Related Experiment Video
Updated: Jan 18, 2026
Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines
Published on: April 21, 2022
Malignant Local Seeding in Procedure Tracts of Pleural Mesothelioma: Incidence and Novel Risk Factors in 308 Patients
Moshe Lapidot1,2, Emanuele Mazzola3, Raphael Bueno1
1Division of Thoracic Surgery, Lung Center and International Mesothelioma Program, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Abstract:
Background/Objectives: Unlike other thoracic malignancies, seeding malignant cells along surgical tracts is a known complication of invasive diagnostic or therapeutic procedures for pleural mesothelioma (PM). We report the tract dissemination rate and risk factors in 308 consecutive patients treated over 9 years in a single institution who underwent pleurectomy decortication (PD). Methods: Clinical and outcome data were reviewed. Fisher's exact test, Kaplan-Meier estimators, and log-rank tests were used to identify significant risk factors for surgical tract dissemination and to compare overall survival. Results: There were 233 males (75.6%), 187 right-sided operations (61%), 190 (61.7%) epithelioid histology cases, and the median age was 69 (29-84). During the study, malignant cell dissemination in resected surgical tracts was diagnosed in 69 (22.4%) patients. The dissemination rates in epithelioid, biphasic, and sarcomatoid tumors were 24.7%, 20.4%, and 0%, respectively. Disseminated malignant surgical tract was associated with advanced nodal status (p = 0.001), advanced staging by the American Joint Committee on Cancer (AJCC 8th edition, p = 0.03), female sex (0.02), side of surgery (p = 0.03), and the number of video-assisted thoracoscopic surgery (VATS) ports (p = 0.003). In epithelioid mesothelioma, the median survival from diagnosis was 19.7 months in patients with tract seeding versus 36.3 months in patients without seeding (hazard ratio, 1.9; p = 0.001). Conclusions: Procedure tract dissemination occurs in almost every fourth patient with pleural mesothelioma and is associated with shorter overall survival in the epithelioid subtype.
Insights
Tract seeding of malignant cells occurs in nearly 25% of pleural mesothelioma patients undergoing surgery. This complication is linked to reduced survival, particularly in epithelioid mesothelioma cases.
Area of Science:
- Thoracic Oncology
- Surgical Pathology
- Malignant Pleural Mesothelioma Research
Background:
- Surgical tract seeding is a known complication for thoracic malignancies.
- Pleural mesothelioma (PM) patients undergoing invasive procedures face this risk.
- Understanding tract dissemination is crucial for patient outcomes.
Purpose of the Study:
- To determine the rate of malignant cell dissemination along surgical tracts in pleural mesothelioma patients.
- To identify risk factors associated with surgical tract seeding.
- To evaluate the impact of tract seeding on overall survival.
Main Methods:
- Retrospective review of clinical and outcome data from 308 consecutive pleural mesothelioma patients.
- Analysis of surgical tract dissemination rates and associated risk factors.
- Statistical analysis including Fisher's exact test, Kaplan-Meier estimators, and log-rank tests.
Main Results:
- Malignant cell dissemination was diagnosed in 22.4% of patients.
- Dissemination rates varied by histology: epithelioid (24.7%), biphasic (20.4%), sarcomatoid (0%).
- Risk factors included advanced nodal status, advanced AJCC staging, female sex, surgical side, and number of VATS ports.
Conclusions:
- Procedure tract dissemination is frequent in pleural mesothelioma, affecting nearly one in four patients.
- Tract seeding is significantly associated with shorter overall survival in epithelioid mesothelioma.
- These findings highlight the importance of considering tract seeding in surgical planning and patient management.
