Meta-analysis of survival after extrapleural pneumonectomy (EPP) versus pleurectomy/decortication (P/D) for malignant pleural mesothelioma in the context of macroscopic complete resection (MCR)

Magouliotis, Dimitrios; Zotos, Prokopis-Andreas; Rad, Arian Arjomandi; Koukousaki, Despoina; Vasilaki, Vasiliki; Portesi, Ioustini; Spiliopoulos, Kyriakos; Athanasiou, Thanos

doi:10.1007/s13304-022-01369-4

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Extra pleural pneumonectomy (EPP) is no longer performed by many thoracic surgeons for the high rate of mortality and complications (up to 11% and 45% respectively) ( 67 ) in particular if compared to extended pleurectomy (EP) or pleurectomy/decortication (P/D). In the unique randomized controlled trial (RCT) published until now, no advantage in terms of OS and quality of life (QoL) was achieved by EPP with adjuvant hemithorax irradiation ( 68 ); on the contrary, a recent meta-analysis indicates that P/D compared to EPP is associated with enhanced outcomes regarding 30-day mortality, median OS, and complications ( 69 ). We are waiting for the results in terms of effectiveness, OS, health-related QoL, progression-free survival (PFS), and measures of safety (adverse events of a UK multicentric RCT comparing (extended) pleurectomy decortication plus chemotherapy versus chemotherapy alone ( 70 ).…”

Section: Differences Between Ar-mpm and Non-ar-mpmmentioning

confidence: 99%

The genetic susceptibility in the development of malignant pleural mesothelioma: somatic and germline variants, clinicopathological features and implication in practical medical/surgical care: a narrative review

Congedo,

West,

Evangelista

et al. 2024

J Thorac Dis

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Background and Objective Malignant pleural mesothelioma (MPM) is a very aggressive primary tumor of the pleura whose main risk factor is exposure to asbestos. However, only a minority of exposed people develops MPM and the incidence of MPM cases without an apparent association with asbestos exposure has been increasing in recent years, suggesting that genetic predisposing factors may play a crucial role. In addition, several studies reported familial cases of MPM, suggesting that heredity may be an important and underestimated feature in MPM development. Several candidate genes have been associated with a predisposition to MPM and most of them play a role in DNA repair mechanisms: overall, approximately 20% of MPM cases may be related to genetic predisposition. A particular category of patients with high susceptibility to MPM is represented by carriers of pathogenic variants in the BAP1 gene. Germline variants in BAP1 predispose to the development of MPM following an autosomal dominant pattern of inheritance in the familial cases. MPMs in these patients are significantly less aggressive, and patients require a multidisciplinary approach that involves genetic counseling, medical genetics, pathology, surgical, medical, and radiation oncology expertise. In the present narrative review, we presented a comprehensive overview of genetic susceptibility in the development of MPM. Methods The narrative review is based on a selective literature carried out in PubMed in 2023. Inclusion criteria were original articles in English language, and clinical trials (randomized, prospective, or retrospective). Key Content and Findings We summarized the somatic and germline variants and the differences in terms of clinicopathological features and prognosis between gene-related MPM (GR-MPM) and asbestos-related MPM (AR-MPM). We also discussed the indications for screening, genetic testing, and surveillance of patients with BAP1 germline variants. Conclusions In this narrative review, we have emphasized that the BAP1 gene’s harmful germline variations are inherited in an autosomal dominant manner in familial cases. MPMs in individuals with these variations are less severe, and their medical care necessitates a collaborative effort. Additionally, we have outlined the current therapeutic prospects for MPM, including the possibility of gene-specific therapy, which is currently promising but still requires clinical validation.

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Section: Differences Between Ar-mpm and Non-ar-mpmmentioning

confidence: 99%

The genetic susceptibility in the development of malignant pleural mesothelioma: somatic and germline variants, clinicopathological features and implication in practical medical/surgical care: a narrative review

Congedo,

West,

Evangelista

et al. 2024

J Thorac Dis

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“…In a study of 1,307 patients, Verma et al found the incidences of patients undergoing surgery for newly diagnosed DPM were 79% and 21% for P/D and EPP, respectively (8). In addition, in a study of 4,852 patients, Magouliotis et al showed P/D to have fewer complications and improved 30-day mortality and median overall survival when compared to EPP (9). Editorial Some like it hot: the potential role of hyperthermic intrathoracic chemotherapy in the multimodality treatment of pleural mesothelioma Klotz et al reported 30-day mortalities for the EPD/ HITOC and EPP cohorts of 0% and 2.9%, respectively.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Some like it hot: the potential role of hyperthermic intrathoracic chemotherapy in the multimodality treatment of pleural mesothelioma

Branch¹,

Adusumilli²,

Zauderer³

2023

Transl Lung Cancer Res

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Surgery for pleural mesothelioma in multimodality setting: comparison between surgical techniques in a high-volume centre

Faccioli,

Dell’Amore,

Lorenzoni

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Pleural mesothelioma (PM) is an aggressive disease linked to asbestos exposure, presenting significant treatment challenges. The recommended approach is multimodal treatment, even if the concept of resectable PM and the superiority of one surgical technique over the other [(extended) pleurectomy decortication [(E)PD] vs extra-pleural pneumonectomy (EPP)] are matter of debates. The aim of this study is to compare the two techniques in terms of short- and long-term outcomes at a high-volume center. METHODS Clinical data from PM patients who underwent radical surgery [(E)PD and EPP] between 1994 and 2022 were collected. A propensity score weighting approach was used for non-random intervention allocation. Survival distribution was estimated using Kaplan–Meier method and the association with outcomes was evaluated using a weighted Cox Proportional Hazard Models. RESULTS Among 254 patients, 125 (49%) underwent EPP and 129 (51%) (E)PD. The 90-day mortality was higher in the EPP group (7.2% vs 0%; p = 0.01). No difference in 1-,3- and 5-year survival was found: 65.8%, 26%, 17% for EPP and 75.5%, 39.7% and 21.3% for (E)PD; p = 0.39). The multivariable weighted Cox model identified no increased risk of death (HR 1.25; p = 0.49) or recurrence (HR 1.05; p = 0.858) in the EPP group. Pre-operative total lung capacity (TLC) was significantly associated with a reduced risk of death (HR 0.96; p = 0.023) and recurrence (HR 0.97; p = 0.019) at follow-up while preoperative disease burden to a higher risk of recurrence (HR 1.01; p = 0.02). CONCLUSIONS Our experience showed acceptable short- and long-term outcomes in both procedures, making EPP still an option only for carefully selected patients at high volume center. Surgery, although recently debated, should be performed exclusively in expert centers to minimize post-operative risks. The identification of new prognostic factors is crucial for better selecting patients who may benefit from surgery within the context of multimodal treatment.

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Meta-analysis of survival after extrapleural pneumonectomy (EPP) versus pleurectomy/decortication (P/D) for malignant pleural mesothelioma in the context of macroscopic complete resection (MCR)

Cited by 4 publications

References 28 publications

The genetic susceptibility in the development of malignant pleural mesothelioma: somatic and germline variants, clinicopathological features and implication in practical medical/surgical care: a narrative review

The genetic susceptibility in the development of malignant pleural mesothelioma: somatic and germline variants, clinicopathological features and implication in practical medical/surgical care: a narrative review

Some like it hot: the potential role of hyperthermic intrathoracic chemotherapy in the multimodality treatment of pleural mesothelioma

Surgery for pleural mesothelioma in multimodality setting: comparison between surgical techniques in a high-volume centre

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