Predictive factors analysis for malignant peritoneal mesothelioma

Our plain-English summary of Predictive factors analysis for malignant peritoneal mesothelioma, by S. Jin, S. Cao, J. Cao, et al (Journal of Gastrointestinal Surgery, 2015).

The study

• Authors: S. Jin, S. Cao, J. Cao, J. Shen, J. Hu, D. Che, J. Zhang, Y. Yu
• Journal: Journal of Gastrointestinal Surgery
• Published: 2015;19(2):319-26
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is an uncommon disease with a dismal prognosis and unclear natural history. The present study aims to assess potential prognostic factors and management of MPM.

Methods: Clinical records of 39 patients with MPM between December 2003 and April 2014 were retrospectively reviewed. Overall survival was identified with Kaplan-Meier curves and Cox regression analysis.

Results: Mean age of 39 patients was 55.0 years; asbestos exposure was recorded in two patients. Main presentations were abdominal distension, abdominal pain, and weight loss. Thrombocytosis, low serum albumin level, and anemia were principal laboratory abnormalities. Ascites, peritoneal cavity mass, and peritoneum thickening were the main signs on CT scans. Cytoreductive surgery (CRS) plus adjuvant therapies were performed in 22 patients, single chemotherapy in 13, and best supportive care in 4. Median survival time was 10.0 months after pathological diagnosis, with a 6-, 12-, 18-, and 24-month survival rate of 84.4, 31.6, 18.5, and 15.8 %, respectively. Significant prognostic factors were age, performance status (PS), abdominal pain, serum albumin level, thrombocytosis, and treatment strategy on univariate analysis, while only age, abdominal pain, and treatment strategy hold statistical significance on multivariate analysis.

Conclusions: Age ≤65 years, abdominal pain, and CRS plus adjuvant therapy are independent positive prognostic factors of MPM.

In plain English

This was a retrospective review of the medical records of 39 patients with pathologically confirmed malignant peritoneal mesothelioma (cancer of the abdominal lining) admitted to Harbin Medical University Cancer Hospital in China between December 2003 and April 2014. The study looked for factors linked to survival. A history of asbestos exposure was recorded in only 2 of the 39 patients (5.1%). Twenty-two patients had cytoreductive surgery (CRS) plus other therapies, 13 had chemotherapy alone, and 4 had best supportive care. Median survival from diagnosis was 10.0 months overall (95% confidence interval 6.388 to 13.612 months): 6.0 months with supportive care, 8.0 with chemotherapy and 12.0 in the surgery group. Survival was 84.4% at 6 months and 15.8% at 24 months. In the combined (multivariate) analysis, only age, abdominal pain and treatment strategy stayed statistically significant. The authors concluded that age 65 or under, abdominal pain, and CRS plus adjuvant therapy were independent positive prognostic factors. Only 3 patients were over 65. The authors noted that they could not assess CRS with heated intraperitoneal chemotherapy (HIPEC), tumor type, or stage.

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 review of hospital clinical records (single-hospital case series with survival analysis using Kaplan-Meier curves and Cox regression)
• Who was studied: 39 patients with pathologically confirmed malignant peritoneal mesothelioma admitted to Harbin Medical University Cancer Hospital, Harbin, China, December 2003 to April 2014; mean age 55.0 years (range 29 to 72); 15 men and 24 women
• Exposure: Asbestos was not the focus of the study. A history of asbestos exposure was recorded in 2 of the 39 patients (5.1%). No fiber types, products or jobs were reported. The factors studied were clinical, laboratory, imaging and treatment variables.
• Main results:
  • Median survival from diagnosis for all 39 patients was 10.0 months (95% CI 6.388 to 13.612). By treatment group it was 6.0 months with best supportive care (4 patients), 8.0 months with chemotherapy (13 patients), and 12.0 months in the CRS group (22 patients). No confidence intervals were given for the group medians.
  • Overall survival rates for the whole group at 6, 12, 18 and 24 months were 84.4%, 31.6%, 18.5% and 15.8%
  • On univariate analysis, factors significantly related to survival were age (p=0.003), performance status (p=0.003), abdominal pain (p less than 0.001), serum albumin level (p=0.010), thrombocytosis (p=0.030) and treatment strategy (p less than 0.001)
  • On multivariate analysis, only age, abdominal pain and treatment strategy remained statistically significant. Table 2 gives these hazard ratios: 5.893 for age (p=0.016, 95% CI 1.397 to 24.863), 0.221 for abdominal pain (p=0.002, 95% CI 0.086 to 0.570) and 0.367 for treatment strategy (p=0.016, 95% CI 0.163 to 0.828). The table does not state which group was the comparison group.
  • In the age comparison, 36 patients were 65 or younger (median survival 11 months) and 3 were older than 65 (median survival 6 months)
  • Patients with abdominal pain (23) had a median survival of 14 months, compared with 8 months for those without it (16)
• The authors' conclusion: The authors concluded that age 65 or under, abdominal pain, and CRS plus adjuvant therapy are independent positive prognostic factors for malignant peritoneal mesothelioma.
• Limitations the authors state:
  • CRS combined with HIPEC could not be assessed because too few patients were enrolled
  • Pathological types and clinical stage were not evaluated because adequate surgical information was lacking

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, Overall Survival, Kaplan-Meier Curve, Asbestos Exposure, Ascites, Peritoneal Cavity, Peritoneum.

Related studies

• Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Adolescent and Young Adults with Peritoneal Metastases — M. Dhir, L. Ramalingam, et al. (2017)
• Peritoneal carcinomatosis: intraoperative parameters in open (coliseum) versus closed abdomen HIPEC — E. Halkia, A. Tsochrinis, et al. (2015)
• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• Radiological predictors of complete cytoreduction in 59 patients with peritoneal mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a UK referral centre — A. Chandramohan, A. Thrower, et al. (2017)
• Treating peritoneal mesothelioma with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A case series and review of the literature — K. Stamou, D. Tsamis, 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)

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