Treatment of Malignant Pleural Mesothelioma
In 2011 we published a series of in Boston in the European Journal of cardiothoracic surgery describing all Malignant Pleural Mesothelioma patients who survived at least three years after surgery or after extrapleural pneumonectomy from mesothelioma. I called this long-term survival and the reviewers panned it. They didn’t think that three years was a long term for Malignant Pleural Mesothelioma, I would argue it is but there you are.
We looked at all patients who survived at least 3 years to see how they differed from those who didn’t. In terms of clinic demographic factors, the idea is to figure out who we should operate on. So all patients who had surged strip Laurel pneumonectomy between 1988 and 2007 and looked at their complete preoperative data including labs and that will be relevant in a minute the reason we chose extra pleural pneumonectomy only is for that reason I showed you that picture of the specimen.
The most complete staging is obtained from an extra pleural pneumonectomy specimen, so you know you’re comparing apples to apples, oranges to oranges. if you’re looking at those specimens for the patients who survived at least 3 years of Malignant Pleural Mesothelioma, we looked more closely at their perioperative morbidity staging and survival and the groups differed on many fronts the I’m gonna call them long-term survivors because the reviewers are in this audience.
I don’t think the long-term survivors were more likely to be women, more commonly had an epithelial disease as we would expect based on what I told you earlier and more commonly had normal labs preoperatively.
The purpose of this slide is just to show you that the long-term survivors included patients with advanced stage disease staging mesothelioma is not surprisingly also controversial. There are multiple staging systems. there is one that has been abandoned the Butchart system we rarely use there was a Brigham system in 1999 and a later revised system for Malignant Pleural Mesothelioma.
There’s, of course, the AJC C TM or I’m the staging system no matter what staging system you used, you can see that there were some advanced stage disease patients who had surgery and went on to live against Malignant Pleural Mesothelioma. Looking at the morbidity, I can tell you having taken care of these patients for at least half a decade.
The survival rate of Malignant Pleural Mesothelioma Patients:
These are all the usual suspects in terms of post-operative complications and the usual rates the concept being. Post-operative morbidity did not prohibit long-term survival and here’s the overall survival for the entire group. The reason for the flat part of the curve as you may have guessed is because we only included patients who survived at least 3 years of Malignant Pleural Mesothelioma but importantly if they survived at least 3 years. There was about a 50% chance they would survive about 5 years.
It’s a long time in mesothelioma the other major finding of this paper and that has driven me to my current research. I was looking at the differences between men and women 59 was the median age for the groups and dichotomizing around that median age.
We see that older and younger men have the same Malignant Pleural Mesothelioma survival, yet older and younger women differ substantially we’ll come back to that but what we see here is that there’s something to being a young woman that facilitates long term survival in this disease and the findings as I had stated if you live 50.
If you live at least 3 years, there is about a 50% chance of living 5 years defeating Malignant Pleural Mesothelioma, those young women are disproportionately represented in this long-term survival, as survivors that perioperative morbidity does not prohibit long term survival. The young age female gender epithelial histology and normal labs were the predictors of better survival now that graph I showed you a few slides back superimposed and placed on the same scale, so these are younger and older men and older women.
Their survival is very similar this line represents the younger women so the role of gender in survival mesothelioma and the role of the genitive female gender as a positive prognosticator for long-term survival has been intermittently reported in the literature.
Here’s an old dana-Farber series by Karen ant-man here’s an Italian registry series this was a multicenter trial in the 80s and early 90s by the CA LGB. This chart comes from Herndon’s paper showing that of the 16 studies at that time only 4 of them reported female gender as a positive prognosticator for long-term survival and only these parentheses to represent ones that withstood multivariable analysis.
I looked at this issue more closely in the Brigham data and this series was published in 2010 in the annals of thoracic surgery there are at that time too fat 2100 patients in the patient registry. 715 of whom underwent extra pleural pneumonectomy and we chose 2008 as an endpoint to allow for follow-up and again chose extra pleural pneumonectomy to allow for complete staging just for research about Malignant Pleural Mesothelioma.
Continue to read Part 3 about Malignant Pleural Mesothelioma