title: Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma.
abstract: OBJECTIVE
  Malignant peritoneal mesothelioma (MPM) is a primary cancer that arises diffusely from the mesothelial cells lining the peritoneum. Morbidity and mortality are almost invariably owing to locoregional progression. Cytoreduction surgery (CRS) with intraoperative or perioperative high-dose regional chemotherapy has been established as the preferred approach in selected patients. This study was performed to identify factors associated with long-term outcome.
  
  
  METHODS
  Between January 1992 and 2010, 211 patients with MPM treated at 3 major referral centers with operative CRS and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) were analyzed.
  
  
  RESULTS
  The median, actuarial overall survival was 38.4 months; the actuarial 5- and 10-year survivals were 41% and 26%, respectively. On multivariate analysis, factors independently associated with favorable outcome were younger age <60 years (P < .01), complete or near complete (R0-1) versus incomplete (R2-3) resection (P < .02), low versus high histologic grade (P < .01), and the use of cisplatin versus mitomycin-C during HIPEC (P < .01). There was a trend toward female sex and improved survival (male hazard ratio, 1.46; 95% confidence interval, 0.89-2.41; P = .13).
  
  
  CONCLUSIONS
  Operative CRS with HIPEC is associated with prolonged survival in patients with MPM. Factors associated with survival include age, complete or near complete gross tumor resection, histologic tumor grade, and HIPEC with cisplatin. Cisplatin (versus mitomycin-C) was independently associated with improved survival and demonstrates a salutary effect for HIPEC with cisplatin in the management of patients with MPM.
authors.affiliation: Divisions of General and Oncologic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. HRAlexander@smail.umaryland.edu
authors.forename: H Richard
authors.initials: HR
authors.lastname: Alexander
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.forename: Richard
authors.initials: R
authors.lastname: Royal
authors.forename: Marybeth S
authors.initials: MS
authors.lastname: Hughes
authors.forename: Matthew
authors.initials: M
authors.lastname: Holtzman
authors.forename: Nader
authors.initials: N
authors.lastname: Hanna
authors.forename: Keli
authors.initials: K
authors.lastname: Turner
authors.forename: Tatiana
authors.initials: T
authors.lastname: Beresneva
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult