Effects of sex hormones on survival of peritoneal mesothelioma

Our plain-English summary of Effects of sex hormones on survival of peritoneal mesothelioma, by Y. Huang, N.A. Alzahrani, W. Liauw, et al (World Journal of Surgical Oncology, 2015).

The study

• Authors: Y. Huang, N.A. Alzahrani, W. Liauw, D.L. Morris
• Journal: World Journal of Surgical Oncology
• Published: 2015;13:210
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Previous studies have suggested the presence of steroid receptors as a favourable prognostic factor in peritoneal mesothelioma (PM). This study aims to investigate possible hormonal effects on survival of PM.

Methods: This is a retrospective study of prospectively collected data of 52 consecutive patients with PM who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by the same surgical team at St George Hospital in Sydney, Australia, between April 1996 and April 2013. Females were arbitrarily divided into assumed premenopausal (< 51 years old; n = 15) and assumed postmenopausal (≥ 51 years old, n = 9). In each gender group, patients were furthered divided into three age groups (< 40, 40-60, > 60). A significant statistical difference was defined as p < 0.05.

Results: Females with epithelial mesothelioma had a significantly higher survival than males (p = 0.023). They also had a better overall median survival (> 60 months) than males (43 months), although this difference was not statistically significant (p = 0.098). Survival of postmenopausal females became similar to males after excluding benign cystic mesothelioma.

Conclusions: The better survival in premenopausal females could probably be explained by higher levels of oestradiol and progesterone. Also, our data suggests that higher rates of benign cystic mesothelioma in females was not the key reason for the better survival in female patients, further supporting the hypothesis of hormonal links with survival of PM. Therapeutic effects of sex steroid hormones on PM may be a valuable area to explore.

In plain English

This study reviewed records of 52 consecutive patients (24 females, 28 males) with peritoneal (abdominal) mesothelioma, treated by one surgical team at St George Hospital, Sydney, Australia, from April 1996 to April 2013. The treatment protocol was cytoreductive surgery (removing visible tumour) plus heated chemotherapy into the abdomen (HIPEC), though the article's table records 2 females and 2 males without HIPEC. Females were grouped by age as assumed premenopausal (under 51, n = 15) or postmenopausal (51 or older, n = 9). Sex hormones were not measured, and no asbestos-exposure analysis was reported. Among patients with the epithelial type, females survived significantly longer than males (p = 0.023). Overall, median survival for males was 43.0 months (95% confidence interval 5.5 to 80.5). No female median could be calculated because more than half were alive; the curve indicated more than 60 months. This difference was not statistically significant (p = 0.098). Benign cystic mesothelioma was more common in females (29.1%) than males (3.7%). Differences among premenopausal females, postmenopausal females and males were not statistically significant (p = 0.253). The authors concluded that oestrogen and progesterone may prolong survival.

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 study of prospectively collected data from a single centre
• Who was studied: 52 consecutive patients (24 females, 28 males) with peritoneal mesothelioma (benign cystic, epithelial, sarcomatoid or biphasic), treated with cytoreductive surgery and HIPEC at St George Hospital, Sydney, Australia, April 1996 to April 2013. Table 1 records that 2 females and 2 males did not receive HIPEC.
• Exposure: No asbestos-exposure analysis was reported. The factors compared were sex, assumed menopausal status defined by age only (under 51 premenopausal, n = 15; 51 or older postmenopausal, n = 9), age group (under 40, 40 to 60, over 60) and tumour subtype. Sex hormones were not measured.
• Main results:
  • Histological diagnosis differed between the sexes (p = 0.045): 29.1% of females had benign cystic mesothelioma, compared with 3.7% of males
  • In patients with epithelial mesothelioma, survival was significantly higher in females (p = 0.023). A female median could not be calculated, but the survival curve indicated more than 60 months. Males had a median of 22.0 months (95% CI 7.9 to 36.1).
  • For all subtypes combined, males had a median survival of 43.0 months (95% CI 5.5 to 80.5). The female median could not be calculated; the survival curve indicated more than 60 months. This difference was not statistically significant (p = 0.098).
  • When benign cystic mesothelioma was excluded, survival of postmenopausal females became more similar to that of males
  • The survival curves showed premenopausal females doing better than postmenopausal females and males, but the difference among the three groups was not statistically significant (p = 0.253)
  • Females aged over 60 had a median survival of 23 months. Survival in females aged 60 or under looked better on the curve, but the difference was not statistically significant (p = 0.952).
  • Median survival for males was 62 months under age 40, 43 months (95% CI 13.5 to 72.5) at ages 40 to 60, and 18 months (95% CI 15.4 to 20.6) over 60. This trend was not statistically significant (p = 0.486).
• The authors' conclusion: The authors concluded that oestrogen and progesterone may prolong survival in peritoneal mesothelioma. They also concluded that the higher rate of benign cystic mesothelioma in females was not the key reason for their better survival, and that therapeutic effects of sex steroid hormones may be worth exploring.
• Limitations the authors state:
  • Sex hormones and their receptors were not measured
  • Retrospective study at a single centre
  • Selection bias, because only selected patients were offered the combined surgery and chemotherapy
  • Small sample size, due to the low incidence of the disease
  • The data give insufficient evidence for the hormonal explanations proposed for the age-related survival patterns

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Cytoreductive Surgery, HIPEC, Mesothelioma, Median Overall Survival.

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• Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases — L.S. Kyang, N.A. Alzahrani, et al. (2019)
• Malignant Peritoneal Mesothelioma: National Practice Patterns, Outcomes, and Predictors of Survival — V. Verma, R.L. Sleightholm, et al. (2018)
• Long-term Survival and Propensity Score Matched Outcomes of Bilateral vs. Unilateral Diaphragm Interventions in Cytoreductive Surgery plus Intra-peritoneal Chemotherapy — B. Singh, G. Singh, et al. (2018)
• Institutional learning curve of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for peritoneal malignancies — P.M. Polanco, Y. Ding, et al. (2015)
• A novel nomogram for peritoneal mesothelioma predicts survival — N.P. Schaub, M. Alimchandani, et al. (2013)

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