Preoperative Thrombocytosis Predicts Shortened Survival in Patients with Malignant Peritoneal Mesothelioma Undergoing Operative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy.
BACKGROUND
This study was designed to determine the clinical significance of preoperative thrombocytosis in patients with malignant peritoneal mesothelioma (MPM) undergoing operative cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). CRS and HIPEC have been associated with prolonged survival in patients with MPM and is the preferred treatment in select patients. However, patient selection criteria remain ill-defined for this operation that is also associated with significant morbidity and mortality. Preoperative thrombocytosis has been associated with poor outcomes in various malignancies but never studied in MPM.


METHODS
Between January 2006 and December 2015, 100 patients with high-grade epithelioid MPM were evaluated and selected for CRS and HIPEC at our center (M: 53, F: 47; mean age: 54 years [range 17-81 years]). We analyzed various patient and treatment related factors potentially associated with overall survival (OS).


RESULTS
The median actuarial overall survival was 32.8 months; the actuarial 1-, 3-, 5-year survivals were 70, 49, and 36%, respectively. On multivariate analysis, suboptimal resection (CCR > 1), high tumor burden (PCI > 20), and elevated preoperative platelet count (>367,000/mm3) were independently associated with shortened OS (P < 0.05). Median OS in patients with elevated versus normal platelet counts were 13 and 58 months, respectively (P < 0.001). Compared with patients with normal platelet counts, patients with elevated counts had significantly greater residual disease after operation (P = 0.008).


CONCLUSIONS
Elevated preoperative platelet count is independently associated with poor outcome. Notably, thrombocytosis reflects aggressive tumor biology and should be considered a factor in patient selection for CRS and HIPEC.
Departments of Surgery, Biochemistry and Molecular Biology and Pathology, The Greenebaum Comprehensive Cancer Center, The University of Maryland School of Medicine, Baltimore, MD, USA.
Yue C
YC
Li
Departments of Surgery, Biochemistry and Molecular Biology and Pathology, The Greenebaum Comprehensive Cancer Center, The University of Maryland School of Medicine, Baltimore, MD, USA.
Tamara
T
Khashab
Departments of Surgery, Biochemistry and Molecular Biology and Pathology, The Greenebaum Comprehensive Cancer Center, The University of Maryland School of Medicine, Baltimore, MD, USA.
Julia
J
Terhune
Departments of Surgery, Biochemistry and Molecular Biology and Pathology, The Greenebaum Comprehensive Cancer Center, The University of Maryland School of Medicine, Baltimore, MD, USA.
Richard L
RL
Eckert
Departments of Surgery, Biochemistry and Molecular Biology and Pathology, The Greenebaum Comprehensive Cancer Center, The University of Maryland School of Medicine, Baltimore, MD, USA.
Nader
N
Hanna
Departments of Surgery, Biochemistry and Molecular Biology and Pathology, The Greenebaum Comprehensive Cancer Center, The University of Maryland School of Medicine, Baltimore, MD, USA.
Allen
A
Burke
Departments of Surgery, Biochemistry and Molecular Biology and Pathology, The Greenebaum Comprehensive Cancer Center, The University of Maryland School of Medicine, Baltimore, MD, USA. HRAlexander@som.umaryland.edu.
H
H
Richard Alexander
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000401:mortality*; D003131:Combined Modality Therapy / Q000401:mortality*; D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000401:mortality*; 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; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011300:Preoperative Care; D011379:Prognosis; D015996:Survival Rate; D013922:Thrombocytosis / Q000503:physiopathology*; D055815:Young Adult