TY - JOUR
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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U2 - 10.1016/j.surg.2013.01.001
DO - 10.1016/j.surg.2013.01.001
M3 - Article
C2 - 23489943
AN - SCOPUS:84878012515
SN - 0039-6060
VL - 153
SP - 779
EP - 786
JO - Surgery (United States)
JF - Surgery (United States)
IS - 6
ER -