bims-mesote 2025-02-09 papers

Issue of 2025–02–09
five papers selected by
Laura Mannarino, Humanitas Research

Lung Cancer. 2025 Jan;pii: S0169-5002(24)00608-1. [Epub ahead of print]199 108074

Efficacy of cryobiopsy during medical thoracoscopy for diagnosing malignant pleural mesothelioma.

Hayato Nanami, Yuji Matsumoto, Hideaki Furuse, Midori Tanaka, Takaaki Tsuchida, Yuichiro Ohe.

OBJECTIVES: Malignant pleural mesothelioma (MPM) is difficult to differentiate from other pleural diseases, and its diagnosis requires adequate tissue sampling. Although medical thoracoscopy is an established diagnostic procedure for pleural diseases, there is no consensus on whether it guarantees a high diagnostic yield for MPM. Cryobiopsy has been shown to have the potential to improve tissue sampling in other diseases; therefore, we aimed to investigate its efficacy in diagnosing MPM.
MATERIAL AND METHODS: Patients who underwent medical thoracoscopy at our institution between January 2013 and June 2023 and were finally diagnosed with MPM were analyzed. Patients who underwent biopsies with forceps and/or electrocautery devices were defined as the conventional group, whereas those who underwent biopsies with an additional cryoprobe were categorized as the cryo group. Diagnostic performance was compared between the two groups.
RESULTS: Among 347 patients who underwent medical thoracoscopy, 69 patients, 34 in the cryo group and 35 in the conventional group, were diagnosed with MPM. The overall diagnostic yield was 76.8 %, and the cryo group had a significantly higher yield than the conventional group (88.2 % vs. 65.7 %, P = 0.044). Furthermore, the subtype was confirmed in most of the patients in the cryo group but only in approximately two-thirds of those in the conventional group (79.4 % vs. 42.9 %, P = 0.003). Regarding safety, two patients (5.9 %) developed pneumothorax in the cryo group, and two (5.7 %) developed pneumonia in the conventional group.
CONCLUSION: Cryobiopsy is effective in improving the subtype confirmation rate as well as MPM diagnostic yield compared to conventional biopsy.

Keywords: Cryobiopsy; Diagnosis; Malignant pleural mesothelioma; Medical thoracoscopy; Subtype; Surgical thoracoscopy

DOI: https://doi.org/10.1016/j.lungcan.2024.108074

BMC Cancer. 2025 Feb 07. 25(1): 212

Exploring RNA cargo in extracellular vesicles for pleural mesothelioma detection.

Agnieszka Kraft, Michaela B Kirschner, Vanessa Orlowski, Manuel Ronner, Caroline Bodmer, Valentina Boeva, Isabelle Opitz, Mayura Meerang.

BACKGROUND: Pleural Mesothelioma (PM) is a highly aggressive cancer, for which effective early detection remains a challenge due to limited screening options and low sensitivity of biomarkers discovered so far. While extracellular vesicles (EVs) have emerged as promising candidates for blood-based biomarkers, their role in PM has not been studied yet. In this study, we characterized the transcriptomic profile of EVs secreted by PM primary cells and explored their potential as a biomarker source for PM detection.
METHODS: We collected cell culture supernatant from early-passage PM cell cultures derived from the pleural effusion of 4 PM patients. EVs were isolated from the supernatant using Qiagen exoEasy Maxi kit. RNA isolation from EVs was done using the mirVana PARIS kit. Finally, single-end RNA sequencing was done with Illumina Novaseq 6000.
RESULTS: We identified a range of RNA species expressed in EVs secreted by PM cells, including protein-coding RNA (80%), long non-coding RNA (13%), pseudogenes (4.5%), and short non-coding RNA (1.6%). We detected a subset of genes associated with the previously identified epithelioid (32 genes) and sarcomatoid molecular components (36 genes) in PM-EVs. To investigate whether these markers could serve as biomarkers for PM detection in blood, we compared the RNA content of PM-EVs with the cargo of EVs isolated from the plasma of healthy donors (publicly available data). Majority of upregulated genes in PM-EVs were protein-coding and long non-coding RNAs. Interestingly, 25 of them were the sarcomatoid and epithelioid marker genes. Finally, functional analysis revealed that the PM-EV RNA cargo was associated with Epithelial-Mesenchymal transition, glycolysis, and hypoxia.
CONCLUSIONS: This is the first study to characterize the transcriptomic profile of EVs secreted by PM primary cell cultures, demonstrating their potential as biomarker source for early detection. Further investigation of the functional role of PM-EVs will provide new insights into disease biology and therapeutic avenues.

Keywords: Biomarkers; Diagnosis; Extracellular vesicles; Pleural mesothelioma; Transcriptomics

DOI: https://doi.org/10.1186/s12885-025-13617-y

Ann Surg. 2025 Feb 05.

Multimodality Therapy Including Pleurectomy/Decortication in Pleural Mesothelioma: Long-Term Outcomes in 152 Consecutive Patients A Retrospective Cohort Study.

Loïc Lang-Lazdunski, Yu Zhi Zhang, Andrew G Nicholson.

OBJECTIVE: Evaluate the long-term outcomes of pleurectomy decortication, systemic chemotherapy and prophylactic radiotherapy in pleural mesothelioma (PM).
SUMMARY BACKGROUND DATA: There is no known cure for PM and cytoreductive surgery remains controversial.
METHODS: Retrospective analysis of a cohort of patients treated consecutively between October 2004 and October 2019. Patients with PM were referred to our clinic and those with favorable prognostic factors and with completely resectable disease were selected for trimodality therapy. Our treatment protocol involved total pleurectomy decortication (P/D) and hyperthermic intrapleural povidone-iodine, prophylactic chest wall radiotherapy and systemic chemotherapy. 18FDG-PET-CT was used routinely to diagnose disease recurrence. Further systemic therapies were administered when appropriate. Survival and prognostic factors were analyzed using the Kaplan-Meier method and univariate and multivariate Cox regressions.
RESULTS: 152 consecutive patients had P/D performed with curative intent. Median age was 64 years and the male/female ratio was 123/29. Thirty-one patients (20.4%) had received chemotherapy preoperatively. Thirty-five patients (23%) underwent extended resections. Sixty-four patients (42%) suffered a postoperative complication, but 90-day mortality was nil. Histological types were epithelioid in 107 patients (70.4%) and non-epithelioid in 45 (29.6%). Pathological stages were: I:88, II: 0, III: 63, and IV:1 (8th TNM classification). Six patients (4%) did not receive systemic chemotherapy and three (2%) no radiotherapy, postoperatively. Seventy-four patients (48.7%) received further systemic therapies for relapse. Median overall survival was 31.7 months, 35.0 months for epithelioid and 18.3 months for non-epithelioid histology. Histological type was the only predictor of overall survival, independent of resection status, pathological stage, or lymph node status, on multivariate analysis.
CONCLUSIONS: P/D is a safe and well-tolerated procedure resulting in no mortality and acceptable morbidity. Most patients can receive radiotherapy and systemic chemotherapy in due time and receive further therapies on relapse, resulting in prolonged survival mainly in those with early-stage epithelioid mesothelioma.

DOI: https://doi.org/10.1097/SLA.0000000000006654

Rep Pract Oncol Radiother. 2024 ;29(4): 509-515

Radiotherapy of the pleural cavity in patients with primary and secondary malignancies of the pleura.

Dimcho Georgiev, Marija Jankova, Bozhidar Krastev, Svetlana Bilyukova.

Background: Although there have been various attempts to find appropriate treatment from best conservative care to multimodal treatments, curative outcomes remain poor.
Materials and methods: 30 patients with primary and secondary malignant tumors of the pleura were treated in the Radiotherapy Clinic of USHATO during the period from December 2016 to April 2023. Video-assisted thoracoscopic surgery (VATS) and talc pleurodesis was performed in 18 patients (60%). In all patients, radiotherapy for the pleura was performed on a helical tomotherapy machine. In 21 patients (70%), normal fractionated radiotherapy was performed at daily dose of 1.8-2 Gy to total dose of 40 Gy (5 times a week), and in 6 patients (20%), integrated surdosage to 50 Gy was also performed for visible lesions. Hypofractionated radiotherapy (10 fractions of 3 Gy and 4 fractions of 4 Gy) was performed in 3 (10%) patients.
Results: Patients were followed up from 1 month to 57 months (median 14 months) or until death. The observed median survival for all patients was 19.2 months [95% confidence interval (CI): 11.5-26.9] (Fig. 3). The 1-, 2- and 3-year survival rates were 40%, 23% and 7% of patients, respectively. Malignant mesothelioma patients had 1-, 2- and 3-year survival rates of 31%, 10% and 0%, respectively. The 1-, 2-, and 3-year survival rates for patients with secondary malignancies were 54%, 45%, and 18%, respectively.
Conclusion: Our results suggest that helical tomotherapy is a feasible therapeutic option for patients with malignant mesothelioma or malignant secondary pleural involvement with a reasonable toxicity profile relative to other unaffected lung.

Keywords: malignant pleural mesothelioma; secondary malignancies of the pleura; tomotherapy

DOI: https://doi.org/10.5603/rpor.102614