Impact of tumor angiogenesis in peritoneal mesothelioma after radical cytoreduction and hyperthermic intraperitoneal chemotherapy

Our plain-English summary of Impact of tumor angiogenesis in peritoneal mesothelioma after radical cytoreduction and hyperthermic intraperitoneal chemotherapy, by T.C. Chua, P. Yao, J. Akther, et al (Pathology Oncology Research, 2010).

The study

• Authors: T.C. Chua, P. Yao, J. Akther, D.L. Morris
• Journal: Pathology Oncology Research
• Published: 2010;16(2):217-22
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal mesothelioma is one of the peritoneal surface malignancies where long-term survival is a reality after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Tumor angiogenesis has been shown to be of prognostic significance on survival in mesothelioma. We investigated the impact of survival of patients with peritoneal mesothelioma following CRS and HIPEC to determine the impact of tumor angiogenesis on survival after this radical surgical treatment. Paraffin sections of 23 patients who were treated with CRS and HIPEC were retrieved for immunohistochemical analysis. The immunostaining was performed using monoclonal mouse anti-human antibodies (VEGF-C and CD31) on an autostainer (Autostainer Plus; Dako, Inc.). The intensity of the stains were quantified using the Image-Pro Plus (IPP) 4.5 (Media Cybernetics, Silver Spring, MD). VEGF expression and microvessel density (MVD) using CD31 staining were studied. The median survival was 94 months with a 3-year survival rate of 51%. There was no impact on patient's age, sex, peritoneal cancer index, tumor histopathology and survival outcomes between patients with low or high MVD and VEGF expression. After CRS and HIPEC, our results demonstrate that the prognostic significance of tumor angiogenesis is negated, highlighting the potential importance of other co-contributory mechanisms in mesotheliomagenesis and undergoing radial treatment.

In plain English

This study, from St George Hospital in Sydney, Australia, asked whether signs of new blood-vessel growth in tumors (angiogenesis) were linked to survival in 23 patients with peritoneal mesothelioma, a cancer of the abdominal lining. All had been treated with cytoreductive surgery, which removes visible tumor, plus heated chemotherapy given inside the abdomen (HIPEC). The authors stained stored tumor tissue for two markers: VEGF, a growth factor, and CD31, which was used to count small blood vessels (microvessel density). The article does not report the patients' asbestos exposure. Median survival for the 23 patients was 94 months. Survival at 1, 2 and 3 years was 83%, 58% and 51%. Patients whose tumor was completely removed lived longer than those with incomplete removal (94 vs. 17 months; p=0.008). No statistically significant survival difference was found between low and high microvessel density (p=0.62) or low and high VEGF (p=0.68). The authors concluded that in these long-term survivors after radical treatment, tumor angiogenesis had no influence on survival. They contrasted this with its reported influence in patients given palliative treatments.

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: Case series of surgically treated patients, with laboratory staining (immunohistochemistry) of their stored tumor tissue and survival analysis; clinical data were collected prospectively
• Who was studied: 23 patients with peritoneal mesothelioma treated with cytoreductive surgery and HIPEC by a single surgeon team (University of New South Wales, St George Hospital, Sydney, Australia); 15 men and 8 women, median age 50.5 years (range 32.7 to 71.5); 19 epithelioid, 3 sarcomatoid and 1 multi-cystic tumor. Treatment dates are not given.
• Exposure: No asbestos exposure was studied. The factors examined were tumor VEGF protein expression and microvessel density measured with CD31 staining. Each was split into low and high groups: microvessel density 10 or less vs more than 10, and VEGF 3 or less vs more than 3.
• Main results:
  • All 23 patients: median survival 94 months; 1-, 2- and 3-year survival rates 83%, 58% and 51%
  • Median follow-up was 18 months (range 1 to 94)
  • Patients with complete cytoreduction had longer overall survival than patients with incomplete cytoreduction (94 vs. 17 months; p=0.008)
  • Log-rank tests found no statistically significant effect of microvessel density (p=0.62) or of VEGF expression (p=0.68) on overall survival
  • There were no differences in age, sex, peritoneal cancer index or tumor histopathology between the low and high microvessel density groups, or between the low and high VEGF groups
• The authors' conclusion: The authors concluded that in long-term survivors after radical cytoreduction and HIPEC, tumor angiogenesis had no influence on survival, unlike its influence in patients with short-term survival after palliative treatments. They suggested that other mechanisms matter more for prognosis. They proposed that the prolonged survival after treatment might explain why angiogenesis lost its prognostic significance in their study.

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: Angiogenesis, Peritoneal Mesothelioma, Cytoreductive Surgery, HIPEC, Mesothelioma, Monoclonal Antibody, Median Overall Survival, Peritoneal Cancer Index (PCI).

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• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• Recurrence of Optimally Treated Malignant Peritoneal Mesothelioma with Cytoreduction and Heated Intraperitoneal Chemotherapy — D.R. Heller, C. Chiuzan, et al. (2017)
• Preoperative Thrombocytosis Predicts Shortened Survival in Patients with Malignant Peritoneal Mesothelioma Undergoing Operative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy — Y.C. Li, T. Khashab, et al. (2017)

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