Malignant peritoneal mesothelioma: Prognostic factors and oncologic outcome analysis

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

Research output: Contribution to journalArticle

43 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1159-1165
Number of pages7
JournalAnnals of Surgical Oncology
Volume21
Issue number4
DOIs
StatePublished - Apr 2014
Externally publishedYes

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Histology
Proportional Hazards Models
Survival
Neoplasms
Joints
Kaplan-Meier Estimate
Disease-Free Survival
Disease Progression
Malignant Mesothelioma
Sepsis
Lymph Nodes
Morbidity
Drug Therapy
Mortality
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Magge, D., Zenati, M. S., Austin, F., Mavanur, A., Sathaiah, M., Ramalingam, L., ... Choudry, H. A. (2014). Malignant peritoneal mesothelioma: Prognostic factors and oncologic outcome analysis. Annals of Surgical Oncology, 21(4), 1159-1165. https://doi.org/10.1245/s10434-013-3358-y

Malignant peritoneal mesothelioma : Prognostic factors and oncologic outcome analysis. / Magge, Deepa; Zenati, Mazen S.; Austin, Frances; Mavanur, Arun; Sathaiah, Magesh; Ramalingam, Lekshmi; Jones, Heather; Zureikat, Amer H.; Holtzman, Matthew; Ahrendt, Steven; Pingpank, James; Zeh, Herbert J.; Bartlett, David L.; Choudry, Haroon A.

In: Annals of Surgical Oncology, Vol. 21, No. 4, 04.2014, p. 1159-1165.

Research output: Contribution to journalArticle

Magge, D, Zenati, MS, Austin, F, Mavanur, A, Sathaiah, M, Ramalingam, L, Jones, H, Zureikat, AH, Holtzman, M, Ahrendt, S, Pingpank, J, Zeh, HJ, Bartlett, DL & Choudry, HA 2014, 'Malignant peritoneal mesothelioma: Prognostic factors and oncologic outcome analysis', Annals of Surgical Oncology, vol. 21, no. 4, pp. 1159-1165. https://doi.org/10.1245/s10434-013-3358-y
Magge D, Zenati MS, Austin F, Mavanur A, Sathaiah M, Ramalingam L et al. Malignant peritoneal mesothelioma: Prognostic factors and oncologic outcome analysis. Annals of Surgical Oncology. 2014 Apr;21(4):1159-1165. https://doi.org/10.1245/s10434-013-3358-y
Magge, Deepa ; Zenati, Mazen S. ; Austin, Frances ; Mavanur, Arun ; Sathaiah, Magesh ; Ramalingam, Lekshmi ; Jones, Heather ; Zureikat, Amer H. ; Holtzman, Matthew ; Ahrendt, Steven ; Pingpank, James ; Zeh, Herbert J. ; Bartlett, David L. ; Choudry, Haroon A. / Malignant peritoneal mesothelioma : Prognostic factors and oncologic outcome analysis. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 4. pp. 1159-1165.
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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.",
author = "Deepa Magge and Zenati, {Mazen S.} and Frances Austin and Arun Mavanur and Magesh Sathaiah and Lekshmi Ramalingam and Heather Jones and Zureikat, {Amer H.} and Matthew Holtzman and Steven Ahrendt and James Pingpank and Zeh, {Herbert J.} and Bartlett, {David L.} and Choudry, {Haroon A.}",
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T1 - Malignant peritoneal mesothelioma

T2 - Prognostic factors and oncologic outcome analysis

AU - Magge, Deepa

AU - Zenati, Mazen S.

AU - Austin, Frances

AU - Mavanur, Arun

AU - Sathaiah, Magesh

AU - Ramalingam, Lekshmi

AU - Jones, Heather

AU - Zureikat, Amer H.

AU - Holtzman, Matthew

AU - Ahrendt, Steven

AU - Pingpank, James

AU - Zeh, Herbert J.

AU - Bartlett, David L.

AU - Choudry, Haroon A.

PY - 2014/4

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N2 - 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.

AB - 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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