Prognosis of diffuse malignant peritoneal mesothelioma (DMPM) has been recently improved by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). As with other peritoneal surface malignancies, the survival benefit is maximal when a complete surgical cytoreduction is achieved, but additional factors predicting long-term outcome are still poorly understood. We sought to investigate outcome and prognostic factors in patients with DMPM treated by complete cytoreduction and HIPEC.
From a prospective database, we selected 108 patients with DMPM undergoing complete cytoreduction (residual tumour nodules ⩽2.5 mm) and closed-abdomen HIPEC with cisplatin and doxorubicin or mitomycin-C. Twenty-seven patient-, tumour- and treatment-related variables were assessed by multivariate analysis with respect to overall (OS) and progression-free (PFS) survival. A panel of immunohistochemical markers was tested.
Operative mortality was 1.9% and major morbidity 38.9%. Median follow-up was 48.8 months (95% confidence interval (CI) 37.1–60.6). Median OS and PFS were 63.2 months (95%CI 29.6–96.7) and 25.1 months (95%CI 5.1–45.1). The survival curve reached a plateau after 7 years, representing 19 actual survivors of 39 patients (43.6%) with potential follow-up ⩾7 years. Cytokeratin 5/6, calretinin, Wilms tumour-1 (WT-1), podoplanin and epithelial growth factor receptor (EGFR) were mostly positive. At multivariate analysis, epithelial histological subtype, negative lymph-nodes, ⩽10% Ki67-positive cells correlated with both increased OS and PFS. Positive podoplanin correlated to increased PFS.
After complete cytoreduction and HIPEC, prognosis of DMPM is primarily dependent on pathologic and biologic features. Patients with DMPM surviving ⩾7 years appeared to be cured. Cure rate was 43.6%. Proliferative index and podoplanin may be used for prognostic stratification.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Cancer
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Guidelines for pathologic diagnosis of malignant mesothelioma: a consensus statement from the International Mesothelioma Interest Group.Arch Pathol Lab Med. 2009; 133: 1317-1331
- Diffuse malignant peritoneal mesothelioma: systematic review of clinical management and biological research.J Surg Oncol. 2011; 103: 822-831
- Malignant peritoneal mesothelioma: a multicenter study on 81 cases.Ann Oncol. 2010; 21: 348-353
- Malignant peritoneal mesothelioma – results from the International Expanded Access Program using pemetrexed alone or in combination with a platinum agent.Lung Cancer. 2009; 64: 211-218
- Pemetrexed plus gemcitabine as first-line chemotherapy for patients with peritoneal mesothelioma: final report of a phase II trial.J Clin Oncol. 2008; 26: 3567-3572
- Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy.J Clin Oncol. 2003; 21: 4560-4567
- Prognostic indicators for patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma.Ann Surg Oncol. 2007; 14: 41-49
- Malignant peritoneal mesothelioma: treatment with maximal cytoreductive surgery plus intraperitoneal chemotherapy.Gastroenterol Clin Biol. 2007; 31: 784-788
- Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience.J Clin Oncol. 2009; 27: 6237-6242
- Lymph node metastases in diffuse malignant peritoneal mesothelioma.Ann Surg Oncol. 2010; 17: 45-53
- Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for malignant peritoneal mesothelioma: mitomycin versus cisplatin.Ann Surg Oncol. 2010; 17: 2720-2727
- Peritonectomy procedures.Ann Surg. 1995; 221: 29-42
- Platinum distribution in intraperitoneal tumors after intraperitoneal cisplatin treatment.Cancer Chemother Pharmacol. 1990; 25: 389-394
- Diffuse malignant mesothelioma of the peritoneum.Cancer. 2005; 104: 2181-2188
- Current methodologies for clinical assessment of patients with peritoneal carcinomatosis.J Exp Clin Cancer Res. 1996; 15: 49-58
- Prognostic analysis of clinicopathologic factors in 49 patients with diffuse malignant peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion.Ann Surg Oncol. 2006; 13: 229-237
- Cytoreductive surgery with selective versus complete parietal peritonectomy followed by hyperthermic intraperitoneal chemotherapy in patients with diffuse malignant peritoneal mesothelioma: a controlled study.Ann Surg Oncol. 2012; ([epub ahead of print])
- Hyperthermic intraoperative intraperitoneal chemotherapy with cisplatin and doxorubicin in patients who undergo cytoreductive surgery for peritoneal carcinomatosis and sarcomatosis: phase I study.Cancer. 2002; 94: 492-499
- Differential expression of Ki-67 and sex steroid hormone receptors between genders in peritoneal mesothelioma.Pathol Oncol Res. 2009; 15: 671-678
- New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada.J Natl Cancer Inst. 2000; 92: 205-216
- Nonparametric estimation from incomplete observations.J Am Stat Soc. 1958; 53: 457-481
- Regression models and life tables (with discussion).J R Stat Soc B. 1972; 34: 187-220
- Continued uncertainty regarding hyperthermic intraperitoneal chemotherapy in malignant peritoneal mesothelioma.J Clin Oncol. 2010; 28: e418
- Multidimensional analysis of the learning curve for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal surface malignancies.Ann Surg. 2012; 255: 348-356
- Survivin is highly expressed and promotes cell survival in malignant peritoneal mesothelioma.Cell Oncol. 2007; 29: 453-466
- P16 loss and mitotic activity predict poor survival in patients with peritoneal malignant mesothelioma.Clin Cancer Res. 2005; 11: 3303-3308
- Low podoplanin expression in pretreatment biopsy material predicts poor prognosis in advanced-stage squamous cell carcinoma of the uterine cervix treated by primary radiation.Mod Pathol. 2006; 19: 708-716
- Low podoplanin expression of tumor cells predicts poor prognosis in pathological stage IB squamous cell carcinoma of the lung, tissue microarray analysis of 136 patients using 24 antibodies.Lung Cancer. 2009; 63: 418-424
- Podoplanin expression in the development and progression of laryngeal squamous cell carcinomas.Mol Cancer. 2010; 9: 48
- Prognostic significance of high podoplanin expression after chemoradiotherapy in esophageal squamous cell carcinoma patients.J Surg Oncol. 2012; 105: 183-188
- Novel and existing mutations in the tyrosine kinase domain of the epidermal growth factor receptor are predictors of optimal resectability in malignant peritoneal mesothelioma.Ann Surg Oncol. 2009; 16: 152-158
- Receptor tyrosine kinase and downstream signaling analysis in diffuse malignant peritoneal mesothelioma.Eur J Cancer. 2010; 46: 2837-2848
Published online: July 08, 2013
© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.