Doctors could soon pick the best surgery for pleural mesothelioma patients because of a new predictive model created by Harvard researchers. There are different types of mesothelioma surgery: one involves removing a lung while the other leaves the lungs. The best surgery for each individual patient depends on the person’s demographics, symptoms, and lab values. Surgeons and institutions are also a factor since they have preferences on the type of surgery they will be giving. If the model is used, there could be better and more accurate clinical trials and treatment outcomes.
Extrapleural pneumonectomy (EPP) is the most aggressive type of mesothelioma surgery. It involves removing a lung while pleurectomy and decortication (P/D) surgery keeps the lungs in the body and takes out the pleural membrane and other cancerous tissue. If the surgeons see cancer on the lungs, they scrape it away as well. There are mixed results with both surgeries. Some patients live longer because of EPP surgery while others live longer because of P/D surgery. With the data from the research at Harvard, doctors could know why certain people benefit from each surgery over others.
Multiple tests were performed on mesothelioma tissue from 400 patients that had either EPP or P/D surgery between the years 2007 and 2014. Different tests called The Mesothelioma Prognostic Test and molecular subtype based on Claudin 15 to Vimentin expression ratio are involved, which help doctors determine survival. They were combined with tumor volume and a white blood test called the neutrophil-to-lymphocyte ratio. The results from these tests were able to create a more accurate predictive model for mesothelioma surgery survival. The four different tests helped determine the outcome for EPP patients independently while a poor risk value from The Mesothelioma Prognostic Test with a tumor volume greater than 200 cc had triple the risk of a poor outcome for P/D surgery patients. Both models were better than the predictive tests we have now.
Mesothelioma tests like this can help patients live longer, better lives. Mesothelioma is a very aggressive cancer with no cure, so clinical trials like this help doctors understand the cancer and create better treatments. This test will allow doctors to determine if a surgery is warranted and then help doctors pick the best surgery for each patient.
