Advances in malignant peritoneal mesothelioma

Our plain-English summary of Advances in malignant peritoneal mesothelioma, by S. Cao, S. Jin, J. Cao, et al (International Journal of Colorectal Disease, 2015).

The study

• Authors: S. Cao, S. Jin, J. Cao, J. Shen, J. Hu, D. Che, B. Pan, J. Zhang, X. He, D. Ding, F. Gu, Y. Yu
• Journal: International Journal of Colorectal Disease
• Published: 2015;30(1):1-10
• Type of article: Review
• Cited by: 43 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant mesothelioma is a rare, insidious, and aggressive tumor arising from the mesothelial surface of pleural and peritoneal cavities, the pericardium, or the tunica vaginalis, with an increasing incidence worldwide, high misdiagnosis rate, and overall negative prognosis. A total of 20% of all cases is peritoneum in origin.

Methods: The present study is a review of literatures focusing on the advances in epidemiology, clinical presentations, radiological features, diagnosis, misdiagnosis, management, and prognostic factors of malignant peritoneal mesothelioma (MPM) occurred in the past decades.

Results: Asbestos, SV40, and radiation exposures have been demonstrated to be correlated with the pathogenesis of MPM. The main presentations are abdominal distension and pain. Computed tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomography (PET) play an important role in the preoperative imaging and staging. Definitive diagnosis is made on the basis of immunohistochemistry. Prognostic factors have been identified and verified. Negative indicators include advanced age, male gender, poor performance status, non-epithelial histology, and absence of surgery. The management of MPM has evolved from single chemotherapy to multimodality treatment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), chemotherapy, radiotherapy, and immunotherapy. Promising results have been achieved after a combined treatment of CRS and HIPEC, with an elevated median survival time of 29.5-92 months and a 5-year survival rate of 39-63%.

Conclusions: CRS and HIPEC represent the standard treatment strategy for selected patients with MPM, and patients with unresectable tumors can benefit from the combined treatment of chemotherapy, radiotherapy, and immunotherapy.

In plain English

This article reviewed published research on malignant peritoneal mesothelioma (MPM), a cancer of the abdominal lining, and reported no new patient data. Citing other work, the authors wrote that asbestos is the main cause of MPM and that 90 % of MPM is associated with asbestos exposure. Radiation, talc, mica, erionite, thorotrast, Hodgkin's disease and SV40 were also reported as linked. They cited a delay of 25–71 years between asbestos exposure and the disease. The main symptoms were abdominal swelling and pain. The authors summarized outcomes of surgery to remove visible tumor (CRS) plus heated chemotherapy inside the abdomen (HIPEC) as median survival of 29.5–92 months and 5-year survival of 39–63 %. However, their main text also cited a 5-year rate of 91.3 %. In the review's table, MPM studies reported death rates around the time of surgery of 1.9–6.0 % and complication rates of 15–46 %. The authors concluded that CRS and HIPEC are the standard treatment for selected patients. They also concluded that patients whose tumors cannot be removed can benefit from pemetrexed and cisplatin chemotherapy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative literature review (no new data; search method and number of studies not stated)
• Who was studied: Published studies on malignant peritoneal mesothelioma from the past decades, covering epidemiology, symptoms, imaging, diagnosis, treatment and prognosis
• Exposure: Asbestos, described from other studies as the main cause of MPM; fiber types are not specified. Radiation, talc, mica, erionite, thorotrast, Hodgkin's disease and SV40 are also mentioned.
• Main results:
  • Citing other work, the review states that 90 % of MPM is associated with asbestos exposure
  • Other exposures reported in other studies to be linked with MPM: radiation, talc, mica, erionite, thorotrast, Hodgkin's disease and SV40
  • The latency between asbestos exposure and MPM is cited as 25–71 years
  • The main presenting symptoms are abdominal distension and pain
  • The authors' headline summary (introduction, abstract and conclusions) of CRS plus HIPEC in MPM: median survival 29.5–92 months and 5-year overall survival 39–63 %
  • For the studies of CRS plus HIPEC from the past 3 years, the main text reports median survival of 38.4–63.2 months and 5-year survival of 39–91.3 %. This exceeds the headline 39–63 % range.
  • In the largest cited multi-institutional registry study of CRS plus HIPEC, median survival of all 401 patients was 53 months, with 3- and 5-year survival of 60 and 47 %
  • The authors give perioperative mortality of 0.0–6.0 % and morbidity of 15–56 % from Table 3. Table 3 also includes studies of peritoneal carcinomas of mixed origin. In its MPM-only rows, mortality is 1.9–6.0 % and morbidity 15–46 %.
  • Negative prognostic indicators identified in the reviewed literature: advanced age, male gender, poor performance status, non-epithelial histology and absence of surgery
  • Pemetrexed with cisplatin, borrowed from the treatment of malignant pleural mesothelioma, became the standard for unresectable patients, with a median survival time of 12.1 months
• The authors' conclusion: The authors concluded that CRS and HIPEC represent the standard strategy for selected patients, and that patients with unresectable tumors can benefit from systemic chemotherapy with pemetrexed and cisplatin
• Limitations the authors state:
  • The authors note that few clinical trials of chemotherapy in MPM have been performed because the disease is rare
  • The authors note that the role of radiotherapy in MPM remains unclear
  • The authors note that data on immunotherapy are limited

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Malignant Mesothelioma, Pericardium, Tunica Vaginalis, Misdiagnosis, Prognosis, Peritoneum, Epidemiology.

Related studies

• Predictive factors analysis for malignant peritoneal mesothelioma — S. Jin, S. Cao, et al. (2015)
• Malignant pericardial mesothelioma : A systematic review of current practice — S. Cao, S. Jin, et al. (2018)
• Colonic invasion induced by malignant peritoneal mesothelioma — S.B. Cao, S. Jin, et al. (2014)
• Elevated aspartate aminotransferase and monocyte counts predict unfavorable prognosis in patients with malignant pleural mesothelioma — A. Zhang, S. Cao, et al. (2017)
• Malignant peritoneal mesothelioma — K.E. Bani-Hani, K.A. Gharaibeh (2005)
• Peritoneal mesothelioma presenting as an adnexal mass — R.A. Komorowski, D.H. Bobert (1975)

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