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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2014

01-04-2014 | Gastrointestinal Oncology

Malignant Peritoneal Mesothelioma: Prognostic Factors and Oncologic Outcome Analysis

Authors: Deepa Magge, MD, Mazen S. Zenati, MD, MPH, PhD, Frances Austin, MD, Arun Mavanur, MD, Magesh Sathaiah, MD, Lekshmi Ramalingam, MD, Heather Jones, MPA-C, Amer H. Zureikat, MD, Matthew Holtzman, MD, Steven Ahrendt, MD, James Pingpank, MD, Herbert J. Zeh, MD, David L. Bartlett, MD, Haroon A. Choudry, MD

Published in: Annals of Surgical Oncology | Issue 4/2014

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Abstract

Background

Most patients with malignant peritoneal mesothelioma (MPM) present with late-stage, unresectable disease that responds poorly to systemic chemotherapy while, at the same time, effective targeted therapies are lacking. We assessed the efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) in MPM.

Methods

We prospectively analyzed 65 patients with MPM undergoing CRS/HIPEC between 2001 and 2010. Kaplan–Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes.

Results

Adequate CRS was achieved in 56 patients (CC-0 = 35; CC-1 = 21), and median simplified peritoneal cancer index (SPCI) was 12. Pathologic assessment revealed predominantly epithelioid histology (81 %) and biphasic histology (8 %), while lymph node involvement was uncommon (8 %). Major postoperative morbidity (grade III/IV) occurred in 23 patients (35 %), and 60-day mortality rate was 6 %. With median follow-up of 37 months, median overall survival was 46.2 months, with 1-, 2-, and 5-year overall survival probability of 77, 57, and 39 %, respectively. Median progression-free survival was 13.9 months, with 1-, 2-, and 5-year disease failure probability of 47, 68, and 83 %, respectively. In a multivariate Cox-regression model, age at surgery, SPCI >15, incomplete cytoreduction (CC-2/3), aggressive histology (epithelioid, biphasic), and postoperative sepsis were joint significant predictors of poor survival (chi square = 42.8; p = 0.00001), while age at surgery, SPCI >15, incomplete cytoreduction (CC-2/3), and aggressive histology (epithelioid, biphasic) were joint significant predictors of disease progression (Chi square = 30.6; p = 0.00001).

Conclusions

Tumor histology, disease burden, and the ability to achieve adequate surgical cytoreduction are essential prognostic factors in MPM patients undergoing CRS/HIPEC.
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Metadata
Title
Malignant Peritoneal Mesothelioma: Prognostic Factors and Oncologic Outcome Analysis
Authors
Deepa Magge, MD
Mazen S. Zenati, MD, MPH, PhD
Frances Austin, MD
Arun Mavanur, MD
Magesh Sathaiah, MD
Lekshmi Ramalingam, MD
Heather Jones, MPA-C
Amer H. Zureikat, MD
Matthew Holtzman, MD
Steven Ahrendt, MD
James Pingpank, MD
Herbert J. Zeh, MD
David L. Bartlett, MD
Haroon A. Choudry, MD
Publication date
01-04-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 4/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3358-y

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