title: Malignant peritoneal mesothelioma: prognostic factors and oncologic outcome analysis.
abstract: BACKGROUND
  Most patients with malignant peritoneal mesothelioma (MPM) present with late-stage, unresectable disease that responds poorly to systemic chemotherapy while, at the same time, effective targeted therapies are lacking. We assessed the efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) in MPM.
  
  
  METHODS
  We prospectively analyzed 65 patients with MPM undergoing CRS/HIPEC between 2001 and 2010. Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes.
  
  
  RESULTS
  Adequate CRS was achieved in 56 patients (CC-0 = 35; CC-1 = 21), and median simplified peritoneal cancer index (SPCI) was 12. Pathologic assessment revealed predominantly epithelioid histology (81 %) and biphasic histology (8 %), while lymph node involvement was uncommon (8 %). Major postoperative morbidity (grade III/IV) occurred in 23 patients (35 %), and 60-day mortality rate was 6 %. With median follow-up of 37 months, median overall survival was 46.2 months, with 1-, 2-, and 5-year overall survival probability of 77, 57, and 39 %, respectively. Median progression-free survival was 13.9 months, with 1-, 2-, and 5-year disease failure probability of 47, 68, and 83 %, respectively. In a multivariate Cox-regression model, age at surgery, SPCI >15, incomplete cytoreduction (CC-2/3), aggressive histology (epithelioid, biphasic), and postoperative sepsis were joint significant predictors of poor survival (chi square = 42.8; p = 0.00001), while age at surgery, SPCI >15, incomplete cytoreduction (CC-2/3), and aggressive histology (epithelioid, biphasic) were joint significant predictors of disease progression (Chi square = 30.6; p = 0.00001).
  
  
  CONCLUSIONS
  Tumor histology, disease burden, and the ability to achieve adequate surgical cytoreduction are essential prognostic factors in MPM patients undergoing CRS/HIPEC.
authors: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Deepa
authors: D
authors: Magge
authors: Mazen S
authors: MS
authors: Zenati
authors: Frances
authors: F
authors: Austin
authors: Arun
authors: A
authors: Mavanur
authors: Magesh
authors: M
authors: Sathaiah
authors: Lekshmi
authors: L
authors: Ramalingam
authors: Heather
authors: H
authors: Jones
authors: Amer H
authors: AH
authors: Zureikat
authors: Matthew
authors: M
authors: Holtzman
authors: Steven
authors: S
authors: Ahrendt
authors: James
authors: J
authors: Pingpank
authors: Herbert J
authors: HJ
authors: Zeh
authors: David L
authors: DL
authors: Bartlett
authors: Haroon A
authors: HA
authors: Choudry
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D016685:Mitomycin; D002945:Cisplatin