Risk factors and prognosis of malignant peritoneal mesothelioma with paraneoplastic syndrome

Our plain-English summary of Risk factors and prognosis of malignant peritoneal mesothelioma with paraneoplastic syndrome, by X.L. Liang, Y.D. Su, X.B. Li, et al (World Journal of Surgical Oncology, 2024).

The study

• Authors: X.L. Liang, Y.D. Su, X.B. Li, Y.B. Fu, R. Ma, R. Yang, H.L. Wu, Y. Li
• Journal: World Journal of Surgical Oncology
• Published: 2024;22(1):29
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is a rare and highly aggressive tumor. Its clinical manifestations are diverse, and the symptoms are not specific. Some patients will develop paraneoplastic syndrome (PS) during the disease course. This study aims to analyze the risk factors of PS in patients with MPM and their impacts on prognosis.

Methods: The clinical data of MPM patients who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) at our center from June 2015 to May 2023 were retrospectively analyzed. MPM patients were divided into PS group and non-PS group according to the diagnostic criteria. Univariate and multivariate analyses were performed to explore the risk factors of PS in MPM patients, and to analyze the impact of PS on prognosis.

Results: There were 146 MPM patients in this study, including 60 patients (41.1%) with PS and 86 patients (58.9%) without PS. The highest incidence of PS was thrombocytosis (33.6%), followed by neoplastic fever (9.6%). Univariate analysis revealed 8 factors (P < 0.05) with statistically significant differences between the two groups: prior surgical scores, targeted therapy history, Karnofsky performance status score, preoperative carbohydrate antigen (CA) 125 level, vascular tumor embolus, peritoneal cancer index, completeness of cytoreduction (CC) score and intraoperative ascites. Multivariate analysis identified 3 independent factors associated with PS: preoperative CA 125 level, vascular tumor embolus, and CC score. Survival analysis demonstrated that MPM patients with PS had worse prognosis, although PS was not an independent prognostic factor.

Conclusions: PS is not rare in patients with MPM, and is independently associated with preoperative CA 125 level, vascular tumor embolus and CC score. PS often indicates advanced disease and poor prognosis.

© 2024. The Author(s).

In plain English

This retrospective study from Beijing Shijitan Hospital in China reviewed 146 patients with malignant peritoneal mesothelioma, a cancer of the abdominal lining. All had cytoreductive surgery plus heated chemotherapy in the abdomen (CRS + HIPEC) between June 2015 and May 2023. The authors asked how often these patients had paraneoplastic syndromes, which are problems caused indirectly by a cancer rather than by the tumor pressing on or invading tissue, and what factors were linked to them. The article does not report asbestos exposure. Sixty patients (41.1%) had such a syndrome. The most common were a high platelet count (49 patients, 33.6%) and tumor-related fever (14 patients, 9.6%). Three factors were independently associated with having a syndrome: a raised CA 125 blood marker before surgery, tumor cells in blood vessels, and incomplete removal of the tumor. Median survival was 14.0 months in patients with a syndrome and 30.7 months in those without. However, the syndrome was not an independent predictor of survival. The authors concluded that these syndromes are not rare and often indicate advanced disease. They noted that this was a single-center study with a limited sample size.

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 analysis of patients from a single hospital's database, comparing patients with and without paraneoplastic syndrome; the article also includes one illustrative case description
• Who was studied: 146 patients with malignant peritoneal mesothelioma who underwent CRS + HIPEC at Beijing Shijitan Hospital (Capital Medical University), China, June 2015 to May 2023
• Exposure: The article does not report asbestos or fiber exposure. The factors studied were clinical, pathological and surgical characteristics, compared between patients with and without paraneoplastic syndrome.
• Main results:
  • Of 146 patients, 60 (41.1%) had paraneoplastic syndrome and 86 (58.9%) did not
  • The most common syndromes, as a share of all 146 patients, were thrombocytosis (high platelet count), 49 patients (33.6%), and neoplastic fever, 14 patients (9.6%); one patient could have more than one syndrome
  • In multivariate analysis, vascular tumor embolus (tumor cells in blood vessels) was independently associated with paraneoplastic syndrome: odds ratio 2.791 (95% CI 1.203–6.477), P = 0.017
  • Incomplete cytoreduction (CC score 2–3 vs 0–1) was independently associated with paraneoplastic syndrome: odds ratio 3.287 (95% CI 1.593–6.782), P = 0.001. CC 2–3 occurred in 63.3% of the PS group vs 32.6% of the non-PS group
  • Increased preoperative CA 125 was independently associated with paraneoplastic syndrome: odds ratio 2.921 (95% CI 1.263–6.755), P = 0.012
  • In all 146 patients, median overall survival was 23.9 months (95% CI 17.6–30.2 months), at a median follow-up of 36.8 months. 88 patients (60.3%) had died.
  • In univariate analysis, median overall survival was 30.7 months in the non-PS group vs 14.0 months in the PS group (P = 0.016)
  • In multivariate Cox analysis, paraneoplastic syndrome was not an independent prognostic factor. The independent prognostic factors were KPS, preoperative CA 125 level, PCI, RBC transfusion, Ki-67 index and serious adverse events.
• The authors' conclusion: The authors concluded that paraneoplastic syndrome in malignant peritoneal mesothelioma is not rare and often indicates advanced disease. In their view, patients with it have a large tumor burden and higher surgical difficulty, leading to poor prognosis.
• Limitations the authors state:
  • Clinicians' limited understanding of paraneoplastic syndrome, together with incomplete history-taking and examination, may have led to abnormal symptoms being overlooked
  • Single-center study with a limited sample size; the authors call for larger, multi-center studies

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: Prognosis, Peritoneal Mesothelioma, Cytoreductive Surgery, HIPEC, Targeted Therapy, Performance Status, Peritoneal Cancer Index (PCI), Completeness of Cytoreduction (CC) Score.

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