Clinicopathologic indices can improve patient selection in malignant mesothelioma.

The authors should be congratulated for their comprehensive review of prognostic factors in malignant pleural mesothelioma. Although the paper emphasizes the emergence of molecular and genetic biomarkers, which hold great promise for transforming the management of malignant mesothelioma, the authors also cite numerous studies of hard clinical indices that have prognostic significance in mesothelioma. These include basic epidemiologic variables, clinical characteristics, common blood assays, findings on various imaging modalities, gross features of the tumor, and anatomic extent of disease. Perhaps most critical from a surgical perspective is the association between tumor volume and outcome, which was first documented in a prospective study by Pass et al.[1] This study heralded the central role of cytoreductive surgery in the multimodality treatment of malignant mesothelioma.