Co-occurrence of peritoneal mesothelioma and genitourinary cancers: a case series with comparative outcomes

Our plain-English summary of Co-occurrence of peritoneal mesothelioma and genitourinary cancers: a case series with comparative outcomes, by E.M. Bradley, J.L. Rogers, M.C. Kuo, et al (Pleura and Peritoneum, 2025).

The study

• Authors: E.M. Bradley, J.L. Rogers, M.C. Kuo, D. Magge
• Journal: Pleura and Peritoneum
• Published: 2025;10(4):177-184
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Peritoneal mesothelioma (PM) shares features with genitourinary (GU) malignancies, including histologic appearance, embryologic origin and genetic predispositions. However, data on their co-occurrence are limited. The study presents a case series of PM patients with associated GU malignancies and explores outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

Methods: A prospectively maintained CRS-HIPEC database from a tertiary referral center (2011-2024) was reviewed. Demographics, tumor characteristics and outcomes were compared between PM patients with and without GU malignancies (including gynecologic and urologic cancers).

Results: Among 237 CRS-HIPEC patients, 8/17 patients with PM were found to have another GU malignancy (median age 52.8, 62.5 % male). This included renal cell carcinoma, prostate cancer, ovarian tumors and cervical carcinoma. Most GU malignancies were diagnosed before PM (5/8), two were diagnosed post-CRS-HIPEC, and one synchronously. Three patients reported asbestos exposure; two had BAP1 mutations. Compared to those without GU malignancies, affected patients tended to have higher PCI (19.8 vs. 14.3) and poorer 3-year survival (62.5 vs. 100 %).

Conclusions: GU malignancy is common among PM patients undergoing CRS-HIPEC and could represent a higher-risk subgroup. These findings raise the hypothesis of a potential association between PM and GU malignancy. Shared origins, oncogenesis of similar cell types, environmental exposures or genetic predispositions may contribute and warrant further investigation.

© 2025 the author(s), published by De Gruyter, Berlin/Boston.

In plain English

In this case series, the authors reviewed a tertiary referral center's database of patients who had cytoreductive surgery with heated abdominal chemotherapy (CRS-HIPEC) from 2011 to 2024. Of 17 patients with peritoneal mesothelioma, 8 (47.1 %) also had a genitourinary cancer or tumor: prostate adenocarcinoma (3), renal cell carcinoma (2), ovarian neoplasms (2) and cervical carcinoma (1). Five of these were diagnosed before the mesothelioma, two after, and one at the same time. Three of the 8 had known asbestos exposure. The article gives no fiber types or jobs. Two carried BAP1 mutations, although 6 of the 8 had no genetic testing available. The 9 patients without such a cancer or tumor were the comparison group. Against them, the 8 had a higher average peritoneal cancer index, a measure of disease extent (19.8 vs. 14.3), but this difference was not statistically significant. The 8 also had lower 3-year survival (62.5 vs. 100 %). The authors concluded this group could represent a higher-risk subgroup, raising a hypothesis of an association. They noted the study was small and exploratory and cannot show cause.

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: Case series: retrospective review of a prospectively maintained institutional CRS-HIPEC database, with a descriptive comparison of peritoneal mesothelioma patients with and without an associated genitourinary malignancy as classified by the authors. The article also contains a literature review of other studies, which are not this study's findings.
• Who was studied: 17 patients with histologically confirmed peritoneal mesothelioma who underwent CRS-HIPEC at a tertiary referral center between 2011 and 2024. They came from 237 CRS-HIPEC patients in total. 8 were placed in the authors' associated genitourinary malignancy group (median age 53 years, range 20 to 75; 62.5 % male; 75 % White). This group included two ovarian neoplasms, a serous cystadenoma and a mature cystic teratoma. The other 9 had no associated genitourinary cancer or tumor.
• Exposure: The main factor studied was the co-occurrence of genitourinary cancers or tumors with peritoneal mesothelioma. Asbestos exposure was recorded: 3 of the 8 patients in the genitourinary group had known asbestos exposure (2 with prostate cancer, 1 with renal cell carcinoma). No fiber types, products, jobs or doses were reported. One patient had received radiation for cervical carcinoma before the mesothelioma diagnosis.
• Main results:
  • Among the 8 patients in the genitourinary group, the associated tumors were ovarian neoplasms (n=2: one serous cystadenoma, one mature cystic teratoma), cervical carcinoma (n=1), prostate adenocarcinoma (n=3) and renal cell carcinoma (n=2).
  • Of the 8 genitourinary cancers or tumors, 5 were diagnosed before the peritoneal mesothelioma, 2 after CRS-HIPEC, and 1 at the same time.
  • Two of the 8 patients in the genitourinary group carried BAP1 mutations. Genetic testing was not available for 6 of the 8.
  • Mean peritoneal cancer index at surgery was 19.8 in the 8-patient genitourinary group vs. 14.3 in the 9-patient comparison group (p=0.19, not statistically significant).
  • Complete cytoreduction was 62.5 % in the genitourinary group vs. 75 % in the comparison group (p=0.59).
  • Three-year survival was 62.5 % in the genitourinary group vs. 100 % in the comparison group. All three deaths within 3 years occurred in the genitourinary group.
  • Neoadjuvant chemotherapy was given to 77.8 % of the comparison group vs. 25 % of the genitourinary group (p=0.030).
• The authors' conclusion: The authors concluded that genitourinary malignancy is common among peritoneal mesothelioma patients undergoing CRS-HIPEC and could represent a higher-risk subgroup. They considered the findings hypothesis-generating, raising a possible association between the two cancers that warrants further investigation.
• Limitations the authors state:
  • Small sample size and a retrospective, exploratory design that cannot establish a definitive epidemiological link.
  • The cohort was mainly epithelioid and well-differentiated papillary mesothelioma, in patients healthy enough for major surgery, so findings may not apply to the broader peritoneal mesothelioma population.
  • The genitourinary malignancies were heterogeneous in type and clinical behavior.
  • Causal relationships between peritoneal mesothelioma and genitourinary cancers cannot be inferred.
  • The comparison between groups was underpowered, so its statistics should be read descriptively.
  • The small sample precluded multivariable survival analysis, so the authors could not adjust for confounders.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Cytoreductive Surgery, HIPEC, Carcinoma, Asbestos Exposure, BAP1, Carcinogenesis, Environmental Exposure.

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