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Prognostic Analysis of Clinicopathologic Factors in 49 Patients With Diffuse Malignant Peritoneal Mesothelioma Treated With Cytoreductive Surgery and Intraperitoneal Hyperthermic Perfusion

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Abstract

Background

Diffuse malignant peritoneal mesothelioma (DMPM) is a subset of peritoneal mesothelioma with a poor clinical outcome. We performed a prognostic analysis in a cohort of DMPM patients treated homogeneously by cytoreductive surgery and intraperitoneal hyperthermic perfusion (IPHP).

Methods

Forty-nine DMPM patients who underwent 52 consecutive procedures were enrolled onto the study. Cytoreductive surgery was performed according to the peritonectomy technique, and the IPHP was performed with cisplatin plus doxorubicin or cisplatin plus mitomycin C. We assessed the correlation of the clinicopathologic variables (previous surgical score, age, sex, performance status, previous systemic chemotherapy, carcinomatosis extension, completeness of cytoreduction, IPHP drug schedule, mitotic count [MC], nuclear grade, and biological markers [epidermal growth factor receptor, p16, matrix metalloproteinase 2 and matrix metalloproteinase 9]) with overall and progression-free survival.

Results

The mean age was 52 years (range, 22–74 years). The mean follow-up was 20.3 months (range, 1–89 months). Regarding the biological markers, the rates of immunoreactivity of epidermal growth factor receptor, p16, matrix metalloproteinase 2, and matrix metalloproteinase 9 were 94%, 60%, 100%, and 85%, respectively. The strongest factors influencing overall survival were completeness of cytoreduction and MC, whereas those for progression-free survival were performance status and MC. No biological markers were shown to be of prognostic value.

Conclusions

Completeness of cytoreduction, performance status, and MC seem to be the best determinants of outcome. These data warrant confirmation by a further prospective formal trial. No biological markers presented a significant correlation with the outcome. The overexpression of epidermal growth factor receptor, matrix metalloproteinase 2, and matrix metalloproteinase 9 and absent or reduced expression of p16 might be related to the underlining tumor kinetics of DMPM and warrant further investigation with other methods.

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Acknowledgments

Supported by the Associazione Italiana Ricerca sul Cancro.

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Authors and Affiliations

  1. Department of Surgery, National Cancer Institute, Via Venezian, 1, 20133, Milan, Italy

    Marcello Deraco MD, Rami Younan MD & Shigeki Kusamura MD

  2. Department of Pathology, National Cancer Institute, Milan, Italy

    Daisuke Nonaka MD, Dario Baratti MD, Juan Rosai MD, Andreola Salvatore MD & Antonello D. Cabras AD MD

  3. Department of Medical Oncology, National Cancer Institute, Milan, Italy

    Paolo Casali MD

  4. Department of Surgery, Centre Hospitalier de l’Université de Montreal, University of Montreal Health Center, Montreal, Canada

    Rami Younan MD

  5. Department of Obstetrics & Gynaecology, School of Medical Science, State University of Campinas, Campinas, Brazil

    Shigeki Kusamura MD

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  1. Marcello Deraco MD
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  2. Daisuke Nonaka MD
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Correspondence to Marcello Deraco MD.

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Deraco, M., Nonaka, D., Baratti, D. et al. Prognostic Analysis of Clinicopathologic Factors in 49 Patients With Diffuse Malignant Peritoneal Mesothelioma Treated With Cytoreductive Surgery and Intraperitoneal Hyperthermic Perfusion. Ann Surg Oncol 13, 229–237 (2006). https://doi.org/10.1245/ASO.2006.03.045

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  • DOI: https://doi.org/10.1245/ASO.2006.03.045

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