J Gastrointest Surg (2015) 19:319–326 DOI 10.1007/s11605-014-2664-4
ORIGINAL ARTICLE
Predictive Factors Analysis for Malignant Peritoneal Mesothelioma Shi Jin & Shoubo Cao & Jingyan Cao & Jing Shen & Jing Hu & Dehai Che & Jiawen Zhang & Yan Yu
Received: 11 August 2014 / Accepted: 19 September 2014 / Published online: 9 October 2014 # 2014 The Society for Surgery of the Alimentary Tract
Abstract Background Malignant peritoneal mesothelioma (MPM) is an uncommon disease with a dismal prognosis and unclear natural history. The present study aims to assess potential prognostic factors and management of MPM. Methods Clinical records of 39 patients with MPM between December 2003 and April 2014 were retrospectively reviewed. Overall survival was identified with Kaplan-Meier curves and Cox regression analysis. Results Mean age of 39 patients was 55.0 years; asbestos exposure was recorded in two patients. Main presentations were abdominal distension, abdominal pain, and weight loss. Thrombocytosis, low serum albumin level, and anemia were principal laboratory abnormalities. Ascites, peritoneal cavity mass, and peritoneum thickening were the main signs on CT scans. Cytoreductive surgery (CRS) plus adjuvant therapies were performed in 22 patients, single chemotherapy in 13, and best supportive care in 4. Median survival time was 10.0 months after pathological diagnosis, with a 6-, 12-, 18-, and 24-month survival rate of 84.4, 31.6, 18.5, and 15.8 %, respectively. Significant prognostic factors were age, performance status (PS), abdominal pain, serum albumin level, thrombocytosis, and treatment strategy on univariate analysis, while only age, abdominal pain, and treatment strategy hold statistical significance on multivariate analysis. Conclusions Age ≤65 years, abdominal pain, and CRS plus adjuvant therapy are independent positive prognostic factors of MPM. Keywords Malignant peritoneal mesothelioma . Prognostic factors . Treatment . CRS . HIPEC
Introduction Malignant mesotheliomas are highly aggressive tumors arising from the pleura, peritoneum, tunica vaginalis testis, and pericardium. It is estimated that mesotheliomas represent less than 1 % of all cancers.1 Mesotheliomas are rare malignancies Shi Jin and Shoubo Cao contributed equally to this work and should be considered co-first authors. S. Jin : S. Cao : J. Cao : J. Shen : J. Hu : D. Che : J. Zhang : Y. Yu (*) Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Harbin 150081, China e-mail: [email protected] Y. Yu e-mail: [email protected]
with increasing frequency, and a total of 20 % mesothelioma is peritoneum in origin.1–6 It is regarded as a lethal disease closely associated with asbestos contact raised by Wagner et al. in 1960 with a negative prognosis of within 1 year,7,8 and the onset of about 60 % Malignant peritoneal mesothelioma (MPM) patients was correlated with direct or indirect asbestos contact. MPM carries a different incidence in various literatures, such as 1:1,000,000 in Sharma H et al.9 and 2.2:1,000,000 in Piazza D et al.10 However, regional distinctions also exist, with an incidence of 7, 15, 18, and 40 per million in Japan, USA, Europe, and Australia, respectively.2 Owing to the rarity of this disease, only few studies report numerous cases; most of them report small series or single case. MPM is usually diagnosed in advanced stage because of its nonspecific clinical and radiographic manifestations. The rarity of MPM and its diagnostic uncertainties limit the understanding of its clinical features and course. Given its increasing incidence, limited understandings, dismal prognosis, and effective and timely therapies are urgently needed.
320
At present, the treatment of MPM had evolved from single chemotherapy to multiple modality strategies. The role of chemotherapy and radiotherapy remains limited. Current standard first-line chemotherapy of MPM is pemetrexed (ALIMTA) combined with cisplatin, with a median survival time of 12.1 months.4 Cytoreductive surgery (CRS) plus heated intraperitoneal chemotherapy (HIPEC) have reformed the management for MPM in selected patients, with an increased median survival of 31–92 months and a 5-year overall survival rate of 39–63 %.6,11–14,27 Prognostic factors have been identified, but no unified results have been well established at present. In this study, we aim to investigate the effects of variable clinical, laboratory, radiological, and management parameters on survival of patients with MPM, which has not been studied previously in China.
Materials and Methods Patients A retrospective analysis was performed on the clinical, laboratory, radiological, and management data of 39 cases with pathologically confirmed MPM who were admitted to our hospital between December 2003 and April 2014. Our work has been approved by the ethical committees of Harbin Medical University Cancer Hospital with written informed consent for each patient. Certain laboratory, clinical, and radiographic variables were defined as potential prognostic factors and measured at the time of diagnosis. The following parameters were evaluated for prognostic evaluation: age, gender, the presence of hypertension, diabetes, smoking history, drinking history, family history of cancer, performance status (PS, ECOG scale), duration of symptoms, abdominal distension, abdominal pain, weight loss (>5 % in the last 3 months), fever, bowel obstruction, diarrhea, serum albumin level, platelet count, white blood cell count, hemoglobin, CA125, ascites on radiography, peritoneal cavity mass on radiography, peritoneum thickening on radiography, and different management. Thrombocytosis was defined with a platelet count >300,000/mm3 and anemia with a hemoglobin value
ORIGINAL ARTICLE
Predictive Factors Analysis for Malignant Peritoneal Mesothelioma Shi Jin & Shoubo Cao & Jingyan Cao & Jing Shen & Jing Hu & Dehai Che & Jiawen Zhang & Yan Yu
Received: 11 August 2014 / Accepted: 19 September 2014 / Published online: 9 October 2014 # 2014 The Society for Surgery of the Alimentary Tract
Abstract Background Malignant peritoneal mesothelioma (MPM) is an uncommon disease with a dismal prognosis and unclear natural history. The present study aims to assess potential prognostic factors and management of MPM. Methods Clinical records of 39 patients with MPM between December 2003 and April 2014 were retrospectively reviewed. Overall survival was identified with Kaplan-Meier curves and Cox regression analysis. Results Mean age of 39 patients was 55.0 years; asbestos exposure was recorded in two patients. Main presentations were abdominal distension, abdominal pain, and weight loss. Thrombocytosis, low serum albumin level, and anemia were principal laboratory abnormalities. Ascites, peritoneal cavity mass, and peritoneum thickening were the main signs on CT scans. Cytoreductive surgery (CRS) plus adjuvant therapies were performed in 22 patients, single chemotherapy in 13, and best supportive care in 4. Median survival time was 10.0 months after pathological diagnosis, with a 6-, 12-, 18-, and 24-month survival rate of 84.4, 31.6, 18.5, and 15.8 %, respectively. Significant prognostic factors were age, performance status (PS), abdominal pain, serum albumin level, thrombocytosis, and treatment strategy on univariate analysis, while only age, abdominal pain, and treatment strategy hold statistical significance on multivariate analysis. Conclusions Age ≤65 years, abdominal pain, and CRS plus adjuvant therapy are independent positive prognostic factors of MPM. Keywords Malignant peritoneal mesothelioma . Prognostic factors . Treatment . CRS . HIPEC
Introduction Malignant mesotheliomas are highly aggressive tumors arising from the pleura, peritoneum, tunica vaginalis testis, and pericardium. It is estimated that mesotheliomas represent less than 1 % of all cancers.1 Mesotheliomas are rare malignancies Shi Jin and Shoubo Cao contributed equally to this work and should be considered co-first authors. S. Jin : S. Cao : J. Cao : J. Shen : J. Hu : D. Che : J. Zhang : Y. Yu (*) Department of Medical Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Harbin 150081, China e-mail: [email protected] Y. Yu e-mail: [email protected]
with increasing frequency, and a total of 20 % mesothelioma is peritoneum in origin.1–6 It is regarded as a lethal disease closely associated with asbestos contact raised by Wagner et al. in 1960 with a negative prognosis of within 1 year,7,8 and the onset of about 60 % Malignant peritoneal mesothelioma (MPM) patients was correlated with direct or indirect asbestos contact. MPM carries a different incidence in various literatures, such as 1:1,000,000 in Sharma H et al.9 and 2.2:1,000,000 in Piazza D et al.10 However, regional distinctions also exist, with an incidence of 7, 15, 18, and 40 per million in Japan, USA, Europe, and Australia, respectively.2 Owing to the rarity of this disease, only few studies report numerous cases; most of them report small series or single case. MPM is usually diagnosed in advanced stage because of its nonspecific clinical and radiographic manifestations. The rarity of MPM and its diagnostic uncertainties limit the understanding of its clinical features and course. Given its increasing incidence, limited understandings, dismal prognosis, and effective and timely therapies are urgently needed.
320
At present, the treatment of MPM had evolved from single chemotherapy to multiple modality strategies. The role of chemotherapy and radiotherapy remains limited. Current standard first-line chemotherapy of MPM is pemetrexed (ALIMTA) combined with cisplatin, with a median survival time of 12.1 months.4 Cytoreductive surgery (CRS) plus heated intraperitoneal chemotherapy (HIPEC) have reformed the management for MPM in selected patients, with an increased median survival of 31–92 months and a 5-year overall survival rate of 39–63 %.6,11–14,27 Prognostic factors have been identified, but no unified results have been well established at present. In this study, we aim to investigate the effects of variable clinical, laboratory, radiological, and management parameters on survival of patients with MPM, which has not been studied previously in China.
Materials and Methods Patients A retrospective analysis was performed on the clinical, laboratory, radiological, and management data of 39 cases with pathologically confirmed MPM who were admitted to our hospital between December 2003 and April 2014. Our work has been approved by the ethical committees of Harbin Medical University Cancer Hospital with written informed consent for each patient. Certain laboratory, clinical, and radiographic variables were defined as potential prognostic factors and measured at the time of diagnosis. The following parameters were evaluated for prognostic evaluation: age, gender, the presence of hypertension, diabetes, smoking history, drinking history, family history of cancer, performance status (PS, ECOG scale), duration of symptoms, abdominal distension, abdominal pain, weight loss (>5 % in the last 3 months), fever, bowel obstruction, diarrhea, serum albumin level, platelet count, white blood cell count, hemoglobin, CA125, ascites on radiography, peritoneal cavity mass on radiography, peritoneum thickening on radiography, and different management. Thrombocytosis was defined with a platelet count >300,000/mm3 and anemia with a hemoglobin value
