Prognostic factors of malignant peritoneal mesothelioma: a retrospective study of 52 female patients

Our plain-English summary of Prognostic factors of malignant peritoneal mesothelioma: a retrospective study of 52 female patients, by J. Ma, S. Zhang (World Journal of Surgical Oncology, 2022).

The study

• Authors: J. Ma, S. Zhang
• Journal: World Journal of Surgical Oncology
• Published: 2022;20(1):219
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Prognosis in malignant peritoneal mesothelioma (MPM) remains poor, and the associated factors are unclear. Therefore, this study aimed to investigate the prognostic factors of MPM.

Methods: A total of 52 female MPM patients treated in 2012-2017 were retrospectively analyzed. Kaplan-Meier survival curves were generated for survival analysis by the log-rank test. The Cox regression model was used for univariate and multivariate analyses.

Results: Univariate analysis showed that median survival time (MST) was longer in the epithelioid type compared with the sarcomatoid type (12 months vs 5 months); cumulative survival rates at 12 months were 45.7% and 0%, respectively (P=0.005). MST was longer in patients with proliferating cell nuclear antigen (Ki67) ≤ 10% compared with those with Ki67 > 10% (15 months vs 11 months). Cumulative survival rates at 12 months were 60.0% and 28.1%, respectively (P=0.036). MSTs in patients administered peritoneal biopsy or adnexectomy + paclitaxel + platinum perfusion, peritoneal biopsy (or adnexectomy) + pemetrexed + platinum perfusion, cytoreductive surgery + paclitaxel + platinum perfusion, and cytoreductive surgery + pemetrexed + platinum perfusion were 6, 11, 12, and 24 months, respectively, with cumulative survival rates at 12 months of 0%, 35.7%, 45.5%, and 73.3%, respectively. Survival time after cytoreductive surgery combined with pemetrexed + platinum was the longest. In multivariate analysis, pathological type, T staging, and therapeutic regimen were independent prognostic factors of MPM (P < 0.05).

Conclusions: Prognosis in MPM is associated with pathological subtype, clinical staging, cytoreductive surgery, and subsequent pemetrexed use. Radical cytoreductive surgery and postoperative use of pemetrexed prolong survival.

© 2022. The Author(s).

In plain English

This retrospective study reviewed 52 women treated for malignant peritoneal mesothelioma (abdominal-lining cancer) at Yuyao People's Hospital, China, from 2012 to 2017. Of these, 44 (84.6%) had 1 to 12 years of asbestos exposure; the article does not name fiber types. Median survival was 12.0 months (95% CI 9.7 to 14.3), and 50 women died. Median survival was 11 months (95% CI 7.8 to 14.3) with exposure and 12 months (4.6 to 19.4) without; this was not statistically significant (P = 0.537). The sarcomatoid type (6 women) had a median of 5 months (2.0 to 9.8), against 12 months (10.1 to 13.9) for the epithelioid type (46 women). In the combined analysis, tumor type, T stage and treatment were each independently linked to survival. Women given cytoreductive surgery (removal of visible tumor) and pemetrexed plus platinum had the longest median survival, 24 months (20.0 to 28.0); those given biopsy or adnexectomy with paclitaxel plus platinum had the shortest, 6 months (3.8 to 8.2). The authors concluded pemetrexed could prolong survival, and noted the study was small, single-center and not randomized.

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, single-center study of patient records analyzing survival and prognostic factors (Kaplan-Meier and Cox regression)
• Who was studied: 52 women with malignant peritoneal mesothelioma, aged 42 to 75 (mean 60.63), treated January 2012 to December 2017 at Yuyao People's Hospital, Zhejiang, China; 46 epithelioid and 6 sarcomatoid; all stage T3 (36) or T4 (16)
• Exposure: 44 of the 52 women had a history of asbestos exposure lasting 1 to 12 years and 8 had none. The article does not give fiber types or sources. The main factors studied were tumor type, T stage, Ki67 level and four treatment regimens (biopsy or adnexectomy, or cytoreductive surgery, each combined with either paclitaxel plus platinum or pemetrexed plus platinum)
• Main results:
  • All 52 patients: median survival 12.0 months (95% CI 9.7 to 14.3); 50 deaths (96.2%)
  • Women with an asbestos exposure history (44): median survival 11 months (95% CI 7.8 to 14.3). Women without (8): 12 months (95% CI 4.6 to 19.4). The difference was not statistically significant (P = 0.537)
  • Epithelioid type (46 patients): median survival 12 months (95% CI 10.1 to 13.9), 12-month survival 45.7%. Sarcomatoid type (6 patients): median 5 months (95% CI 2.0 to 9.8), 12-month survival 0% (P = 0.005)
  • In multivariate analysis, the sarcomatoid type had a hazard ratio for death of 7.663 (95% CI 2.715 to 21.625) compared with the epithelioid type (P less than 0.001)
  • Stage T4 compared with stage T3: hazard ratio 2.024 (95% CI 1.032 to 3.971), P = 0.040. In the univariate analysis, median survival was 12 months for T3 and 6 months for T4
  • Ki67 of 10% or less (20 patients): median survival 15 months, 12-month survival 60.0%. Ki67 above 10% (32 patients): 11 months and 28.1% (P = 0.036). In the multivariate analysis, Ki67 was not related to survival
  • Median survival by treatment: biopsy/adnexectomy plus paclitaxel and platinum (12 patients) 6 months (95% CI 3.8 to 8.2); biopsy/adnexectomy plus pemetrexed and platinum (14) 11 months (95% CI 3.7 to 18.3); cytoreductive surgery plus paclitaxel and platinum (11) 12 months (95% CI 8.0 to 16.0); cytoreductive surgery plus pemetrexed and platinum (15) 24 months (95% CI 20.0 to 28.0)
  • 12-month survival for the same four treatment groups was 0%, 35.7%, 45.5% and 73.3% respectively; the differences among the four groups were statistically significant (P less than 0.001)
  • Compared with cytoreductive surgery plus pemetrexed and platinum, the hazard ratios for death were 22.794 (95% CI 7.302 to 71.149) for biopsy/adnexectomy plus paclitaxel and platinum, 5.797 (2.312 to 14.538) for biopsy/adnexectomy plus pemetrexed and platinum, and 4.823 (1.735 to 13.405) for cytoreductive surgery plus paclitaxel and platinum
  • Cytoreductive surgery plus paclitaxel and platinum compared with biopsy/adnexectomy plus pemetrexed and platinum: the difference in survival was not statistically significant
• The authors' conclusion: The authors concluded that T staging and cytoreductive surgery combined with pemetrexed plus platinum chemotherapy are independent prognostic factors of malignant peritoneal mesothelioma. They concluded that pemetrexed could prolong survival time, although long-term survival remains not ideal, and they called for larger multi-center studies.
• Limitations the authors state:
  • Single-center study with a small sample size, no randomization and insufficient statistical power
  • Markers previously identified as prognostic factors (WT1, BAP1, p16/CDKN2A) were not tested
  • Ki67 was split into categories, which might cause bias and loss of information
  • The sarcomatoid group was small, so the statistical bias in that comparison was high

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Prognosis, Median Overall Survival, Epithelioid, Sarcomatoid, Biopsy, Pemetrexed (Alimta), Cytoreductive Surgery.

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• Analysis of prognostic factors of patients with malignant peritoneal mesothelioma — W. Yin, G. Zheng, et al. (2018)
• Prognostic factors influencing survival in 35 patients with malignant peritoneal mesothelioma — H. Kaya, C. Sezgı, et al. (2014)
• Malignant peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is GLUT1 expression a major prognostic factor? A preliminary study — J. Hommell-Fontaine, S. Isaac, et al. (2013)
• Osteopontin, GLUT1 and Ki-67 expression in malignant peritoneal mesothelioma: prognostic implications — Y. Liu, G. Zheng, et al. (2021)

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