Malignant peritoneal mesothelioma: a multicenter study on 81 cases

Our plain-English summary of Malignant peritoneal mesothelioma: a multicenter study on 81 cases, by V.P. Manzini, L. Recchia, M. Cafferata, et al (Annals of Oncology, 2010).

The study

• Authors: V.P. Manzini, L. Recchia, M. Cafferata, C. Porta, S. Siena, L. Giannetta, F. Morelli, F. Oniga, A. Bearz, V. Torri, M. Cinquini
• Journal: Annals of Oncology
• Published: 2010;21(2):348-353
• Cited by: 90 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is a rare disease characterized by a difficult diagnosis, different types of presentation, variable course and poor prognosis.

Materials And Methods: Eighty-one patients with MPM observed in 14 Italian oncology institutions from 1982 to 2007 have been examined with the aim of delineating the history of MPM.

Results: Presentation symptoms were ascites, abdominal pain, asthenia, weight loss, anorexia, abdominal mass, fever, diarrhea and vomiting in various associations. Computed tomography scan and echotomography signs were ascites, abdominal mass and peritoneal thickening. Peritoneal fluid cytology (61 cases) was positive for mesothelioma in 31 and for malignancy, not mesothelioma, in 13. Laparoscopy was carried out in 40 cases and laparotomy in 36. Thrombocytosis was present in 59 cases. Associated tumors diagnosed during the lifetime were colorectal cancer in two cases and cheek carcinoma, thyroid carcinoma, tongue carcinoma, bladder carcinoma and testicular seminoma. Thirty patients were treated with surgery and 45 with chemotherapy. The median survival time from diagnosis is 13 months. Ascites, fever and vomiting were significative variables at presentation; only vomiting holds significance in a multivariate analysis.

Conclusions: MPM is a disease with various types of presentation, frequently associated with thrombocytosis, sometimes with other tumors. Survival and diagnosis time can differ in various types of MPM. Prognosis is poor.

In plain English

This retrospective study reviewed 81 patients with malignant peritoneal mesothelioma (abdominal-lining cancer) at 14 Italian institutions, 1982 to 2007. There were 57 men and 24 women, mean age 64. Asbestos exposure history was positive in 42 (34 men) and doubtful in nine; fiber types were not reported. Presentation was classed as classic (59), surgical (13) or medical (9). Thrombocytosis (raised platelets) appeared at some stage in 59 of 81 patients. Median survival from diagnosis was 13 months overall (95% confidence interval 7.5 to 46): 17 months for classic (10 to not reached), 6 for medical (4 to 13) and 12 for surgical (2 to not reached). Among presentation symptoms analysed singly, ascites was linked with lower risk of death (hazard ratio 0.44, 95% interval 0.196 to 0.99), and fever (2.52, 1.11 to 5.71) and vomiting (8.34, 2.94 to 23.62) with higher risk. In a combined analysis only vomiting stayed statistically significant (hazard ratio 8.18). The authors concluded the disease has various presentation types with different survival times, and a poor prognosis. They said the long study period made their data unsuitable for judging treatment.

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 multicenter cohort study
• Who was studied: 81 patients with cytology- or histology-proven malignant peritoneal mesothelioma at 14 Italian oncology institutions, 1982 to 2007; 57 men and 24 women, mean age 64 years (range 19 to 85)
• Exposure: History of asbestos exposure was positive in 42 cases (34 men) and doubtful in nine (eight men). No fiber types or doses were reported. In the discussion the authors note that most cases came from Monfalcone (shipyards) and Casale Monferrato (Eternit factory).
• Main results:
  • Presentation type among the 81 patients: classic in 59 (73%), surgical in 13 (16%), medical in 9 (11%)
  • Peritoneal fluid cytology was done in 61 cases. It was positive for mesothelioma in 31 and positive for malignancy other than mesothelioma in 13.
  • Thrombocytosis was present at some phase of the disease in 59 of 81 patients (73%)
  • Median survival from diagnosis in the whole series was 13 months (95% CI 7.5 to 46). By presentation type it was 17 months (10 to upper limit not reached) for classic, 6 months (4 to 13) for medical and 12 months (2 to upper limit not reached) for surgical.
  • Among symptoms at presentation, ascites, fever and vomiting were the variables most significantly associated with death
  • Ascites at presentation was associated with a lower hazard of death: HR 0.44 (95% CI 0.196 to 0.99), p = 0.0463
  • Fever at presentation was associated with a higher hazard of death: HR 2.52 (95% CI 1.11 to 5.71), p = 0.0267
  • Vomiting at presentation was associated with a higher hazard of death: HR 8.34 (95% CI 2.94 to 23.62), p less than 0.0001
  • In the multivariate model of presentation variables, only vomiting remained significant (HR 8.18, p less than 0.0001)
  • Evaluated from the start of therapy, weight loss, fever and abdominal mass were significant in a multivariate analysis
  • Cause of death could be assessed in 41 cases: cachexia in 29, intestinal obstruction in 14, pulmonary thromboembolism in 5
  • Seven patients were diagnosed during their lifetime with another malignant tumor
  • 30 patients were treated with surgery, of whom only seven had peritonectomy with hyperthermic intraperitoneal chemotherapy; 45 received chemotherapy
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma has various types of presentation, each with different survival times, and a poor prognosis
• Limitations the authors state:
  • Because of the long recruitment period (1982 to 2007), some data are not homogeneous or comparable, particularly for treatment
  • The authors state the data are unsuitable for drawing conclusions about therapy
  • The recorded asbestos exposure rate was lower than expected, which the authors attribute to the long latency and difficulty identifying remote exposures

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, Ascites, Fluid Cytology, Mesothelioma, Laparotomy, Colorectal Cancer, Carcinoma.

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• Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands — T.R. van Oudheusden, V.E. Lemmens, et al. (2015)
• Epidemiology of malignant peritoneal mesothelioma: A population-based study — S.A.S. Salo, I. Ilonen, et al. (2017)

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