Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma

H. Richard Alexander, David L. Bartlett, James F. Pingpank, Steven K. Libutti, Richard Royal, Marybeth S. Hughes, Matthew Holtzman, Nader Hanna, Keli Turner, Tatiana Beresneva, Yue Zhu

Research output: Contribution to journalArticle

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Abstract

Objectives: Malignant peritoneal mesothelioma (MPM) is a primary cancer that arises diffusely from the mesothelial cells lining the peritoneum. Morbidity and mortality are almost invariably owing to locoregional progression. Cytoreduction surgery (CRS) with intraoperative or perioperative high-dose regional chemotherapy has been established as the preferred approach in selected patients. This study was performed to identify factors associated with long-term outcome. Methods: Between January 1992 and 2010, 211 patients with MPM treated at 3 major referral centers with operative CRS and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) were analyzed. Results: The median, actuarial overall survival was 38.4 months; the actuarial 5- and 10-year survivals were 41% and 26%, respectively. On multivariate analysis, factors independently associated with favorable outcome were younger age <60 years (P <.01), complete or near complete (R0-1) versus incomplete (R 2-3) resection (P <.02), low versus high histologic grade (P <.01), and the use of cisplatin versus mitomycin-C during HIPEC (P <.01). There was a trend toward female sex and improved survival (male hazard ratio, 1.46; 95% confidence interval, 0.89-2.41; P =.13). Conclusion: Operative CRS with HIPEC is associated with prolonged survival in patients with MPM. Factors associated with survival include age, complete or near complete gross tumor resection, histologic tumor grade, and HIPEC with cisplatin. Cisplatin (versus mitomycin-C) was independently associated with improved survival and demonstrates a salutary effect for HIPEC with cisplatin in the management of patients with MPM.

Original languageEnglish (US)
Pages (from-to)779-786
Number of pages8
JournalSurgery (United States)
Volume153
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

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Drug Therapy
Cisplatin
Survival
Mitomycin
Therapeutics
Neoplasms
Peritoneum
Malignant Mesothelioma
Referral and Consultation
Multivariate Analysis
Confidence Intervals
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery

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Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma. / Alexander, H. Richard; Bartlett, David L.; Pingpank, James F.; Libutti, Steven K.; Royal, Richard; Hughes, Marybeth S.; Holtzman, Matthew; Hanna, Nader; Turner, Keli; Beresneva, Tatiana; Zhu, Yue.

In: Surgery (United States), Vol. 153, No. 6, 06.2013, p. 779-786.

Research output: Contribution to journalArticle

Alexander, HR, Bartlett, DL, Pingpank, JF, Libutti, SK, Royal, R, Hughes, MS, Holtzman, M, Hanna, N, Turner, K, Beresneva, T & Zhu, Y 2013, 'Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma', Surgery (United States), vol. 153, no. 6, pp. 779-786. https://doi.org/10.1016/j.surg.2013.01.001
Alexander, H. Richard ; Bartlett, David L. ; Pingpank, James F. ; Libutti, Steven K. ; Royal, Richard ; Hughes, Marybeth S. ; Holtzman, Matthew ; Hanna, Nader ; Turner, Keli ; Beresneva, Tatiana ; Zhu, Yue. / Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma. In: Surgery (United States). 2013 ; Vol. 153, No. 6. pp. 779-786.
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T1 - Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma

AU - Alexander, H. Richard

AU - Bartlett, David L.

AU - Pingpank, James F.

AU - Libutti, Steven K.

AU - Royal, Richard

AU - Hughes, Marybeth S.

AU - Holtzman, Matthew

AU - Hanna, Nader

AU - Turner, Keli

AU - Beresneva, Tatiana

AU - Zhu, Yue

PY - 2013/6

Y1 - 2013/6

N2 - Objectives: Malignant peritoneal mesothelioma (MPM) is a primary cancer that arises diffusely from the mesothelial cells lining the peritoneum. Morbidity and mortality are almost invariably owing to locoregional progression. Cytoreduction surgery (CRS) with intraoperative or perioperative high-dose regional chemotherapy has been established as the preferred approach in selected patients. This study was performed to identify factors associated with long-term outcome. Methods: Between January 1992 and 2010, 211 patients with MPM treated at 3 major referral centers with operative CRS and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) were analyzed. Results: The median, actuarial overall survival was 38.4 months; the actuarial 5- and 10-year survivals were 41% and 26%, respectively. On multivariate analysis, factors independently associated with favorable outcome were younger age <60 years (P <.01), complete or near complete (R0-1) versus incomplete (R 2-3) resection (P <.02), low versus high histologic grade (P <.01), and the use of cisplatin versus mitomycin-C during HIPEC (P <.01). There was a trend toward female sex and improved survival (male hazard ratio, 1.46; 95% confidence interval, 0.89-2.41; P =.13). Conclusion: Operative CRS with HIPEC is associated with prolonged survival in patients with MPM. Factors associated with survival include age, complete or near complete gross tumor resection, histologic tumor grade, and HIPEC with cisplatin. Cisplatin (versus mitomycin-C) was independently associated with improved survival and demonstrates a salutary effect for HIPEC with cisplatin in the management of patients with MPM.

AB - Objectives: Malignant peritoneal mesothelioma (MPM) is a primary cancer that arises diffusely from the mesothelial cells lining the peritoneum. Morbidity and mortality are almost invariably owing to locoregional progression. Cytoreduction surgery (CRS) with intraoperative or perioperative high-dose regional chemotherapy has been established as the preferred approach in selected patients. This study was performed to identify factors associated with long-term outcome. Methods: Between January 1992 and 2010, 211 patients with MPM treated at 3 major referral centers with operative CRS and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) were analyzed. Results: The median, actuarial overall survival was 38.4 months; the actuarial 5- and 10-year survivals were 41% and 26%, respectively. On multivariate analysis, factors independently associated with favorable outcome were younger age <60 years (P <.01), complete or near complete (R0-1) versus incomplete (R 2-3) resection (P <.02), low versus high histologic grade (P <.01), and the use of cisplatin versus mitomycin-C during HIPEC (P <.01). There was a trend toward female sex and improved survival (male hazard ratio, 1.46; 95% confidence interval, 0.89-2.41; P =.13). Conclusion: Operative CRS with HIPEC is associated with prolonged survival in patients with MPM. Factors associated with survival include age, complete or near complete gross tumor resection, histologic tumor grade, and HIPEC with cisplatin. Cisplatin (versus mitomycin-C) was independently associated with improved survival and demonstrates a salutary effect for HIPEC with cisplatin in the management of patients with MPM.

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