Clinical presentation of peritoneal mesothelioma

Our plain-English summary of Clinical presentation of peritoneal mesothelioma, by Y.I. Acherman, L.S. Welch, C.M. Bromley, et al (Tumori, 2003).

The study

• Authors: Y.I. Acherman, L.S. Welch, C.M. Bromley, P.H. Sugarbaker
• Journal: Tumori
• Published: 2003;89(3):269-73
• Cited by: 77 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: To describe the clinical presentation of peritoneal mesothelioma and its impact on survival.

Methods: Data was collected from 51 patients with peritoneal mesothelioma treated at the Washington Cancer Institute. The demographic, clinical and pathologic information were analyzed.

Results: Pain was the most common symptom (recorded in 33% of patients); increased abdominal girth occurred in 31%, increased abdominal girth and pain in 5%, and a new onset hernia in 12%. In an additional 14% of patients, a variety of other clinical findings led to the diagnosis. There was a statistically significant difference in survival by gender, weight loss and volume of disease.

Conclusions: Pain was the most common initial presenting symptom, with increased abdominal girth as a second. A more favorable prognosis occurred in women with a small disease volume.

In plain English

This study reviewed records of patients with primary peritoneal surface cancers treated at the Washington Cancer Institute from 1989 through May 2001. It included 51 patients with peritoneal mesothelioma (34 men, 17 women). Pleural mesothelioma patients were excluded, and the article did not report asbestos or other exposures. Pain was the most common first symptom (17 patients, 33%). It was followed by increased abdominal girth (16, 31%), both together (5, 10%) and a new hernia (6, 12%). In 4 women the disease was found incidentally, and 4 patients presented with an acute abdomen. Median survival overall was 56 months. It was 21 months for men and not yet reached for women (P = 0.007). Three factors were each linked to shorter survival: weight loss of more than 10% of body weight, a peritoneal cancer index (a score of tumor extent) above 28, and sarcomatoid and biphasic tumors grouped together (versus epithelial). Differences by pain, ascites and fever were not statistically significant; for age, P was 0.060. The authors concluded that women with a small disease volume had a more favorable prognosis.

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: Retrospective review of medical records at a single institution (case series), with survival analysis by Kaplan-Meier estimates and logrank tests
• Who was studied: 51 patients with primary peritoneal mesothelioma (34 men, 17 women; mean age at diagnosis 50.3 years, range 16-78) treated at the Washington Cancer Institute, Washington, DC, from 1989 through May 2001. They were drawn from 55 confirmed cases; 4 were excluded for missing data. Patients with pleural mesothelioma were excluded.
• Exposure: Not studied. The article does not report asbestos or other exposures for these patients. It mentions asbestos only when discussing other studies.
• Main results:
  • Pain was the most common predominant initial symptom, in 17 of 51 patients (33%)
  • Increased abdominal girth was the second most common predominant initial symptom, in 16 of 51 patients (31%)
  • 5 patients (10% in Table 1) had pain and increased abdominal girth together as the initial presentation
  • A new onset hernia containing ascites fluid was the initial sign in 6 patients (12%): 5 inguinal and 1 umbilical
  • In 4 female patients the disease was found incidentally during workup for another condition (3 during laparoscopy for infertility, 1 during laparotomy for a gynecological lesion)
  • 4 patients presented with an acute abdomen needing emergency evaluation (3 with appendicitis, 1 with an incarcerated umbilical hernia)
  • Median survival of all 51 patients was 56 months
  • Median survival was 21 months for the 34 men; the median for the 17 women had not yet been reached. The difference was statistically significant (logrank = 7.40, P = 0.007)
  • Weight loss was defined from the patient's report at the initial encounter and was always more than 10% of body weight
  • Median survival was 16 months for the 11 patients with weight loss vs 68 months for the 40 without (logrank = 6.29, P = 0.012)
  • Of 48 patients with a peritoneal cancer index available, those scoring above 28 (17 patients) had significantly shorter survival than those scoring 28 or less (31 patients) (logrank = 4.81, P = 0.028)
  • Epithelial type (n = 42) had significantly better survival than sarcomatoid and biphasic types grouped together (n = 5) (P = 0.04). The 4 cystic mesothelioma patients were all alive and were excluded from this analysis
  • Patients under the age-53 cutoff had longer survival (median 68 vs 15 months in Table 2; logrank = 3.53, P = 0.060). The text calls this 'statistically improved', although P = 0.060 is above the 0.05 level used for significance
  • There was no significant survival difference between the 22 patients with pain and the 29 without
  • There was no significant survival difference between the 39 patients with ascites and the 12 without
  • The 4 patients with fever had short survival, but the difference was not statistically significant
  • Paracentesis in 39 patients gave a definitive diagnosis by cytology in only 2. Diagnosis was otherwise made by laparotomy (23, 45%), laparoscopy with biopsy (26, 51%) or guided biopsy (2, 4%)
• The authors' conclusion: The authors concluded that pain was the most common initial presenting symptom, with increased abdominal girth second, and that a more favorable prognosis occurred in women with a small disease volume
• Limitations the authors state:
  • Too few patients presented with a hernia to test the difference between men and women statistically
  • The peritoneal cancer index was available for only 48 patients, and for 23 of them the surgery at which it was scored was not their initial surgery
  • 4 of 55 eligible patients were excluded because of missing clinical and initial pathologic data

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Prognosis.

Related studies

• A novel nomogram for peritoneal mesothelioma predicts survival — N.P. Schaub, M. Alimchandani, et al. (2013)
• Current trends in the management of malignant peritoneal mesothelioma — J.T. Miura, F.M. Johnston, et al. (2014)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma — G.H. Eltabbakh, M.S. Piver, et al. (1999)
• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)
• Malignant peritoneal mesothelioma in a 16-year-old girl: presentation of a rare disease — I.B. Brecht, A. Agaimy, et al. (2012)

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