Malignant Peritoneal Mesothelioma: Patterns of Care and Survival in the Netherlands: A Population-Based Study

Our plain-English summary of Malignant Peritoneal Mesothelioma: Patterns of Care and Survival in the Netherlands: A Population-Based Study, by N.L. de Boer, J.P. van Kooten, R.A.M. Damhuis, et al (Annals of Surgical Oncology, 2019).

The study

• Authors: N.L. de Boer, J.P. van Kooten, R.A.M. Damhuis, J.G.J.V. Aerts, C. Verhoef, E.V.E. Madsen
• Journal: Annals of Surgical Oncology
• Published: 2019;26(13):4222-4228
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, focus has shifted toward a more aggressive and multimodal treatment approach. This study aimed to assess the patterns of care and survival for MPM patients in the Netherlands on a nationwide basis.

Methods: The records of patients with a diagnosis of MPM from 1993 to 2016 were retrieved from the Dutch Cancer Registry. Data regarding diagnosis, staging, treatment, and survival were extracted. Cox regression analyses and Kaplan-Meier survival curves were used to study overall survival.

Results: Between 1993 and 2016, MPM was diagnosed for 566 patients. Overall, the prognosis was very poor (24% 1-year survival). The most common morphologic subtype was the epithelioid subtype (88%), followed by the biphasic (8%) and sarcomatoid (4%) subtypes. Surgical treatment has become more common in recent years, which most likely has resulted in improved survival rates. In this study, improved survival was independently associated with hyperthermic intraperitoneal chemotherapy (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.21-0.55) and surgery with adjuvant systemic chemotherapy (HR, 0.33; 95% CI, 0.23-0.48). Nonetheless, most patients (67%) do not receive any form of anti-cancer treatment.

Conclusion: This study indicated that MPM still is a rare and fatal disease. The survival rates in the Netherlands have improved slightly in the past decade, most likely due to more aggressive treatment approaches and increased use of surgery. However, most patients still do not receive cancer-directed treatment. To improve MPM management, and ultimately survival, care should be centralized in expert medical centers.

In plain English

Using the Netherlands Cancer Registry, this study examined care and survival for 566 people diagnosed with malignant peritoneal mesothelioma (of the abdominal lining) from 1993 through 2016: 420 men and 146 women. The registry did not record asbestos exposure, so the study did not examine it. Median survival was 4.5 months; 24% of patients lived at least one year. One-year survival rose from 17% in 1993 to 2000 to 31% in 2009 to 2016. Most patients (67%) received no cancer-directed treatment, though this share fell from 75% to 60%. In adjusted analyses, compared with best supportive care or other care, longer survival was associated with surgery with or without chemotherapy (hazard ratio 0.33, 95% CI 0.23 to 0.48), HIPEC (heated abdominal chemotherapy) with or without cytoreductive surgery (0.33, 0.21 to 0.55) and chemotherapy alone (0.61, 0.49 to 0.76). Women and younger patients survived longer. The authors noted the data were retrospective and could not account for patients' fitness or other illnesses. They concluded that survival improved slightly, most likely through more aggressive treatment, and that care should be centralized in expert centers.

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 population-based study of national cancer registry records
• Who was studied: 566 patients (420 men, 146 women) diagnosed with malignant peritoneal mesothelioma in the Netherlands from 1993 through 2016, recorded in the Netherlands Cancer Registry. Median age at diagnosis was 69 years for men and 65 years for women.
• Exposure: The study compared treatments: systemic chemotherapy alone, surgery with or without chemotherapy, HIPEC (hyperthermic intraperitoneal chemotherapy) with or without cytoreductive surgery, and best supportive care or other care. Asbestos exposure was not recorded in the registry and was not analysed.
• Main results:
  • Of the 566 patients, 420 were men (74%) and 146 were women (26%).
  • For all 566 patients, median survival was 4.5 months (interquartile range 1.5 to 11.6). One-year survival was 24% and two-year survival was 15%.
  • Survival was better for patients diagnosed in 2009 to 2016 than for those diagnosed in 1993 to 2000 (p = 0.023). One-year survival by period was 17% (1993 to 2000), 23% (2001 to 2008) and 31% (2009 to 2016).
  • Overall, 67% of patients (378 of 566) received best supportive care or other care rather than cancer-directed treatment. The share of patients receiving no cancer-directed treatment fell from 75% to 60% over the study period.
  • In the multivariable analysis, compared with best supportive care or other care, better survival was independently associated with surgery with or without chemotherapy (HR 0.33; 95% CI 0.23 to 0.48), HIPEC with or without cytoreductive surgery (HR 0.33; 95% CI 0.21 to 0.55) and systemic chemotherapy alone (HR 0.61; 95% CI 0.49 to 0.76).
  • Median survival by treatment group: HIPEC with or without cytoreductive surgery (28 patients) 23.4 months, with 68% alive at one year; surgery with or without chemotherapy (43 patients) 15.5 months; chemotherapy (117 patients) 8.8 months; best supportive care or other care (378 patients) 2.5 months.
  • Women had better survival than men (HR 0.65; 95% CI 0.53 to 0.81). Compared with patients aged 0 to 64, survival was worse at ages 65 to 74 (HR 1.55; 95% CI 1.25 to 1.92) and at ages 75 or older (HR 2.00; 95% CI 1.59 to 2.51).
  • Compared with the epithelioid subtype, worse survival was associated with the biphasic subtype (HR 1.54; 95% CI 1.05 to 2.26) and with an unspecified subtype (HR 1.26; 95% CI 1.05 to 1.52). The result for the sarcomatoid subtype (HR 1.23; 95% CI 0.70 to 2.15; p = 0.476) was not statistically significant.
  • Tumor stage was not shown to have prognostic value (p = 0.102 in the survival-by-stage comparison).
  • Among the 566 patients, 89% of those with a recorded subtype had the epithelioid subtype, 8% biphasic and 4% sarcomatoid. Subtype information was available for 65% of patients.
  • In 2009 to 2016, distant progression was recorded for 23.4% of patients. The authors estimated that the disease had spread outside the abdominal cavity in between 8.8% and 13.5% of cases.
• The authors' conclusion: The authors concluded that survival for malignant peritoneal mesothelioma patients improved slightly in recent years, most likely because of more aggressive (multimodal) treatment. They noted that most patients still do not receive cancer-directed treatment, and stated that progress can be achieved only by centralizing care in expert centers.
• Limitations the authors state:
  • The data were collected retrospectively, so the authors cautioned that the results should be interpreted carefully.
  • Details on the type of surgery, the extent of cytoreduction, the type of chemotherapy and the number of cycles were not available.
  • Survival differences between treatments are partly due to which patients were selected for treatment. This could not be corrected for because performance status and comorbidity data were not available.
  • No general staging system was used in clinical reports.
  • Cause of death was not available because of privacy regulations.
  • Asbestos exposure was not reported in the national registry.

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, Cancer Registry, Staging, Overall Survival, Prognosis, Epithelioid, Biphasic Mesothelioma, Sarcomatoid.

Related studies

• Malignant Peritoneal Mesothelioma: National Practice Patterns, Outcomes, and Predictors of Survival — V. Verma, R.L. Sleightholm, et al. (2018)
• Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England — R.A. Damhuis, A. Khakwani, et al. (2015)
• Incidence and survival trends for malignant pleural and peritoneal mesothelioma, Australia, 1982-2009 — M.J. Soeberg, J. Leigh, et al. (2016)
• Cancer survival and prevalence in Australia: period estimates from 1982 to 2010 — Australian Institute of Health and Welfare (2013)
• A novel nomogram for peritoneal mesothelioma predicts survival — N.P. Schaub, M. Alimchandani, et al. (2013)
• 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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