Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Our plain-English summary of Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), by D. Baratti, M. Vaira, S. Kusamura, et al (European Journal of Surgical Oncology, 2010).

The study

• Authors: D. Baratti, M. Vaira, S. Kusamura, S. D'Amico, M.R. Balestra, T. Cioppa, E. Mingrone, M. De Simone, M. Deraco
• Journal: European Journal of Surgical Oncology
• Published: 2010;36(11):1047-53
• Cited by: 43 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: This retrospective multi-institutional study addresses the role of surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of multicystic peritoneal mesothelioma (MCPM). MCPM is an uncommon tumour with uncertain malignant potential and no current standard therapy. Additionally, poorly defined pathological and biological features of this disease were investigated.

Methods: Twelve patients with MCPM underwent 14 procedures of cytoreduction and HIPEC in two Italian referral centres. Nine patients had recurrent disease after previous debulking (one operation in six patients, two in two, four in one). Biological markers related to mesothelioma origin and clinical features were assessed by immunohistochemical studies.

Results: Median follow-up was 64 months (range 5-148). Optimal cytoreduction (residual tumour nodules ≤2.5 mm) was performed in all the procedures. One grade IV postoperative complication (NCI/CTCAE v.3.0) and no operative death occurred. All the patients are presently alive with no evidence of disease, including two patients who underwent the procedure twice, due to locoregional disease recurrence. Five- and ten-year progression-free survival was 90% and 72%, accounting for a. statistically significant difference (P = 0.0001) with progression-free survival following previous debulking surgery (median 11 months; range 2-31). All cases showed low proliferative activity assessed by mitotic rate and Ki-67 expression.

Conclusions: MCPM is a borderline tumour with a high propensity to local-regional recurrence. Definitive tumour eradication by means of cytoreduction and HIPEC seems more effective than debulking surgery in preventing disease relapse. Low mitotic rate and poor Ki-67 expression might be related to the peculiar behaviour of MCMP.

Copyright © 2010 Elsevier Ltd. All rights reserved.

In plain English

This retrospective study from two Italian referral centres reviewed 12 patients with multicystic peritoneal mesothelioma (MCPM), a rare tumour of the abdominal lining. Between August 1995 and October 2009, these patients underwent 14 operations combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), which is heated chemotherapy delivered into the abdomen during surgery. Eleven patients were women, and none reported a documented history of asbestos exposure. Before referral, nine patients had undergone 14 debulking operations, and disease progressed after every one of them, after a median of 11 months. After cytoreduction and HIPEC, with a median follow-up of 64 months, the disease came back in two of the 12 patients, and both had the procedure a second time. All patients were alive with no evidence of disease at the time of analysis. Estimated five- and ten-year progression-free survival was 90% and 72%, a statistically significant difference from the earlier debulking operations. There was one grade IV complication and no operative death. Measures of tumour cell proliferation were low in all patients examined. The authors concluded that cytoreduction and HIPEC seems more effective than debulking surgery in preventing relapse, while acknowledging a possible bias in this comparison.

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 multi-institutional case series (two centres), comparing outcomes after cytoreduction and HIPEC with outcomes after the same patients' earlier debulking operations
• Who was studied: 12 patients with multicystic peritoneal mesothelioma who underwent 14 procedures in two Italian referral centres, August 1995 to October 2009; 11 were women
• Exposure: Asbestos exposure was not studied, and no patient reported a documented history of asbestos exposure. The treatment studied was cytoreductive surgery with HIPEC (cisplatin plus doxorubicin in ten of the 14 procedures; other drug schedules in the rest).
• Main results:
  • Before referral, nine patients had 14 debulking operations; disease progressed after each one, with a median time to progression of 11 months
  • Median follow-up after cytoreduction and HIPEC was 64 months
  • Recurrence occurred after two of the 12 cytoreductions with HIPEC
  • All patients were alive with no evidence of disease at the time of analysis, including the two patients who had the procedure twice because of recurrence
  • Estimated five- and ten-year progression-free survival after cytoreduction and HIPEC was 90% and 72%
  • Progression-free survival after cytoreduction and HIPEC differed significantly from progression-free survival after the 14 earlier debulking operations (two-tailed P value less than 0.0001 in the body text and figure)
  • One grade IV postoperative complication (a small bowel perforation requiring re-operation) and no operative death occurred
  • Mitotic count and MIB-1 (Ki-67) staining, both measures of tumour cell proliferation, were low in all patients; immunohistochemistry was available for eight patients
  • Lymph nodes were sampled in six patients, and none showed metastatic involvement
  • None of the patient-, tumour- or treatment-related factors tested was found to be associated with survival
• The authors' conclusion: The authors concluded that MCPM is a borderline tumour with a high tendency to recur locally, and that removing the tumour by cytoreduction and HIPEC seems more effective than debulking surgery in preventing relapse
• Limitations the authors state:
  • The comparison with debulking may be biased, because active disease was a condition for undergoing cytoreduction with HIPEC and only cases with progression after earlier surgery were analyzed
  • Because the study was retrospective, biological markers were not assessed consistently in all patients
  • The prognostic factor analysis found no correlations, probably because of the small number of events and imbalance in prognostic variables
  • Because MCPM is rare, direct comparative studies of treatment are virtually unfeasible

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, Multi-Institutional Series, Cytoreductive Surgery, HIPEC, Mesothelioma, Progression-Free Survival, Ki-67.

Related studies

• 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)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• 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)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)

Browse more research in European Journal of Surgical Oncology, or return to medical research.