Malignant peritoneal mesothelioma: a review

Our plain-English summary of Malignant peritoneal mesothelioma: a review, by J. Kim, S. Bhagwandin, D.M. Labow (Annals of Translational Medicine, 2017).

The study

• Authors: J. Kim, S. Bhagwandin, D.M. Labow
• Journal: Annals of Translational Medicine
• Published: 2017;5(11):236
• Type of article: Review
• Cited by: 125 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma is a malignancy of serosal membranes. It is most commonly encountered in the visceral pleura with the second most common location in the peritoneum. The diagnosis is very rare and has been linked to toxic exposure to industrial pollutants, especially asbestos. Malignant peritoneal mesothelioma (MPM) commonly presents with diffuse, extensive spread throughout the abdomen with rare metastatic spread beyond the abdominal cavity. Due to its rarity and nonspecific symptoms, it is usually diagnosed late when the disease burden is extensive. Because pleural mesothelioma is more common than MPM, most research has been on the pleural variant and extrapolated for MPM. While treatment advances have been made for MPM, the disease is universally fatal from either abdominal complications secondary to the spread of disease or starvation. Untreated, the life expectancy is less than a year. Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) has become the mainstay of therapy with systemic therapies still being developed. We will review the epidemiology of MPM and discuss diagnostic and treatment strategies.

In plain English

This article was a review of published research on malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. It did not report a new study of its own patients. The authors summarized earlier work on how common the disease is, its causes, symptoms, diagnosis, staging, treatment and survival. Citing earlier studies, they wrote that peritoneal disease made up 7–30% of malignant mesothelioma cases. They described asbestos as its best defined risk factor, though the link was weaker than for pleural mesothelioma: only 33–50% of patients with peritoneal mesothelioma reported any known prior asbestos exposure. They noted that there had been no randomized controlled trials of treatment. In the largest registry they described, 405 patients treated with surgery to remove visible tumor plus heated chemotherapy inside the abdomen (CRS-HIPEC) had a median overall survival of 53 months. Cited reports put median survival without treatment at less than 5 months to up to 12 months. The authors concluded that CRS-HIPEC had become first-line therapy for patients with favorable factors.

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 review of published literature on malignant peritoneal mesothelioma (epidemiology, diagnosis, staging, treatment, prognosis); no original data
• Who was studied: Published studies, case series, registries and trials of patients with malignant peritoneal mesothelioma (MPM); the authors did not study a group of patients of their own
• Exposure: Asbestos, described from cited studies as the best defined risk factor for MPM, though more weakly linked than for pleural mesothelioma; radiation, erionite, thorium and mica were mentioned as other risk factors in pleural mesothelioma, reported only in case reports
• Main results:
  • From cited studies: MPM accounted for 7–30% of malignant mesothelioma cases, most of which arise from the pleura
  • From cited studies: about 80% of pleural mesothelioma cases were linked to asbestos, while only 33–50% of patients diagnosed with MPM reported any known prior asbestos exposure
  • From cited studies: approximately 23% of women reported asbestos exposure as a risk factor, compared with 58% of men
  • From the largest cited multi-institutional registry (405 MPM patients across 29 centers treated with CRS-HIPEC): median overall survival 53 months and 5-year survival 47%
  • From cited reports: median survival without treatment ranged from less than 5 months to up to 12 months from diagnosis
  • From one cited study: median survival was 55 months for patients with the epithelioid subtype of MPM and 13 months for the biphasic subtype
  • From cited studies at experienced institutions: CRS-HIPEC operative mortality was 0–8% and serious complication rates were 10–45%
• The authors' conclusion: The authors concluded that treatment had advanced, with CRS-HIPEC as first-line therapy for patients with favorable factors, and that further advances in systemic therapy are likely to come from targeting molecular pathways
• Limitations the authors state:
  • The authors noted that, because MPM is rare, there have been no randomized controlled trials of treatment and most data come from retrospective single-institution reports
  • The authors noted that most research has been on pleural mesothelioma and extrapolated to MPM, although some biological differences have been found
  • The authors noted that the other mineral-associated risks have been reported only in case reports, so the relative risk for developing MPM from them has not been quantified

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Mesothelioma, Visceral Pleura, Peritoneum, Pleural Mesothelioma, Life Expectancy, Cytoreductive Surgery, Chemotherapy.

Related studies

• Peritoneal mesothelioma — M. Kannerstein, J. Churg (1977)
• Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients — E.A. Levine, J.H. Stewart, et al. (2014)
• Epidemiology of peritoneal mesothelioma: a review — P. Boffetta (2007)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis — J.H. Helm, J.T. Miura, et al. (2015)
• Absence of carcinogenic response to multiwall carbon nanotubes in a 2-year bioassay in the peritoneal cavity of the rat — J. Muller, M. Delos, et al. (2009)
• Papillary peritoneal tumors in women — A. Foyle, M. Al-Jabi, et al. (1981)

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