bims-mesote 2022-08-14 papers

Issue of 2022–08–14
three papers selected by
Laura Mannarino, Humanitas Research

J Clin Med. 2022 Aug 03. pii: 4537. [Epub ahead of print]11(15):

Single-Center 20-Year Experience in Surgical Treatment of Malignant Pleural Mesothelioma.

Giuseppe Mangiameli, Edoardo Bottoni, Umberto Cariboni, Giorgio Maria Ferraroli, Emanuela Morenghi, Veronica Maria Giudici, Emanuele Voulaz, Marco Alloisio, Alberto Testori.

OBJECTIVES: We examined a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent surgery in our institution during the last 20 years. Across this period, we changed our surgical approach to MPM, adopting extended pleurectomy and decortication (eP/D) instead of extrapleural pneumonectomy (EPP). In this study, we compare the perioperative outcomes and long-term survival of patients who underwent EPP vs. eP/D.
METHODS: A retrospective analysis was carried out of all the MPM patients identified from our departmental database who underwent EPP or P/D from 2000 to 2021. Clavien-Dindo criteria was adopted to score postoperative complications, while Kaplan-Meier methods and a Cox multivariable analysis were used to perform the survival analysis.
RESULTS: Of 163 patients, 78 (48%) underwent EPP and 85 (52%) eP/D. Induction chemotherapy was significantly administrated more often in the eP/D group (88% vs. 51%). Complete trimodality treatment including induction chemotherapy, radical surgery, and adjuvant radiotherapy was administered in 74% of the eP/D group versus 32% of the EPP group (p < 0.001). The postoperative morbidity rate was higher in the eP/D group (54%) compared to the EPP group (36%) (p = 0.02); no statistically significant differences were identified concerning major complications (EPP 43% vs. eP/D 24%, p = 0.08). No statistical differences were identified in 30-day mortality, 90-day mortality, median disease-free, and overall survival statistics between the two groups. The Cox multivariable analysis confirmed no induction chemotherapy (HR, 0.5; p = 0.002), RDW (HR, 1.08; p = 0.02), and the presence of pathological nodal disease (HR, 1.99; p = 0.001) as factors associated with worse survival in the entire series.
CONCLUSIONS: Our data support that eP/D is a well-tolerated procedure allowing the implementation of a trimodality strategy (induction chemotherapy, surgery, and radiotherapy) in most MPM patients. When eP/D is offered in this setting, the oncological results are comparable to EPP. To obtain the best oncological results, the goal of surgical resection should be macroscopic complete resection (R0) in carefully selected patients (clinical N0).

Keywords: extended pleurectomy and decortication (eP/D); extrapleural pneumonectomy (EPP); malignant pleural mesothelioma (MPM); mesothelioma; pleura; thoracic cancer

DOI: https://doi.org/10.3390/jcm11154537

Cancers (Basel). 2022 Jul 29. pii: 3699. [Epub ahead of print]14(15):

Sarcopenia as a Predictor of Short- and Long-Term Outcomes in Patients Surgically Treated for Malignant Pleural Mesothelioma.

Eleonora Faccioli, Stefano Terzi, Chiara Giraudo, Andrea Zuin, Antonella Modugno, Francesco Labella, Giovanni Zambello, Giulia Lorenzoni, Marco Schiavon, Dario Gregori, Giulia Pasello, Fiorella Calabrese, Andrea Dell'Amore, Federico Rea.

Surgery for malignant pleural mesothelioma (MPM) should be reserved only for patients who have a good performance status. Sarcopenia, a well-known predictor of poor outcomes after surgery, is still underinvestigated in MPM. The aim of this study is to evaluate the role of sarcopenia as a predictor of short-and long-term outcomes in patients surgically treated for MPM. In our analysis, we included patients treated with a cytoreductive intent in a multimodality setting, with both pre- and post-operative CT scans without contrast available. We excluded those in whom a complete macroscopic resection was not achieved. Overall, 86 patients were enrolled. Sarcopenia was assessed by measuring the mean muscular density of the bilateral paravertebral muscles (T12 level) on pre-and post-operative CTs; a threshold value of 30 Hounsfield Units (HU) was identified. Sarcopenia was found pre-operatively in 57 (66%) patients and post-operatively in 61 (74%). Post-operative sarcopenic patients had a lower 3-year overall survival (OS) than those who were non-sarcopenic (34.9% vs. 57.6% p = 0.03). Pre-operative sarcopenia was significantly associated with a higher frequency of post-operative complications (65% vs. 41%, p = 0.04). The evaluation of sarcopenia, through a non-invasive method, would help to better select patients submitted to surgery for MPM in a multimodality setting.

Keywords: mesothelioma; sarcopenia; surgery; survival

DOI: https://doi.org/10.3390/cancers14153699

J Am Soc Cytopathol. 2022 Jul 09. pii: S2213-2945(22)00067-9. [Epub ahead of print]

Diagnostic capacity of BAP1 and MTAP in cytology from effusions and biopsy in mesothelioma.

Louise Andersen Lynggård, Vasiliki Panou, Weronika Szejniuk, Oluf Dimitri Røe, Christos Meristoudis.

INTRODUCTION: Serous effusion is often the first sign of mesothelioma. Diagnosis based on cytologic material from the effusions remains controversial and complementary biopsy is usually required. However, obtaining representative tissue sample may be challenging, while obtaining cytologic material is a minimally invasive procedure, providing potential for an earlier diagnosis. Loss of BRCA1-associated protein (BAP1), combined with loss of methylthionadenosine phosphorylase (MTAP) detected by immunohistochemistry, have shown to be reliable markers in the diagnosis of mesothelioma on histologic sections. Here we evaluate the value of these biomarkers in cytologic specimens.
MATERIALS AND METHODS: The BAP1 and MTAP expression in specimens of 162 mesothelioma patients (156 pleural, 6 peritoneal)-71 cytologic, 91 histologic (44 epithelioid, 31 biphasic, 16 sarcomatoid)-and 20 patients with reactive mesothelial proliferations were investigated.
RESULTS: The loss of BAP1 and/or MTAP was highly sensitive and specific in differentiating mesothelioma from reactive mesothelial proliferations, with no significant difference between pleural effusions and biopsies, specificity of 100% in both and a sensitivity of 78.9% and 80.2%, respectively (P = 0.3). There was a 100% concordance of the expression of BAP1 and MTAP in cytologic and corresponding histopathologic samples. Loss of BAP1 and/or MTAP in histologic sections discriminated sarcomatoid, biphasic, and epithelioid mesothelioma from reactive mesothelial proliferations with a sensitivity of 81.2%, 83.9%, and 77.3% respectively.
CONCLUSION: Loss of expression of BAP1 and/or MTAP differentiated mesothelioma from reactive mesothelial proliferations with excellent specificity and high sensitivity in cytologic samples, comparable to histopathologic sections.

Keywords: BRCA1-Associated protein (BAP1); Effusion cytology; Immunohistochemistry; Mesothelioma; Methylthionadenosine phosphorylase (MTAP)

DOI: https://doi.org/10.1016/j.jasc.2022.07.003