Prognostic role of CD74, CD10 and Ki-67 immunohistochemical expression in patients with diffuse malignant peritoneal mesothelioma: a retrospective study

Our plain-English summary of Prognostic role of CD74, CD10 and Ki-67 immunohistochemical expression in patients with diffuse malignant peritoneal mesothelioma: a retrospective study, by Y. Liang, C. Li, Y. Liu, et al (BMC Cancer, 2023).

The study

• Authors: Y. Liang, C. Li, Y. Liu, L. Tian, D. Yang
• Journal: BMC Cancer
• Published: 2023;23(1):406
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Diagnosis and treatment of diffuse malignant peritoneal mesothelioma (DMPM) are still challenging. The aim of the present study was to explore the correlation between CD74, CD10, Ki-67 and clinicopathological parameters, and identify independent prognostic factors of DMPM.

Methods: Seventy patients with pathologically proven DMPM were retrospectively reviewed. The expression of CD74, CD10 and Ki-67 in peritoneal tissues was detected by immunohistochemical analysis using standard avidin biotin complex (ABC) immunostaining technique. Kaplan-Meier survival analysis and multivariate Cox regression analyses were performed to assess prognostic factors. The nomogram based on the Cox hazards regression model was established. C-index and calibration curve were performed to evaluate the accuracy of nomogram models.

Results: The median age of DMPM was 62.34 years, and the male-to-female ratio was 1: 1.80. CD74 expression was identified in 52 (74.29%) of 70 specimens, CD10 in 34 (48.57%) specimens, and higher Ki-67 in 33(47.14%) specimens. CD74 was negatively associated with asbestos exposure(r = -0.278), Ki-67(r = -0.251) and TNM stage(r = -0.313). All patients were effectively followed up in the survival analysis. Univariate analysis revealed that PCI, TNM stage, treatment, Ki-67, CD74 and ECOG PS were associated with DMPM prognosis. CD74 (HR = 0.65, 95%Cl:0.46-0.91, P = 0.014), Ki-67(HR = 2.09, 95%Cl:1.18-3.73, P = 0.012),TNM stage (HR = 1.89, 95%Cl:1.16-3.09, P = 0.011), ECOG PS(HR = 2.12, 95%Cl:1.06-4.25, P = 0.034), systemic chemotherapy (HR = 0.41, 95%Cl:0.21-0.82, P = 0.011) and intraperitoneal chemotherapy (HR = 0.34, 95%Cl:0.16-0.71, P = 0.004) were independent predictors by multivariate Cox analysis. The C‑index of the nomogram for predicting overall survival (OS) was 0.81. The OS calibration curve showed good agreement between nomogram-predicted and observed survival.

Conclusions: CD74, Ki-67, TNM stage, ECOG PS and treatment were independent factors affecting prognosis of DMPM. Reasonable chemotherapy treatment might improve the prognosis of patients. The proposed nomogram was a visual tool to effectively predict the OS of DMPM patients.

© 2023. The Author(s).

In plain English

This retrospective, single-center study from Cangzhou Central Hospital, China, reviewed 70 patients (25 men, 45 women) with diffuse malignant peritoneal mesothelioma diagnosed between January 2013 and December 2018. The authors said their survival figures cover only patients unsuited to cytoreductive surgery or HIPEC. Sixty-two had confirmed asbestos exposure; fiber types were not named. The authors stained tumor tissue for CD74, CD10 and Ki-67 and tested links with survival. CD74 was found in 52 of 70 samples, CD10 in 34, high Ki-67 in 33. CD74 was negatively correlated with asbestos exposure (r = -0.278). Asbestos exposure was not significantly associated with survival (P = 0.957). Median survival was 7.00 months. In multivariate analysis, CD74 (hazard ratio 0.65, 95% CI 0.46–0.91, linked to longer survival), high Ki-67 (2.09, 1.18–3.73), TNM stage, performance status, and systemic or intraperitoneal chemotherapy versus supportive care were independent predictors of survival. CD10 was not. A prediction chart (nomogram) had a C-index of 0.81 (95% CI 0.76–0.85), tested only within these patients. The authors concluded these factors were associated with prognosis. They noted the small sample and missing surgery and HIPEC information.

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, single-center study of patient records and stored tumor tissue, using immunohistochemistry with survival analysis and a prediction nomogram
• Who was studied: 70 patients (25 male, 45 female) with pathologically proven diffuse malignant peritoneal mesothelioma. They were selected from 126 patients diagnosed between January 2013 and December 2018 at Cangzhou Central Hospital, Hebei, China. Mean age at diagnosis was 62.34 years.
• Exposure: The main factors studied were tumor expression of CD74, CD10 and Ki-67, together with clinical factors. Asbestos exposure was recorded as yes or no: 62 of 70 patients (88.57%) had confirmed exposure and 8 had none. No fiber types, products or doses were given. The authors suggested that the high exposure rate and the many female patients could be attributed to asbestos processing factories in Eastern China employing female workers in the 1970s.
• Main results:
  • The authors stated that the survival statistics refer only to patients not amenable to cytoreductive surgery or HIPEC, which they said are rarely applied in their region.
  • Tumor staining was positive for CD74 in 52 of 70 specimens (74.29%) and for CD10 in 34 (48.57%). Higher Ki-67 (above 15%) was found in 33 (47.14%).
  • CD74 was negatively correlated with TNM stage (P = 0.008, r = -0.313), asbestos exposure (P = 0.020, r = -0.278) and Ki-67 (P = 0.036, r = -0.251).
  • In univariate analysis, asbestos exposure was not significantly associated with survival (P = 0.957). Mean survival was 8.68 months in the 62 exposed patients (58 deaths) and 7.75 months in the 8 unexposed patients (7 deaths).
  • Median survival for all 70 patients was 7.00 plus or minus 0.73 months (range 1 to 24). Five patients were alive at the final analysis.
  • In multivariate Cox analysis, CD74 (HR = 0.65, 95% CI 0.46–0.91, P = 0.014) and TNM stage (HR = 1.89, 95% CI 1.16–3.09, P = 0.011) were independent prognostic factors. So were Ki-67 (HR = 2.09, 95% CI 1.18–3.73, P = 0.012) and ECOG performance status (HR = 2.12, 95% CI 1.06–4.25, P = 0.034).
  • Treatment groups: 26 patients received systemic chemotherapy with pemetrexed plus cisplatin, 19 received intraperitoneal chemotherapy with cisplatin, and 25 received only best supportive care.
  • Compared with best supportive care, systemic chemotherapy was an independent prognostic factor in multivariate analysis (HR = 0.41, 95% CI 0.21–0.82, P = 0.011).
  • Compared with best supportive care, intraperitoneal chemotherapy was an independent prognostic factor in multivariate analysis (HR = 0.34, 95% CI 0.16–0.71, P = 0.004).
  • CD10 expression was not associated with prognosis in univariate or multivariate analysis.
  • The survival nomogram built from the independent factors had a C-index of 0.81 (95% CI 0.76–0.85).
  • The nomogram was checked only by internal (bootstrap) verification within the study's own patients, not in a separate group of patients.
• The authors' conclusion: The authors concluded that CD74, Ki-67, TNM stage, ECOG performance status and tumor-directed treatment were associated with prognosis in diffuse malignant peritoneal mesothelioma. They wrote that reasonable chemotherapy may improve prognosis, and that the nomogram needs to be tested in prospective clinical trials.
• Limitations the authors state:
  • Retrospective, single-center design with a small database; differences between institutions and the number of patients may affect the results.
  • The study had no information on cytoreductive surgery or HIPEC, which the authors said are rarely used in their region.
  • The factors chosen for study were relatively limited and biased to some extent.
  • The authors suggested that the absence of a survival difference by histological type may reflect case selection, because most epithelial cases were treated only after severe disease had developed.

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: Ki-67, Peritoneal Mesothelioma, Asbestos Exposure, Prognosis, Chemotherapy, Overall Survival.

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