Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: July 08, 2013
Identification
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© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
