE) MR parameters as predictors for progression-free (PFS) and overall survival (OS) in patients with MPM treated with cisplatin-based chemotherapy. Methods Thirty-two consecutive patients with MPM were enrolled in this prospective study. Pretreatment and intratreatment DCE-MRI were scheduled in each patient. The DCE parameters were analyzed using the extended Tofts (ET) and the adiabatic approximation tissue homogeneity (AATH) model. Comparison analysis, logistic regression and ROC analysis were used to identify the predictors for the patient’s outcome. Results Patients with higher pretreatment ET and AATH-calculated Ktrans and ve values had longer OS (P≤.006). Patients with a more prominent reduction in ET-calculated Ktrans and kep values during the early phase of chemotherapy had longer PFS (P =.008). No parameter was identified to predict PFS. Pre-treatment ET-calculated Ktrans was found to be an independent predictive marker for longer OS (P=.02) demonstrating the most favourable discrimination performance compared to other DCE parameters with an estimated sensitivity of 89% and specificity of 78% (AUC 0.9, 95% CI 0.74-0.98, cut off > 0.08 min-1). Conclusions In the present study, higher pre-treatment ET-calculated Ktrans values were associated with longer OS. The results suggest that DCE-MRI might provide additional information for identifying MPM patients that may respond to chemotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09277-x.
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Kanayama M, Mori M, Matsumiya H, Taira A, Shinohara S, Takenaka M, Kuroda K, Tanaka F. Surgical strategy for malignant pleural mesothelioma: the superiority of pleurectomy/decortication. Surg Today 2022; 52:1031-1038. [DOI: 10.1007/s00595-021-02437-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
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Ricciardi S, Carleo F, Jaus MO, Di Martino M, Carbone L, Ricci A, Cardillo G. Malignant Pleural Mesothelioma Nodal Status: Where Are We at? J Clin Med 2021; 10:jcm10215177. [PMID: 34768701 PMCID: PMC8584902 DOI: 10.3390/jcm10215177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Due to the lack of both prospective trial and high-volume retrospective studies, the management of clinical N+ malignant pleural mesothelioma (MPM) patients remains highly debated. Node positive patients show poor survival compared with node-negative ones; thus, lymph node staging appears crucial in determining treatment strategy. Notwithstanding the improvement in pre-treatment staging and the update on lymph node classification in the 8th edition of TNM, several open controversies remain on N parameter. How should we stage suspected N+ patients? How should we treat node positive patients? Which is the definition of a “resectable patient”? Is the site or the number the main prognostic factor for node positive patients? The aim of our narrative review is to analyse the existing relevant literature on lymph node status in MPM.
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Affiliation(s)
- Sara Ricciardi
- Unity of Thoracic Surgery, Hospital of Bologna, IRCCS University, 40138 Bologna, Italy
- Alma Mater, Studiorum University of Bologna, 40138 Bologna, Italy
- Correspondence:
| | - Francesco Carleo
- Unity of Thoracic Surgery, San Camillo Forlanini Hospital, 00152 Rome, Italy; (F.C.); (M.O.J.); (M.D.M.); (L.C.); (G.C.)
| | - Massimo O. Jaus
- Unity of Thoracic Surgery, San Camillo Forlanini Hospital, 00152 Rome, Italy; (F.C.); (M.O.J.); (M.D.M.); (L.C.); (G.C.)
| | - Marco Di Martino
- Unity of Thoracic Surgery, San Camillo Forlanini Hospital, 00152 Rome, Italy; (F.C.); (M.O.J.); (M.D.M.); (L.C.); (G.C.)
| | - Luigi Carbone
- Unity of Thoracic Surgery, San Camillo Forlanini Hospital, 00152 Rome, Italy; (F.C.); (M.O.J.); (M.D.M.); (L.C.); (G.C.)
| | - Alberto Ricci
- Respiratory Unit, Sant’Andrea Hospital, 00189 Rome, Italy;
- Medicina Clinica e Molecolare, University of Rome La Sapienza, 00185 Rome, Italy
| | - Giuseppe Cardillo
- Unity of Thoracic Surgery, San Camillo Forlanini Hospital, 00152 Rome, Italy; (F.C.); (M.O.J.); (M.D.M.); (L.C.); (G.C.)
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Luerken L, Thurn PL, Zeman F, Stroszczynski C, Hamer OW. Conspicuity of malignant pleural mesothelioma in contrast enhanced MDCT - arterial phase or late phase? BMC Cancer 2021; 21:1144. [PMID: 34702213 PMCID: PMC8549213 DOI: 10.1186/s12885-021-08842-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To determine if late phase is superior to arterial phase intraindividually regarding conspicuity of MPM in contrast enhanced chest MDCT. METHODS 28 patients with MPM were included in this retrospective study. For all patients, chest CT in standard arterial phase (scan delay ca. 35 s) and abdominal CT in portal venous phase (scan delay ca. 70 s) was performed. First, subjective analysis of tumor conspicuity was done independently by two radiologists. Second, objective analysis was done by measuring Hounsfield units (HU) in tumor lesions and in the surrounding tissue in identical locations in both phases. Differences of absolute HUs in tumor lesions between phases and differences of contrast (HU in lesion - HU in surrounding tissue) between phases were determined. HU measurements were compared using paired t-test for related samples. Potential confounding effects by different technical and epidemiological parameters between phases were evaluated performing a multiple regression analysis. RESULTS Subjective analysis: In all 28 patients and for both readers conspicuity of MPM was better on late phase compared to arterial phase. Objective analysis: MPM showed a significantly higher absolute HU in late phase (75.4 vs 56.7 HU, p < 0.001). Contrast to surrounding tissue was also significantly higher in late phase (difference of contrast between phases 18.5 HU, SD 10.6 HU, p < 0.001). Multiple regression analysis revealed contrast phase and tube voltage to be the only significant independent predictors for tumor contrast. CONCLUSIONS In contrast enhanced chest-MDCT for MPM late phase scanning seems to provide better conspicuity and higher contrast to surrounding tissue compared to standard arterial phase scans.
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Affiliation(s)
- Lukas Luerken
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Philipp Laurin Thurn
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Okka Wilkea Hamer
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Brims F. Epidemiology and Clinical Aspects of Malignant Pleural Mesothelioma. Cancers (Basel) 2021; 13:cancers13164194. [PMID: 34439349 PMCID: PMC8391310 DOI: 10.3390/cancers13164194] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
Mesothelioma is a cancer predominantly of the pleural cavity. There is a clear association of exposure to asbestos with a dose dependent risk of mesothelioma. The incidence of mesothelioma in different countries reflect the historical patterns of commercial asbestos utilisation in the last century and predominant occupational exposures mean that mesothelioma is mostly seen in males. Modern imaging techniques and advances in immunohistochemical staining have contributed to an improved diagnosis of mesothelioma. There have also been recent advances in immune checkpoint inhibition, however, mesothelioma remains very challenging to manage, especially considering its limited response to conventional systemic anticancer therapy and that no cure exists. Palliative interventions and support remain paramount with a median survival of 9-12 months after diagnosis. The epidemiology and diagnosis of mesothelioma has been debated over previous decades, due to a number of factors, such as the long latent period following asbestos exposure and disease occurrence, the different potencies of the various forms of asbestos used commercially, the occurrence of mesothelioma in the peritoneal cavity and its heterogeneous pathological and cytological appearances. This review will describe the contemporary knowledge on the epidemiology of mesothelioma and provide an overview of the best clinical practice including diagnostic approaches and management.
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Affiliation(s)
- Fraser Brims
- Curtin Medical School, Curtin University, Perth, WA 6845, Australia;
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
- National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA 6009, Australia
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14
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Hasegawa S, Yokoi K, Okada M, Tanaka F, Shimokawa M, Daimon T, Nakano T. Neoadjuvant pemetrexed plus cisplatin followed by pleurectomy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2021; 163:1940-1947.e5. [PMID: 34419248 DOI: 10.1016/j.jtcvs.2021.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/12/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Despite becoming the preferred surgical technique for malignant pleural mesothelioma, pleurectomy/decortication has received few prospective clinical trials. Therefore, the Japan Mesothelioma Interest Group conducted a prospective multi-institutional study to evaluate the feasibility of neoadjuvant chemotherapy followed by pleurectomy/decortication. METHODS Patients with histologically confirmed, resectable malignant pleural mesothelioma underwent neoadjuvant chemotherapy comprising pemetrexed 500 mg/m2 plus cisplatin 75 mg/m2 for 3 cycles, followed by pleurectomy/decortication. The primary end point was macroscopic complete resection rate regardless of the surgical technique used. RESULTS Among the 24 patients enrolled, 20 received neoadjuvant chemotherapy and 18 proceeded to surgery, all of whom achieved macroscopic complete resection. Pleurectomy/decortication was performed in 15 patients. The trial satisfied the primary end point, with a macroscopic complete resection rate of 90% (18/20, 95% confidence interval, 68.3-98.8). No treatment-related 30- and 90-day mortality occurred. The overall survival after 1 and 2 years and median overall survival after registration were 95.0% (95% confidence interval, 69.5-99.3), 70.0% (95% confidence interval, 45.1-85.3), and 3.45 years (95% confidence interval, 1.64 to not available), respectively. The cumulative incidence of progression after 1 and 2 years and median time to progression were 33.3% (95% confidence interval, 17.3-64.1), 61.1% (95% confidence interval, 42.3-88.3), and 1.71 years (95% confidence interval, 1.00-2.99), respectively. The best postoperative value for forced expiratory volume was 78.0% of preoperative values. CONCLUSIONS Neoadjuvant chemotherapy followed by pleurectomy/decortication was feasible with acceptable survival and mortality/morbidity. Postoperative pulmonary function was approximately 80% of the preoperative pulmonary function.
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Affiliation(s)
- Seiki Hasegawa
- Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube-shi, Yamaguchi, Japan
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Japan
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15
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Aprile V, Bacchin D, Korasidis S, Ricciardi R, Petrini I, Ambrogi MC, Lucchi M. Hypertermic Intrathoracic Chemotherapy (HITHOC) for thymoma: a narrative review on indications and results. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:957. [PMID: 34350272 PMCID: PMC8263885 DOI: 10.21037/atm-20-6704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/27/2021] [Indexed: 11/06/2022]
Abstract
Objective With this narrative review, we retraced the history of hypertermic intrathoracic chemotherapy (HITHOC) since the beginning, analyzing literature on operative technique, feasibility and efficacy of this treatment. Moreover, we report the fifteen-year experience of our center in this relatively new technique, for what concerns both early postoperative results and long-term oncological outcomes. Background Thymomas are frequently misdiagnosed and recognized in advanced stage, often with pleural dissemination, especially when not associated to Myasthenia Gravis that allows an early diagnosis during the initial assessment. Moreover, the natural history of locally advanced thymoma is characterized by a high rate of pleural or pericardial relapses. Surgery has always been considered a milestone in thymoma’s treatment, even in case of serous dissemination or relapses, although his role as exclusive therapy does not guarantee an acceptable local disease control. In case of disseminated disease, different multidisciplinary protocols have been experimented, from chemotherapy to radiation therapy, alone or associated to surgery, in order to increase overall and disease-free survival, but the breakthrough happened in the early 90s with the introduction of HITHOC following surgery. Combination of surgery and HITHOC resulted in less toxic than systemic chemotherapy and providing a good local disease control in patients with stage IVa thymomas or thymoma’s pleural recurrences. Methods We searched PubMed for relevant literature, up to January 2020, on hypertermic intrapleural chemotherapy for thymomas (TPR or DNT), selecting only those reporting information about HITHOC protocol used, postoperative course and oncological outcomes. Conclusions HITHOC is a safe and feasible procedure, with a very low complication rate and negligible systemic effects of chemotherapeutic agents, effective in controlling both TPR and DNT, in particular as regards local disease-free survival. Keywords Hypertermic intrathoracic chemotherapy (HITHOC); thymoma; intracavitary chemotherapy; hyperthermia; redo-surgery
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Affiliation(s)
- Vittorio Aprile
- Thoracic Surgery, Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Diana Bacchin
- Thoracic Surgery, Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Stylianos Korasidis
- Thoracic Surgery, Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Roberta Ricciardi
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Iacopo Petrini
- Unit of Respiratory Medicine, Department of Critical Area and Surgical, Medical and Molecular Pathology, University Hospital of Pisa, Pisa, Italy
| | - Marcello Carlo Ambrogi
- Thoracic Surgery, Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Thoracic Surgery, Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy
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16
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Brcic L, Klikovits T, Megyesfalvi Z, Mosleh B, Sinn K, Hritcu R, Laszlo V, Cufer T, Rozman A, Kern I, Mohorcic K, Jakopovic M, Samarzija M, Seiwerth S, Kolek V, Fischer O, Jakubec P, Škarda J, Gieszer B, Hegedus B, Fillinger J, Renyi-Vamos F, Buder A, Bilecz A, Berger W, Grusch M, Hoetzenecker K, Klepetko W, Hoda MA, Filipits M, Dome B. Prognostic impact of PD-1 and PD-L1 expression in malignant pleural mesothelioma: an international multicenter study. Transl Lung Cancer Res 2021; 10:1594-1607. [PMID: 34012777 PMCID: PMC8107750 DOI: 10.21037/tlcr-20-1114] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/28/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Programmed cell death 1/programmed death ligand 1 (PD-1/PD-L1) immune-checkpoint blockade is a promising new therapeutic strategy in cancer. However, expression patterns and prognostic significance of PD-L1 and PD-1 are still controversial in human malignant pleural mesothelioma (MPM). METHODS Formalin-fixed paraffin-embedded (FFPE) tumor samples from 203 MPM patients receiving standard treatment without immunotherapy were collected from 5 European centers. PD-L1 and PD-1 expression of tumor cells (TCs) and tumor-infiltrating lymphocytes (TILs) were measured by immunohistochemistry and correlated with clinical parameters and long-term outcome. RESULTS High (>10%) PD-L1 TC and PD-1 TILs expressions were found in 18 (8%) and 39 (24%) patients, respectively. PD-L1 was rarely expressed by TILs [≥1%, n=13 (8%); >10%, n=1]. No significant associations were found between the PD-L1 or PD-1 expression of TCs or TILs and clinicopathological parameters such as stage or histological subtype. Notably, patients with high (>10%) TC-specific PD-L1 expression exhibited significantly worse median overall survival (OS) (6.3 vs. 15.1 months of those with low TC PD-L1 expression; HR: 2.51, P<0.001). In multivariate cox regression analysis adjusted for clinical parameters, high TC PD-L1 expression (>10%) proved to be an independent negative prognostic factor for OS (HR: 2.486, P=0.005). There was no significant correlation between PD-L1 or PD-1 expression of TILs and OS. CONCLUSIONS In this multicenter cohort study, we demonstrate that high (>10%) PD-L1 expression of TCs independently predicts worse OS in MPM. Further studies are warranted to investigate the value of PD-L1/PD-1 expression as a marker for treatment response in MPM patients receiving immunotherapy.
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Affiliation(s)
- Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Thomas Klikovits
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Zsolt Megyesfalvi
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Berta Mosleh
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Katharina Sinn
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Richard Hritcu
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Viktoria Laszlo
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Tanja Cufer
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Ales Rozman
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Izidor Kern
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Katja Mohorcic
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Marko Jakopovic
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miroslav Samarzija
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sven Seiwerth
- Department of Pathology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vitezslav Kolek
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ondřej Fischer
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Jakubec
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jozef Škarda
- Institute of Clinical and Molecular Pathology, Medical Faculty, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Pathology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - Balazs Gieszer
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
| | - Balazs Hegedus
- Department of Thoracic Surgery, University Duisburg-Essen, Ruhrlandklinik, Essen, Germany
| | - Janos Fillinger
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Ferenc Renyi-Vamos
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Anna Buder
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Agnes Bilecz
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Walter Berger
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Grusch
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Balazs Dome
- Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Budapest, Hungary
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Berger I, Simpson S, Friedberg JS, Culligan MJ, Wileyto EP, Alley EW, Sterman D, Patel AM, Khalid U, Simone CB, Cengel KA, Katz SI, Roshkovan L. CT for detection of malignant posterior intercostal lymph nodes in patients undergoing pre-operative staging for malignant pleural mesothelioma. Lung Cancer 2020; 152:34-38. [PMID: 33341086 DOI: 10.1016/j.lungcan.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/06/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Recent evidence suggests that patients with malignant pleural mesothelioma (MPM) undergoing extended pleurectomy/decortication (eP/D) with metastasis to the posterior intercostal lymph nodes (PILN) have a worse prognosis. In this study, we determine if MPM PILN metastasis can be reliably detected on computed tomography (CT). MATERIALS AND METHODS Preoperative staging CT exams were reviewed for the presence of PILN in MPM patients undergoing eP/D between 2007-2013 with surgical sampling of their PILN. CT images were reviewed by two thoracic radiologists blinded to clinical records, including operative pathology reports. The number and short axis size of PILN were recorded and correlated with surgical pathology. Statistical analysis examined the value of preoperative CT to detect metastatic PILN. RESULTS Of 36 patients that underwent eP/D with PILN sampling had preoperative CT images for review. At surgery, 22 of these patients had metastatic PILN and 14 had benign PILN. The positive and negative predictive values for one or more nodes seen on preoperative CT were 60 % and 38 % respectively. The number of PILN on preoperative CT did not predict metastasis (p = 0.40) with an average of 2 PILN seen, regardless of PILN pathology. The average nodal short axis size was 4.6 mm and 4.8 mm for benign and malignant PILN, respectively, and PILN short axis size did not predict metastasis (p = 0.39). There was little inter-observer variability between the size and number of nodes detected by each radiologist. CONCLUSIONS CT does not reliably identify metastatic PILN on preoperative CT for patients with MPM undergoing extended pleurectomy/decortication.
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Affiliation(s)
- I Berger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Scott Simpson
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J S Friedberg
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - E Paul Wileyto
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Evan W Alley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - D Sterman
- NYU School of Medicine, New York, NY, USA
| | - Akash M Patel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - U Khalid
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C B Simone
- New York Proton Center and Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Keith A Cengel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sharyn I Katz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - L Roshkovan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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18
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Brown LB, Corl F, Blackmon SH. Surgical staging and resection of malignant pleural mesothelioma. J Thorac Dis 2020; 12:7467-7480. [PMID: 33447434 PMCID: PMC7797813 DOI: 10.21037/jtd-19-2267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lawrence B Brown
- Johns Hopkins Medicine, Department of Surgery, Baltimore, MD, USA
| | - Frank Corl
- Mayo Clinic, Department of Media Services, Medical Illustration, Rochester, MN, USA
| | - Shanda H Blackmon
- Mayo Clinic, Division of General Thoracic Surgery, Department of Surgery, Rochester, MN, USA
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19
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Guinde J, Chollet B, Laroumagne S, Dutau H, Astoul P. Prolonged survival after multimodal therapy for pleural mesothelioma: Don't give up the follow-up. A case report. Ann Med Surg (Lond) 2020; 60:442-444. [PMID: 33251003 PMCID: PMC7683176 DOI: 10.1016/j.amsu.2020.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 11/01/2022] Open
Abstract
Malignant Pleural mesothelioma (MPM) is a rare disease which is associated with a poor prognosis. Front line chemotherapy represents the cornerstone in the management of MPM, and the place of radical surgery is controversial and reserve in early-stage disease. However prolonged survival (more than 24 months) can be observed in rare cases and only in the context of multimodal treatment including surgical management. We report the case of a patient suffering from an epithelial MPM with a 14-years progression-free survival after trimodal treatment including extrapleural pneumonectomy followed by chemotherapy and radiotherapy. This case illustrates that despite being an aggressive disease, multimodal management including radical surgery may allow a prolonged response in MPM but requires a whole-life surveillance.
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Affiliation(s)
- Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Bertrand Chollet
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France.,Aix-Marseille University, Marseille, France
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20
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Koda Y, Kuribayashi K, Doi H, Kitajima K, Nakajima Y, Ishigaki H, Nakamura A, Minami T, Takahashi R, Yokoi T, Kijima T. Irinotecan and Gemcitabine as Second-Line Treatment in Patients with Malignant Pleural Mesothelioma following Platinum plus Pemetrexed Chemotherapy: A Retrospective Study. Oncology 2020; 99:161-168. [PMID: 33053560 DOI: 10.1159/000510691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cisplatin-pemetrexed combination chemotherapy is the current standard primary treatment for malignant pleural mesothelioma (MPM). It was first approved for untreated and unresectable MPM in the 2003 National Comprehensive Cancer Network (NCCN) guidelines. However, to date, standard treatments for patients with MPM who previously underwent chemotherapy, as recommended by the NCCN Malignant Pleural Mesothelioma guidelines, have been inadequate. To explore treatment options for such patients, we performed this retrospective study of patients who received irinotecan plus gemcitabine as second-line therapy for MPM. METHODS We investigated 62 patients diagnosed with unresectable MPM between January 2008 and October 2017 who experienced recurrence following cisplatin treatment (or carboplatin) plus pemetrexed or pemetrexed monotherapy as first-line treatment, and who underwent irinotecan plus gemcitabine combination therapy as second-line treatment. Irinotecan (60 mg/m2) and gemcitabine (800 mg/m2) were administered on days 1 and 8 every 3 weeks, including a 1-week washout period. Our endpoints were efficacy, survival period, and toxicity. RESULTS patients' median age was 65 years (range 50-79), and the histological MPM types were epithelioid (n = 48), sarcomatoid (n = 6), biphasic (n = 6), and desmoplastic (n = 2). One patient experienced a partial response, 40 had stable disease, and 21 had progressive disease. The disease control rate was 66.1% and the response rate 2.1%. Additionally, the median progression-free and overall survival time were 5.7 and 11.3 months, respectively. The most common adverse events were neutropenia (32.2%), loss of appetite (16.1%), nausea/diarrhea (11.3%), and thrombocytopenia/phlebitis (9.7%). Grade 3 adverse events included neutropenia (12.9%) and thrombocytopenia/phlebitis (2.1%); however, all adverse events were managed with symptomatic therapy. CONCLUSIONS Despite the fact that second-line irinotecan plus gemcitabine combination therapy did not produce marked tumor shrinkage, it achieved a relatively high disease control rate of >65% with an acceptable toxicity profile. Hence, the combination of irinotecan plus gemcitabine may be considered for MPM treatment, with consideration of combination with immune checkpoint inhibitors as a potential next step.
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Affiliation(s)
- Yuichi Koda
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kozo Kuribayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan, .,Department of Thoracic Oncology, Hyogo College of Medicine, Nishinomiya, Japan,
| | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yasuhiro Nakajima
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirotoshi Ishigaki
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Akifumi Nakamura
- Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiyuki Minami
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryo Takahashi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Yokoi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Thoracic Oncology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Kijima
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Thoracic Oncology, Hyogo College of Medicine, Nishinomiya, Japan
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21
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Matsumura E, Kajino K, Abe M, Ohtsuji N, Saeki H, Hlaing MT, Hino O. Expression status of PD-L1 and B7-H3 in mesothelioma. Pathol Int 2020; 70:999-1008. [PMID: 33027549 DOI: 10.1111/pin.13028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022]
Abstract
Mesothelioma is a rare, aggressive malignancy with poor outcome, and has limited treatment options. The aim of this study was to perform a comprehensive analysis of programmed death ligand 1 (PD-L1) and B7 homolog 3 (B7-H3) expression in mesothelioma. We investigated the protein expression of PD-L1 and B7-H3 and their potential correlation with histological subtype, which might help to develop new therapies targeting these immune checkpoint molecules. Expression analysis of PD-L1 and B7-H3 was performed by immunohistochemistry using serial tissue sections of specimens obtained from 31 patients with mesothelioma. Tumors were classified into 22 epithelioid, 6 sarcomatoid, and 3 biphasic types. Of the 31 patients, 13 (41.9%) were positive for PD-L1 and 28 (90.3%) were B7-H3 positive. Twelve of the 13 PD-L1 positive patients were positive for B7-H3. PD-L1 and B7-H3 were widely co-expressed in biphasic and sarcomatoid type tumor cells. These findings might provide a rationale for the use of combination therapy for mesothelioma by targeting PD-L1 and B7-H3, as well as the development of anti-B7-H3 or anti-PD-L1 single agents.
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Affiliation(s)
- Eiji Matsumura
- Departments of Pathology and Oncology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Oncology Medical Science, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Kazunori Kajino
- Departments of Pathology and Oncology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Abe
- Departments of Pathology and Oncology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naomi Ohtsuji
- Departments of Pathology and Oncology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Harumi Saeki
- Departments of Pathology and Oncology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - May Thinzar Hlaing
- Departments of Pathology and Oncology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Okio Hino
- Departments of Pathology and Oncology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Abstract
Staging of malignant pleural mesothelioma has been challenging because of a paucity of cases and poor survival. At least 5 staging systems were proposed before 1990 until the first consensus system was published in 1995. This system used tumor, node, metastasis designations and borrowed heavily from parenchymal lung cancer descriptors. With the establishment of a database to collect cases from 1995 to 2013, evidence-based revisions to the 1995 staging classification were published in 2016. With improving imaging technology, clinical staging will become more refined and, it is hoped, more useful for prognostication even without operative resection.
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Affiliation(s)
- Caleb J Euhus
- Department of Surgery, Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - R Taylor Ripley
- Department of Surgery, Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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Wolf AS, Flores RM. Updates in Staging and Management of Malignant Pleural Mesothelioma. Surg Oncol Clin N Am 2020; 29:603-612. [PMID: 32883461 DOI: 10.1016/j.soc.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
While without treatment, malignant pleural mesothelioma (MPM) confers poor survival, cancer-directed surgery as part of multimodality treatment is associated with a 15% 5-year survival. Extrapleural pneumonectomy (EPP) and radical or extended pleurectomy/decortication (P/D) are the 2 types of resection performed in this context. Preoperative staging is critical to patient selection for surgery; P/D is recommended over EPP in most cases. Adjuvant therapy with intraoperative platforms, traditional chemotherapy, hemithoracic radiotherapy resection, and new immunotherapy agents are instrumental in achieving durable long-term results. We outline the latest understanding of disease staging and describe the current state of literature and practice.
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Affiliation(s)
- Andrea S Wolf
- Department of Thoracic Surgery, The Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Box 1023, New York, NY 10029, USA.
| | - Raja M Flores
- Department of Thoracic Surgery, The Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Box 1023, New York, NY 10029, USA
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Bai Y, Wang X, Hou J, Geng L, Liang X, Ruan Z, Guo H, Nan K, Jiang L. Identification of a Five-Gene Signature for Predicting Survival in Malignant Pleural Mesothelioma Patients. Front Genet 2020; 11:899. [PMID: 32849853 PMCID: PMC7427512 DOI: 10.3389/fgene.2020.00899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022] Open
Abstract
Malignant pleural mesothelioma (MPM), predominantly caused by asbestos exposure, is a highly aggressive cancer with poor prognosis. The staging systems currently used in clinics is inadequate in evaluating the prognosis of MPM. In this study, a five-gene signature was developed and enrolled into a prognostic risk score model by LASSO Cox regression analysis based on two expression profiling datasets (GSE2549 and GSE51024) from Gene Expression Omnibus (GEO). The five-gene signature was further validated using the Cancer Genome Atlas (TCGA) MPM dataset. Univariate and multivariate Cox analyses proved that the five-gene signature was an independent prognostic factor for MPM. The signature remained statistically significant upon stratification by Brigham stage, AJCC stage, gender, tumor size, and lymph node status. Time-dependent receiver operating characteristic (ROC) curve indicated good performance of our model in predicting 1- and 2-years overall survival in MPM patients. The C-index was 0.784 for GSE2549 and 0.753 for the TCGA dataset showing moderate predictive accuracy of our model. Furthermore, Gene Set Enrichment Analysis suggested that the five-gene signature was related to pathways resulting in MPM tumor progression. Together, we have established a five-gene signature significantly associated with prognosis in MPM patients. Hence, the five-genes signature may serve as a potentially useful prognostic tool for MPM patients.
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Affiliation(s)
- Yiyang Bai
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiao Wang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jia Hou
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Luying Geng
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuan Liang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhiping Ruan
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hui Guo
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kejun Nan
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Oncology Hospital, Xi'an International Medical Center Hospital, Xi'an, China
| | - Lili Jiang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Ichiki Y, Goto H, Fukuyama T, Nakanishi K. Should Lung-Sparing Surgery Be the Standard Procedure for Malignant Pleural Mesothelioma? J Clin Med 2020; 9:E2153. [PMID: 32650433 PMCID: PMC7408715 DOI: 10.3390/jcm9072153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Surgical procedures for malignant pleural mesothelioma (MPM) include extrapleural pneumonectomy (EPP), extended pleurectomy/decortication (P/D) and P/D. EPP has been applied to MPM for a long time, but the postoperative status is extremely poor due to the loss of one whole lung. We compared the mortality, morbidity and median survival time (MST) of lung-sparing surgery (extended P/D or P/D) and lung-sacrificing surgery (EPP) for MPM by performing a systematic review. METHODS We extracted the number of events and patients from the literature identified in electronic databases. Ultimately, 15 reports were selected, and 2674 MPM patients, including 1434 patients undergoing EPP and 1240 patients undergoing extended P/D or P/D, were analyzed. RESULTS Our systematic review showed that lung-sparing surgery was significantly superior to lung-sacrificing surgery in both the surgical-related mortality (extended P/D vs. EPP: 3.19% vs. 7.65%, p < 0.01; P/D vs. EPP: 1.85% vs. 7.34%, p < 0.01) and morbidity (extended P/D vs. EPP: 35.7% vs. 60.0%, p < 0.01; P/D vs. EPP: 9.52% vs. 20.89%, p < 0.01). Lung-sparing surgery was not inferior to EPP in terms of MST. CONCLUSION Although no prospective randomized controlled trial has been conducted, it may be time to change the standard surgical method for MPM from lung-sacrificing surgery to lung-sparing surgery.
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Affiliation(s)
- Yoshinobu Ichiki
- Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, 2-1 Suwa, Wako, Saitama 351-0102, Japan; (H.G.); (K.N.)
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Hidenori Goto
- Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, 2-1 Suwa, Wako, Saitama 351-0102, Japan; (H.G.); (K.N.)
| | - Takashi Fukuyama
- Division of Biomedical Research, Kitasato University Medical Center, Kitamoto 364-8501, Japan;
| | - Kozo Nakanishi
- Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, 2-1 Suwa, Wako, Saitama 351-0102, Japan; (H.G.); (K.N.)
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Malignant pleural mesothelioma: Treatment patterns and outcomes from the Spanish Lung Cancer Group. Lung Cancer 2020; 147:83-90. [PMID: 32682189 DOI: 10.1016/j.lungcan.2020.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/13/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Malignant mesothelioma is a rare but aggressive tumor arising from the pleura, typically associated with exposure to asbestos. The purpose of this investigation was to describe mesothelioma patient characteristics, treatment patterns, and outcomes in Spain. MATERIAL AND METHODS Patients diagnosed with malignant mesothelioma of the pleura were recorded in an anonymous online database (BEMME, Epidemiologic Spanish Malignant Mesothelioma Database) from June 2008 through May 2013. Patient and tumor characteristics at time of diagnosis, as well as subsequent treatments (surgery, radiation, and chemotherapy), were collected. Among patients treated with chemotherapy, we explored type of chemotherapy regimen and outcomes by treatments. RESULTS A total of 560 malignant pleural mesothelioma (MPM) patients were recorded. The median age at diagnosis was 68 years, mainly with epithelioid histology (62 %), and any asbestos exposure was noted in 45 % of patients. Nearly two-thirds of patients (71 %) received chemotherapy, mainly platinum-pemetrexed combination, as part of their treatment. Surgery and radiotherapy were given in 36 % and 17 % of patients, respectively. The median overall survival (OS) in the whole cohort was 13.0 months (95 % confidence interval (CI), 11.1-14.8 months) with 1-year OS of 53.2 % (95 % CI, 48.7-57.7 %). In patients receiving first-line chemotherapy (N = 315), the median OS was 13.4 months (95 % CI, 10.8-16.0 months), reaching 20.2 months (95 % CI, 17.2-23.2 months) for those 68 patients receiving maintenance chemotherapy. Results of multivariate analyses showed significant association of ECOG-performance status, histology and treatment response with improved OS in MPM patients treated with palliative chemotherapy. CONCLUSIONS Despite multimodal therapeutic intervention, survival of patients with mesothelioma in Spain remains poor. Although it did not reach significance in the multivariate analysis, a meaningful additional survival benefit was observed among those patients receiving maintenance chemotherapy.
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Doi H, Kuribayashi K, Kitajima K, Yamakado K, Kijima T. Development of a Novel Prognostic Risk Classification System for Malignant Pleural Mesothelioma. Clin Lung Cancer 2020; 21:66-74.e2. [DOI: 10.1016/j.cllc.2019.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/03/2019] [Accepted: 08/24/2019] [Indexed: 01/27/2023]
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Ergönül AG, Akçam Tİ, Özdil A, Turhan K, Çakan A, Nart D, Özkök S, Göker E, Caner A, Çok G, Çağırıcı U. Ege Üniversitesi Hastanesi malign plevral mezotelyoma hastalarının epidemiyolojik ve genel sağ kalım özellikleri. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.669385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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The Prevalence and Clinical Relevance of Nonexpandable Lung in Malignant Pleural Mesothelioma. A Prospective, Single-Center Cohort Study of 229 Patients. Ann Am Thorac Soc 2019; 16:1273-1279. [DOI: 10.1513/annalsats.201811-786oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Vlacic G, Hoda MA, Klikovits T, Sinn K, Gschwandtner E, Mohorcic K, Schelch K, Pirker C, Peter-Vörösmarty B, Brankovic J, Dome B, Laszlo V, Cufer T, Rozman A, Klepetko W, Grasl-Kraupp B, Hegedus B, Berger W, Kern I, Grusch M. Expression of FGFR1-4 in Malignant Pleural Mesothelioma Tissue and Corresponding Cell Lines and its Relationship to Patient Survival and FGFR Inhibitor Sensitivity. Cells 2019; 8:E1091. [PMID: 31527449 PMCID: PMC6769772 DOI: 10.3390/cells8091091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 02/07/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is a devastating malignancy with limited therapeutic options. Fibroblast growth factor receptors (FGFR) and their ligands were shown to contribute to MPM aggressiveness and it was suggested that subgroups of MPM patients could benefit from FGFR-targeted inhibitors. In the current investigation, we determined the expression of all four FGFRs (FGFR1-FGFR4) by immunohistochemistry in tissue samples from 94 MPM patients. From 13 of these patients, we were able to establish stable cell lines, which were subjected to FGFR1-4 staining, transcript analysis by quantitative RT-PCR, and treatment with the FGFR inhibitor infigratinib. While FGFR1 and FGFR2 were widely expressed in MPM tissue and cell lines, FGFR3 and FGFR4 showed more restricted expression. FGFR1 and FGFR2 showed no correlation with clinicopathologic data or patient survival, but presence of FGFR3 in 42% and of FGFR4 in 7% of patients correlated with shorter overall survival. Immunostaining in cell lines was more homogenous than in the corresponding tissue samples. Neither transcript nor protein expression of FGFR1-4 correlated with response to infigratinib treatment in MPM cell lines. We conclude that FGFR3 and FGFR4, but not FGFR1 or FGFR2, have prognostic significance in MPM and that FGFR expression is not sufficient to predict FGFR inhibitor response in MPM cell lines.
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MESH Headings
- Acrylamides/pharmacology
- Antineoplastic Agents/pharmacology
- Cell Line, Tumor
- Dose-Response Relationship, Drug
- Female
- Gene Expression Profiling
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/drug therapy
- Lung Neoplasms/pathology
- Male
- Mesothelioma/diagnosis
- Mesothelioma/drug therapy
- Mesothelioma/pathology
- Mesothelioma, Malignant
- Middle Aged
- Phenylurea Compounds/pharmacology
- Protein Kinase Inhibitors/pharmacology
- Pyrimidines/pharmacology
- Quinazolines/pharmacology
- Receptor, Fibroblast Growth Factor, Type 1/antagonists & inhibitors
- Receptor, Fibroblast Growth Factor, Type 1/genetics
- Receptor, Fibroblast Growth Factor, Type 1/metabolism
- Receptor, Fibroblast Growth Factor, Type 2/antagonists & inhibitors
- Receptor, Fibroblast Growth Factor, Type 2/metabolism
- Receptor, Fibroblast Growth Factor, Type 3/antagonists & inhibitors
- Receptor, Fibroblast Growth Factor, Type 3/metabolism
- Receptor, Fibroblast Growth Factor, Type 4/antagonists & inhibitors
- Receptor, Fibroblast Growth Factor, Type 4/metabolism
- Survival Analysis
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Affiliation(s)
- Gregor Vlacic
- University Clinic for Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia.
| | - Mir A Hoda
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria.
| | - Thomas Klikovits
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria.
| | - Katharina Sinn
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria.
| | - Elisabeth Gschwandtner
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria.
| | - Katja Mohorcic
- University Clinic for Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia.
| | - Karin Schelch
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria.
| | - Christine Pirker
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria.
| | - Barbara Peter-Vörösmarty
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria.
| | - Jelena Brankovic
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria.
| | - Balazs Dome
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria.
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, 1085 Budapest, Hungary.
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, 1085 Budapest, Hungary.
| | - Viktoria Laszlo
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria.
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, 1085 Budapest, Hungary.
| | - Tanja Cufer
- University Clinic for Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia.
| | - Ales Rozman
- University Clinic for Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia.
| | - Walter Klepetko
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria.
| | - Bettina Grasl-Kraupp
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria.
| | - Balazs Hegedus
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, 45239 Essen, Germany.
| | - Walter Berger
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria.
| | - Izidor Kern
- University Clinic for Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia.
| | - Michael Grusch
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria.
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Carbone M, Adusumilli PS, Alexander HR, Baas P, Bardelli F, Bononi A, Bueno R, Felley-Bosco E, Galateau-Salle F, Jablons D, Mansfield AS, Minaai M, de Perrot M, Pesavento P, Rusch V, Severson DT, Taioli E, Tsao A, Woodard G, Yang H, Zauderer MG, Pass HI. Mesothelioma: Scientific clues for prevention, diagnosis, and therapy. CA Cancer J Clin 2019; 69:402-429. [PMID: 31283845 PMCID: PMC8192079 DOI: 10.3322/caac.21572] [Citation(s) in RCA: 273] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mesothelioma affects mostly older individuals who have been occupationally exposed to asbestos. The global mesothelioma incidence and mortality rates are unknown, because data are not available from developing countries that continue to use large amounts of asbestos. The incidence rate of mesothelioma has decreased in Australia, the United States, and Western Europe, where the use of asbestos was banned or strictly regulated in the 1970s and 1980s, demonstrating the value of these preventive measures. However, in these same countries, the overall number of deaths from mesothelioma has not decreased as the size of the population and the percentage of old people have increased. Moreover, hotspots of mesothelioma may occur when carcinogenic fibers that are present in the environment are disturbed as rural areas are being developed. Novel immunohistochemical and molecular markers have improved the accuracy of diagnosis; however, about 14% (high-resource countries) to 50% (developing countries) of mesothelioma diagnoses are incorrect, resulting in inadequate treatment and complicating epidemiological studies. The discovery that germline BRCA1-asssociated protein 1 (BAP1) mutations cause mesothelioma and other cancers (BAP1 cancer syndrome) elucidated some of the key pathogenic mechanisms, and treatments targeting these molecular mechanisms and/or modulating the immune response are being tested. The role of surgery in pleural mesothelioma is controversial as it is difficult to predict who will benefit from aggressive management, even when local therapies are added to existing or novel systemic treatments. Treatment outcomes are improving, however, for peritoneal mesothelioma. Multidisciplinary international collaboration will be necessary to improve prevention, early detection, and treatment.
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Affiliation(s)
- Michele Carbone
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - H. Richard Alexander
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Fabrizio Bardelli
- National Research Council Institute of Nanotechnology, La Sapienza University, Rome, Italy
| | - Angela Bononi
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Raphael Bueno
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emanuela Felley-Bosco
- Laboratory of Molecular Oncology, Division of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | | | - David Jablons
- Thoracic Oncology, Department of Surgery, Helen Diller Cancer Center, University of California at San Francisco, San Francisco, California
| | | | - Michael Minaai
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Marc de Perrot
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Patricia Pesavento
- Pathology, Immunology, and Microbiology Laboratory, University of California at Davis, Sacramento, California
| | - Valerie Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David T. Severson
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emanuela Taioli
- Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anne Tsao
- Division of Cancer Medicine, Department of Thoracic and Head/Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gavitt Woodard
- Thoracic Oncology, Department of Surgery, Helen Diller Cancer Center, University of California at San Francisco, San Francisco, California
| | - Haining Yang
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | - Harvey I. Pass
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York
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32
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Portalone L, Antilli A, Nunziati F, Crispino C, de Marinis F, Friggeri L, Lombardi A, Lorusso V, Pronzato P, Sambiasi D, Signora M. Epirubicin and Gemcitabine as First-Line Treatment in Malignant Pleural Mesothelioma. TUMORI JOURNAL 2019; 91:15-8. [PMID: 15849999 DOI: 10.1177/030089160509100104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malignant pleural mesothelioma represents a rare disease, for which chemotherapy actually remains unsatisfactory. From August 1998 to November 2001, 28 chemo-radio-immunonaive patients were consecutively enrolled in the trial: 22/6 males/females; median age 63 years (range, 45-79); median ECOG PS 1 (range, 0-2). They were treated with epirubicin (100 mg/m2 iv on day 1) plus gemcitabine (1000 mg/m2 iv on days 1 and 8) every 4 weeks for 6 cycles. Patients who responded to chemotherapy (n = 6) were subsequently treated with interleukin-2 (4,500,000 IU) subcutaneously every other day, until progression. A total of 124 epirubicin-gemcitabine cycles were administered (median, 6/patient; range, 2-6). Twenty-six patients were evaluated for toxicity. According to WHO criteria, we observed grade III-IV hematological and gastrointestinal toxicity respectively in 3 patients (11%) and 1 patient (3%). No red cell transfusions were required and no toxic deaths occurred. Two patients (8%) could not be evaluated for response (no therapy performed). According to WHO criteria, the final responses were: partial in 4 patients (14%), stable disease in 19 patients (69%), and progression in 3 patients (10%). In 26 patients, the median survival was 55 weeks (range, 7-222) and median time to progression 30 weeks (range, 4-156). At the time of this writing, no patient is alive. The 1-year survival was 32%, 2-year survival 11%, and 4% at 3 and 4 years. All patients were at stage III, and time to progression was 58 weeks and survival 63.5 weeks, without any toxicity. This multi-center phase II clinical trial showed that epirubicin plus gemcitabine, as a first-line treatment in malignant pleural mesothelioma, has promising activity with a good tolerability profile and symptom palliation. The role of interleukin-2 in maintenance therapy for malignant pleural mesothelioma is encouraging and requires further study.
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Affiliation(s)
- Luigi Portalone
- 16th Pneumo-Oncology Unit, C. Forlanini Hospital, Rome, Italy.
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Berger I, Cengel KA, Simone CB, Alley EW, Roshkovan L, Haas AR, Patel AM, Khalid U, Culligan MJ, McNulty S, Singhal S, Friedberg JS, Katz SI. Lymphangitic carcinomatosis: A common radiographic manifestation of local failure following extended pleurectomy/decortication in patients with malignant pleural mesothelioma. Lung Cancer 2019; 132:94-98. [PMID: 31097101 DOI: 10.1016/j.lungcan.2019.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The lymphangitic carcinomatosis (LC) pattern of metastatic malignancy is associated with a poor prognosis but is currently not well defined in malignant pleural mesothelioma (MPM). Here, we report the incidence and prognostic significance of the radiographic development of LC in MPM following extended pleurectomy/decortication (EPD). METHODS Consecutive patients with biopsy-proven MPM undergoing EPD with intraoperative photodynamic therapy (PDT) at our institution from 2008 to 2014 were included in this retrospective study. Patients without available post-surgical clinical or imaging data for direct review were excluded. CT images were reviewed by an experienced, board-certified thoracic radiologist and confirmed by consensus review. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan Meier methodology. Hazard ratios were compared with a cox proportional hazard model. RESULTS 44 patients underwent EPD with PDT during the study period and had available clinical and imaging data. During the follow-up period (median 34 months), 17 patients (39%) developed LC at a median of 10 months after surgery (IQR 5-21 months). 16 of the 17 patients who developed LC (94%) died during the follow-up period, compared to 17 of the 27 who did not develop LC (63%). OS for the LC versus non-LC group was 53% versus 93% at 1 year and 18% versus 67% at 3 years. LC was significantly associated with a lower OS (HR 4.07; 95% confidence interval 1.44-11.48; p = 0.008). PFS for the LC group versus non-LC group was 8 months (IQR 5-9 months) compared to 17 months (IQR 11-24 months) (p < 0.001). CONCLUSION LC is a common form of failure in MPM following EPD and is associated with a poor prognosis. Thus, further studies are warranted to determine if any evidence of preoperative LC should be an absolute contraindication to EPD and may warrant an EPP or no surgery at all.
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Affiliation(s)
- Ian Berger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Keith A Cengel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Charles B Simone
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Evan W Alley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Leonid Roshkovan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Andrew R Haas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Akash M Patel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Urooj Khalid
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | | | - Sally McNulty
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Sunil Singhal
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | | | - Sharyn I Katz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
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Kobayashi M, Ishibashi H, Takasaki C, Imai S, Kirimura S, Okubo K. Pathological evaluation of the visceral pleura in the radical pleurectomy/decortication for malignant pleural mesothelioma patients. J Thorac Dis 2019; 11:717-723. [PMID: 31019759 DOI: 10.21037/jtd.2019.02.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Radical pleurectomy/decortication (P/D) is applied as a surgical treatment of resectable malignant pleural mesothelioma (MPM). Although P/D removed visceral pleura, dissection plain was not histologically explored previously. We examined a pathological evaluation of surgically removed visceral pleura in P/D. Methods Twenty-five patients with MPM who underwent P/D at the Tokyo Medical and Dental University Hospital between April 2010 and April 2018 were studied. The 25 cases included 20 with epithelioid tumors, 4 with a biphasic tumor and 1 with desmoplastic tumors. Nine, 1, 11 and 4 patients had mesotheliomas of stages I, II, III and IV, respectively. We analyzed the site of the visceral pleural lesions using the HE & Elastica van Gieson (EVG) staining. The tumor involvement of the pleura and the surgical dissection plane were defined using the depth criteria, D0-3. We added survival analyses according to the depth criteria. Results Ninety-nine lesions in total 45 lobes: 20 upper right, 14 middle, 20 lower, 22 upper left, and 23 lower were examined. Based on the depth D 0-3 criteria, there were 21 type D0, 18 type D1, 22 type D2 and 38 type D3 lesions. The growth of tumor cells in the pleura was partially diffuse or nodular in all cases. While 38 lesions which invaded the lung parenchyma were excised, another 61 lesions that reached within the pleura were dissected from lung parenchyma. Type D2&3 showed poor survivals than type D0&1. Conclusions The lung parenchyma was always the dissection plane in P/D, regardless of tumor involvement in the visceral pleura. The depth criteria would help us in classifying pleural invasion histologically and possibly predicting the prognosis.
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Affiliation(s)
- Masashi Kobayashi
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hironori Ishibashi
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chihiro Takasaki
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sachiko Imai
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Kirimura
- Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Okubo
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Gill RR, Yeap BY, Bueno R, Richards WG. Quantitative Clinical Staging for Patients With Malignant Pleural Mesothelioma. J Natl Cancer Inst 2019; 110:258-264. [PMID: 29931180 PMCID: PMC6009654 DOI: 10.1093/jnci/djx175] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/02/2017] [Indexed: 12/29/2022] Open
Abstract
Background Analysis of the International Association for the Study of Lung Cancer (IASLC) Malignant Pleural Mesothelioma (MPM) database revealed that clinical (cTNM) staging minimally stratified survival and was discrepant with pathological (pTNM) staging. To improve prognostic classification of MPM, alternative staging models based on quantitative parameters were explored. Methods An institutional review board–approved MPM registry was queried to identify patients with available pathological and preoperative imaging data. Qualifying patients were randomly assigned to training and test sets in a 1:2 ratio. Computed cTNM and pTNM staging (AJCC Cancer Staging Manual, 7th ed.) were compared. Quantitative image analysis included tumor volume assessed from three-dimensional reconstruction of computed tomography scans (VolCT) and maximal fissural thickness (Fmax). Survival was estimated using the Kaplan-Meier method, and the relationship with VolCT was examined by Cox regression analysis to identify optimized cut-points. Performance of cTNM and quantitative models derived was compared in the test set using Harrell’s C index. Results A total of 472 patients met inclusion criteria. TNM staging was concordant with pathological TNM staging in 171 of 472 (36.2%), understaged in 209 (44.2%), and overstaged in 92 (19.4%) patients. The most concordant feature was involvement of interlobar fissures. A quantitative clinical staging model comprising VolCT and Fmax (c-index = 0.638, 95% confidence interval [CI] = 0.603 to 0.673) performed statistically significantly better as a prognostic classifier when compared in the test set with cTNM (c-index = 0.562, 95% CI = 0.525 to 0.599, P = .001). Conclusions Improved prognostic performance may be achievable by quantitative clinical staging combining VolCT and Fmax, providing a cost-effective and clinically relevant surrogate for clinical TNM stage.
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Affiliation(s)
- Ritu R Gill
- Department of Radiology, Brigham and Women's, Hospital and Harvard Medical School, Boston, MA
| | - Beow Y Yeap
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's, Hospital and Harvard Medical School, Boston, MA
| | - William G Richards
- Division of Thoracic Surgery, Brigham and Women's, Hospital and Harvard Medical School, Boston, MA
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Kai Y, Tsutani Y, Tsubokawa N, Ito M, Mimura T, Miyata Y, Okada M. Prolonged post-recurrence survival following pleurectomy/decortication for malignant pleural mesothelioma. Oncol Lett 2019; 17:3607-3614. [PMID: 30867804 DOI: 10.3892/ol.2019.9979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/21/2018] [Indexed: 11/05/2022] Open
Abstract
The present study analyzed surgical results in patients with malignant pleural mesothelioma (MPM) who underwent extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D). Data for 44 patients who achieved macroscopic complete resection following neoadjuvant chemotherapy followed by EPP (n=29) or P/D (n=15) were reviewed. Patient demographics and oncological outcomes were compared between the EPP and P/D groups. The median overall (OS) and progression-free survival (PFS) times were 22 and 14 months, respectively. OS was significantly different between the EPP and P/D groups (median OS, 17 vs. 34 months; 5-year OS, 11 vs. 44%; P=0.019); no difference was noted in PFS (median PFS, 13 vs. 21 months; 5-year PFS, 11 vs. 17%; P=0.373). Univariate analysis demonstrated that epithelial histology (P=0.0003) and P/D (P=0.018) were significant favorable prognostic factors for OS. Using multivariate analysis, epithelial histology (P=0.001) remained the only significant factor. Post-recurrence survival (PRS) among all patients was significantly longer in the P/D group (median PRS, 3 vs. 20 months; 1.5-year PRS, 5 vs. 54%; P=0.003), even among patients with epithelial-type MPM (median PRS, 6 s vs. 20 months; 1.5-year PRS, 8 vs. 61%; P=0.012). Chemotherapy following recurrence (P=0.033) was significantly associated with superior PRS in multivariate analysis. Postoperative pulmonary function was significantly improved in the P/D group. In summary, P/D may be an alternative procedure to EPP for resectable MPM providing similar PFS and improved PRS.
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Affiliation(s)
- Yuichiro Kai
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan
| | - Norifumi Tsubokawa
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan
| | - Masaoki Ito
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan
| | - Takeshi Mimura
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551, Japan
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Pleural thickness after neoadjuvant chemotherapy is a prognostic factor in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2019; 157:404-413. [DOI: 10.1016/j.jtcvs.2018.09.106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/24/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022]
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Frick AE, Nackaerts K, Moons J, Lievens Y, Verbeken E, Lambrecht M, Coolen J, Dooms C, Vansteenkiste J, De Leyn P, Nafteux P. Combined modality treatment for malignant pleural mesothelioma: a single-centre long-term survival analysis using extrapleural pneumonectomy. Eur J Cardiothorac Surg 2018; 55:934-941. [DOI: 10.1093/ejcts/ezy385] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/21/2018] [Accepted: 10/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna Elisabeth Frick
- Department of Thoracic Surgery, University Hospitals KU Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Department of Histopathology, University Hospitals KU Leuven, Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals KU Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Eric Verbeken
- Department of Histopathology, University Hospitals KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Maarten Lambrecht
- Department of Radiation Oncology, University Hospitals KU Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - Johan Coolen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Christophe Dooms
- Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - Johan Vansteenkiste
- Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals KU Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals KU Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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Berzenji L, Van Schil PE, Carp L. The eighth TNM classification for malignant pleural mesothelioma. Transl Lung Cancer Res 2018; 7:543-549. [PMID: 30450292 PMCID: PMC6204412 DOI: 10.21037/tlcr.2018.07.05] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/12/2018] [Indexed: 11/06/2022]
Abstract
In 2016, the International Association for the Study of Lung Cancer (IASLC) published a number of revisions of the seventh edition of the tumor, node and metastasis (TNM) classification for malignant pleural mesothelioma (MPM). The purpose was to establish a set of recommendations for the eighth edition of the TNM staging system. A large number of patients were included in the IASLC database and subsequently analysed to determine new definitions for the components of the TNM classification. A number of important changes were introduced for the T component. Survival analysis of the different T categories showed no significant difference in categories T1a and T1b. This has resulted in a collapse of categories T1a and T1b into one category T1. In addition, tumor thickness was also significantly associated with overall survival. The descriptors for the N components have been redefined as well for the eighth TNM classification. A major revision is the removal of category N3 in the N component. Both intrapleural and extrapleural (N1 and N2 in the seventh edition) are now combined into a single category N1. Lymph nodes that were previously categorized as N3 are now considered N2. For the M component, no redefinition has been published. However, a recommendation has been made to only consider M1 involvement as stage IV disease. This is in contrast to the seventh edition in which T4 and N3 disease were considered stage IV as well. In conclusion, a number of important revisions for the eighth TNM classification of MPM have been published as a result of this IASLC project. This type of large-scale and international joint efforts are key in establishing effective staging systems. Research into using tumor thickness as a prognostic instrument will be an important part of any future editions of the TNM classification.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul E. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
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Fournel L, Janet-Vendroux A, Canny-Hamelin E, Mansuet-Lupo A, Guinet C, Bobbio A, Damotte D, Alifano M. [Malignant pleural mesothelioma: The role of surgery]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:351-358. [PMID: 30316650 DOI: 10.1016/j.pneumo.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Malignant pleural mesothelioma (MPM) is a rare and highly aggressive disease, whose incidence is increasing. Asbestos is the primary causal agent. STATE OF KNOWLEDGE Knowledge about MPM has evolved. Thoracoscopy is essential for diagnosis of MPM. It allows performing pleural biopsies, to study the extent of the disease and to relieve dyspnea. The pathological diagnosis is also better codified with immunohistochemistry and with analysis by expert of Mesopath group. Curative surgical treatments are pleurectomy decortication and extended pneumonectomy in combination with chemotherapy and/or radiotherapy. Those heavy treatments improve survival in highly selected patients. For the other patients, supportive measures will be considered to reduce pain and dyspnea. PROSPECT Radical surgical treatment is only offered in therapeutic trials or multimodal treatment. Its place is not formally established. New therapies associated to surgical treatment are being studied. CONCLUSIONS Surgical management of MPM has to be operated in specialized teams where the survival benefit and quality of life is discussed case by case.
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Affiliation(s)
- L Fournel
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - A Janet-Vendroux
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - E Canny-Hamelin
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Mansuet-Lupo
- Service d'anatomopathologie, université Paris Descartes, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Guinet
- Service de radiologie, université Paris Descartes, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Bobbio
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - D Damotte
- Service d'anatomopathologie, université Paris Descartes, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Alifano
- Service de chirurgie thoracique, université Paris Descartes, hôpital Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Gudmundsson E, Straus CM, Armato SG. Deep convolutional neural networks for the automated segmentation of malignant pleural mesothelioma on computed tomography scans. J Med Imaging (Bellingham) 2018; 5:034503. [PMID: 30840717 DOI: 10.1117/1.jmi.5.3.034503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/24/2018] [Indexed: 12/29/2022] Open
Abstract
Tumor volume has been a topic of interest in the staging, prognostic evaluation, and treatment response assessment of malignant pleural mesothelioma (MPM). Deep convolutional neural networks (CNNs) were trained separately for the left and right hemithoraces on the task of differentiating between pleural thickening and normal thoracic tissue on computed tomography (CT) scans. A total of 4259 and 6192 axial sections containing segmented tumor were used to train the left-hemithorax CNN and the right-hemithorax CNN, respectively. Two distinct test sets of 131 sections from the CT scans of 43 patients were used to evaluate segmentation performance by calculating the Dice similarity coefficient (DSC) between deep CNN-generated tumor segmentations and reference tumor segmentations provided by a total of eight observers. Median DSC values ranged from 0.662 to 0.800 over the two test sets when comparing deep CNN-generated segmentations with observer reference segmentations. The deep CNN-based method achieved significantly higher DSC values for all three observers on the test set that allowed direct comparisons with a previously published automated segmentation method of MPM tumor on CT scans ( p < 0.0005 ). A deep CNN was implemented for the automated segmentation of MPM tumor on CT scans, showing superior performance to a previously published method.
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Affiliation(s)
- Eyjolfur Gudmundsson
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Christopher M Straus
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Samuel G Armato
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
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Ihara H, Harada N, Shimada N, Kanamori K, Hayashi T, Uekusa T, Takahashi K. Malignant Pleural Mesothelioma with Bone Marrow Metastases. Intern Med 2018; 57:2541-2545. [PMID: 29607973 PMCID: PMC6172530 DOI: 10.2169/internalmedicine.9246-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 64-year-old man with the bone marrow metastasis due to malignant pleural mesothelioma (MPM) was diagnosed with anemia, leukoerythroblastosis, thrombocytopenia, and lower back pain. A bone marrow biopsy demonstrated infiltrative malignant mesothelioma lesions in the bone marrow. The patient died within 15 days of the detection of the bone marrow involvement. Physicians should consider performing a bone marrow biopsy to diagnose bone marrow metastasis and treat patients with palliative chemotherapy at an earlier phase of the disease. To our knowledge, this is the first report of an MPM patient having bone marrow metastasis with anemia, leukoerythroblastosis, and thrombocytopenia.
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Affiliation(s)
- Hiroaki Ihara
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Naoko Shimada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Koichiro Kanamori
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Toshimasa Uekusa
- Department of Pathology, Labour Health and Welfare Organization Kanto Rosai Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
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Otoshi T, Kataoka Y, Kaku S, Iki R, Hirabayashi M. Prognostic Impact of Inflammation-related Biomarkers on Overall Survival of Patients with Inoperable Malignant Pleural Mesothelioma. ACTA ACUST UNITED AC 2018; 32:445-450. [PMID: 29475935 DOI: 10.21873/invivo.11260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/10/2022]
Abstract
AIM The aim of the present study was to assess the prognostic utility of the pretreatment blood neutrophil-to-lymphocyte ratio (NLR) and the C-reactive protein-to-albumin ratio (CAR) in patients with inoperable malignant pleural mesothelioma (MPM). MATERIALS AND METHODS The medical records of consecutive patients with histologically confirmed MPM from our hospital between January 2007 and August 2017 were retrospectively reviewed. The primary outcome was overall survival (OS). Univariate and multivariate analyses for the prognostic factors were performed using a Cox proportional hazards model. RESULTS A total of 143 patients with inoperable MPM were included. On multivariate analysis, pretreatment CAR was an independent factor associated with worse OS (hazard ratio(HR)=1.72; 95% confidence interval(CI)=1.11-2.67; p=0.016). However, NLR was not associated with OS in any of the analyses. CONCLUSION CAR appears to be a prognostic factor in patients with inoperable MPM.
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Affiliation(s)
- Takehiro Otoshi
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yuki Kataoka
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Sawako Kaku
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Reika Iki
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masataka Hirabayashi
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
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Juusela AL, Javadian P, Cho WC, Thani S. Primary Biphasic Peritoneal Mesothelioma Encountered During Myomectomy for Symptomatic Fibroid Uterus. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Pouya Javadian
- Obstetrics/Gynecology Department, Newark Beth Israel Medical Center, Newark, NJ
| | - Woo Cheal Cho
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT
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Abstract
The pleura may be affected by primary tumors or metastatic spread of intrathoracic or extrathoracic neoplasms. Primary pleural neoplasms represent ∼10% of all pleural tumors, and malignant lesions are more common than benign lesions. The most common primary tumors include malignant pleural mesothelioma and solitary fibrous tumor. Although pleural neoplasms may initially be evaluated with computed tomography (CT) and/or fluorodeoxyglucose positron emission tomography (PET)/CT, magnetic resonance (MR) imaging is complementary to these other imaging modalities for disease staging and evaluation of patients. In this article, we discuss the etiology, clinical presentation, and imaging of pleural neoplasms, with specific attention given to the role of MR imaging.
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Zhang C, Kang Y, Ma R, Chen F, Chen F, Dong X. Expression of Numb and Gli1 in malignant pleural mesothelioma and their clinical significance. J Cancer Res Ther 2018; 14:970-976. [PMID: 30197333 DOI: 10.4103/0973-1482.180614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM OF STUDY Malignant pleural mesothelioma (MPM) is a highly lethal and refractory to multimodal treatment tumor. Numb is considered as a tumor suppressor playing critical roles in determining cell fate and has been shown to target the oncogenic transcription factor Gli1 for Itch-dependent ubiquitination, resulting in suppression of the oncogenic sonic hedgehog signaling in medulloblastoma. This study was designed to analysis the role of Numb and Gli1 in MPM. MATERIALS AND METHODS Tissues of 61 MPM patients and 22 normal pleura as control were investigated. Numb and Gli1 expression were evaluated by immunohistochemistry. The associations with clinical and pathological parameters of the two markers were statistically analyzed, and the correlation between them was also demonstrated. RESULTS The expression levels of Numb with nuclear Gli1 exhibited a significant inverse correlation (r = -0.361 P < 0.05). In addition, Numb has an inverse correlation with ki-67 labeling index (P < 0.05), and nuclear Gli1 was found in associated with the tumor International Mesothelioma Interest Group-stage (P < 0.05). The overall survival was influenced by the expression of Numb (P < 0.05) and histological subtype (P < 0.05), further regression analysis showed that only histological subtype has a prognostic influence on survival (P < 0.05). CONCLUSION The results provide new evidence of Numb and Gli1 on the clinical characteristics of MPM, which may be helpful in clinical diagnosis and targeted therapy. Further research with larger sample size is needed.
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Affiliation(s)
- Caiqing Zhang
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Yanmeng Kang
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Ruiping Ma
- Department of Liver Disease, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Feng Chen
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Fangfang Chen
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Xueli Dong
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
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Bretti S, Berruti A, Dogliotti L, Castagneto B, Bertulli R, Spadaro P, Toscano G, Astorre P, Verusio C, Lionetto R, Bruzzi P, Santoro A. Combined Epirubicin and Interleukin-2 Regimen in the Treatment of Malignant Mesothelioma: A Multicenter Phase II Study of the Italian Group on Rare Tumors. TUMORI JOURNAL 2018; 84:558-61. [PMID: 9862516 DOI: 10.1177/030089169808400509] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Italian Group on Rare Tumors undertook a phase II study of a combination of epirubicin and interleukin-2 in 21 chemotherapy-naive patients with malignant mesothelioma. All patients had bidimensionally measurable disease at CT scan. Treatment included intravenous administration of epirubicin at a dose of 110 mg/m2 i.v. on day 1, and interleukin-2 at a dose of 9 MU subcutaneously from day 8 to day 12 and from day 15 to day 19. Cycles were repeated every three weeks, up to six times in the absence of progressive disease. Treatment response was evaluated after two cycles of therapy. Only one patient achieved a partial response, resulting in an overall response rate of 5% (1/21) with a median progression-free and overall survival of 5 and 10 months, respectively. Toxicity was relevant and caused treatment discontinuation in many patients. These results do not support the use of such a combination in the management of malignant mesothelioma.
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Affiliation(s)
- S Bretti
- Divisione di Oncologia Medica, Ospedale Oncologico S. Giovanni A.S., Torino, Italy
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Hoda MA, Ploenes T, Aigner C. Malignant pleural mesothelioma-the impact of globalization on rare diseases. J Thorac Dis 2018; 10:638-640. [PMID: 29607128 DOI: 10.21037/jtd.2017.12.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M Alireza Hoda
- Mesothelioma Program, Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Till Ploenes
- Mesothelioma Program, Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Clemens Aigner
- Mesothelioma Program, Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
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Berzenji L, Van Schil PE, Snoeckx A, Hertoghs M, Carp L. Mesothelioma With a Large Prevascular Lymph Node: N1 Involvement or Something Different? Ann Thorac Surg 2018; 105:e189-e191. [PMID: 29355487 DOI: 10.1016/j.athoracsur.2017.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/12/2017] [Indexed: 11/25/2022]
Abstract
A 64-year-old man presented with a large amount of right-sided pleural fluid on imaging, together with calcified pleural plaques and an enlarged nodular structure in the prevascular mediastinum, presumably an enlarged lymph node. Pleural biopsies were obtained during video-assisted thoracoscopic surgery to exclude malignancy. Histopathology showed an epithelial malignant pleural mesothelioma. Induction chemotherapy with cisplatin and pemetrexed was administered followed by an extended pleurectomy and decortication with systematic nodal dissection. Histopathology confirmed the diagnosis of a ypT3N0M0 (stage IB) mesothelioma, and an unexpected thymoma type B2 (stage II) was discovered in the prevascular nodule. Simultaneous occurrence of a mesothelioma and thymoma is extremely rare.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Marjan Hertoghs
- Department of Anatomical Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
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Bibby AC, De Fonseka D, Morley AJ, Keenan E, Addeo A, Smith S, Edey AJ, Maskell NA. Exploring the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy as first-line treatment: a prospective, observational, single centre study. BMC Palliat Care 2017; 16:71. [PMID: 29221485 PMCID: PMC5723074 DOI: 10.1186/s12904-017-0255-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 11/30/2017] [Indexed: 12/29/2022] Open
Abstract
Background Mesothelioma is an aggressive thoracic tumour with a poor prognosis. The only treatment that extends survival is chemotherapy. However, in the UK, up to 50% of patients who are suitable for chemotherapy choose not to receive it, opting for active symptom control instead. The aim of this prospective, single-centre observational study was to describe the characteristics of patients who chose active symptom control over chemotherapy and explore their reasons for doing so. Methods Two hundred consecutive patients with mesothelioma from one UK centre were included. Eligibility for chemotherapy and choice of first-line treatment were recorded prospectively. Patient characteristics and outcomes were compared using descriptive statistics, regression analysis and survival analysis. Reasons for choosing active symptom control over chemotherapy were extracted, retrospectively. Results People who chose active symptom control were older, more likely to be female and had worse performance statuses than patients who received front-line chemotherapy. Concern over side effects, the modest survival benefit and previous adverse experiences with chemotherapy were reported as reasons for the decision. Median survival was 13.9 months in the chemotherapy group compared with 6.7 months in the active symptom control group. Conclusions This is the first study to describe the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy, in the front-line setting. Important differences were seen between this group and patients who received chemotherapy, although confounding is likely to have affected some outcomes. Future research could use qualitative methods to explore patients’ reasons for choosing active symptom control, and to further elucidate the decision-making process. Electronic supplementary material The online version of this article (10.1186/s12904-017-0255-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna C Bibby
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, 2nd Floor L&R Building, Bristol, BS10 5NB, UK. .,Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Duneesha De Fonseka
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, 2nd Floor L&R Building, Bristol, BS10 5NB, UK.,Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Anna J Morley
- Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Emma Keenan
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, 2nd Floor L&R Building, Bristol, BS10 5NB, UK
| | - Alfredo Addeo
- Bristol Cancer Institute, Bristol Haematology & Oncology Centre, Horfield Rd, Bristol, BS2 8ED, UK
| | - Sarah Smith
- Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Anthony J Edey
- Department of Radiology, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, 2nd Floor L&R Building, Bristol, BS10 5NB, UK.,Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
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