Treatment of Malignant Peritoneal Mesothelioma

Levý, Miroslav; Boublíková, Ludmila; Büchler, Tomáš; Šimša, Jaromír

doi:10.14735/amko2019333

Cited by 14 publications

(14 citation statements)

References 9 publications

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“…For numerous patients with MPeM who are unable to tolerate or unwilling to undergo surgery, clinicians usually provide supportive treatment or chemotherapy. Currently, the first-line clinical systemic therapy is pemetrexed combined with cisplatin or carboplatin (30). In the present study, tumour-directed treatment, especially systemic chemotherapy with pemetrexed alone or in combination with cisplatin and intraperitoneal chemotherapy with cisplatin, had a significantly positive effect on OS in MPeM.…”

Section: Discussionsupporting

confidence: 51%

Survivin expression as an independent predictor of overall survival in malignant peritoneal mesothelioma

Zhang

Yang²,

Guo

et al. 2020

Oncol Lett

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Malignant peritoneal mesothelioma (MPeM) is an incurable cancer strongly associated with asbestos exposure and characterised by poor prognosis. The aim of the present study was to elucidate the prognostic and predictive value of CD146 and survivin expression in MPeM. Diagnostic biopsies from 60 patients with MPeM were collected and analysed for CD146, survivin and Ki-67 expression using immunohistochemistry. Complete clinical and follow-up information was obtained from patients' records. CD146 was expressed in 31/60 MPeM specimens and survivin in 34/60 specimens, with both expression levels being significantly associated with the Ki-67 labelling index (Ki-67LI). Kaplan-Meier and univariate Cox regression analyses revealed that a lower peritoneal cancer index (PCI), tumour-directed treatment, stage I, lower Ki-67LI and lower CD146 and survivin expression had a statistically positive effect on overall survival (OS). Cox regression analysis revealed that PCI [hazard ratio (HR)=1.99; 95% CI, 1.04-3.83; P=0.038], survivin (HR=1.47; 95% CI, 1.03-2.10; P=0.034) and treatment protocol including intraperitoneal chemotherapy (HR=0.28; 95% CI, 0.14-0.57; P=0.013) and systemic chemotherapy (HR=0.13; 95% CI, 0.04-0.42; P=0.013) retained independent prognostic significance for OS. All of these were included in the nomogram. Calibration curves showed good agreement between nomogram-predicted and observed survival. The C-index of the nomogram for predicting OS was 0.77. A lower PCI, intraperitoneal chemotherapy, systemic chemotherapy and a lower level of survivin were powerful prognostic markers in patients with MPeM. The proposed nomogram provides individual survival prediction for patients with MPeM.

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Section: Discussionsupporting

confidence: 51%

Survivin expression as an independent predictor of overall survival in malignant peritoneal mesothelioma

Zhang

Yang²,

Guo

et al. 2020

Oncol Lett

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“…The type of therapy employed is determined by the patient clinical status and spread of the disease [ 29 ]. Cytoreductive surgery with HIPEC remains the gold standard for suitable candidates, and for those who cannot tolerate surgical resection, systemic chemotherapy alone can be considered [ 11 , 29 , 30 ]. However, the long-term benefits of systemic chemotherapy alone are not well understood.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, no specific guidelines exist for PPM management; however, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are recommended in most eligible patients [ 11 ]. The role of systemic chemotherapy is limited to patients who are not good candidates for cytoreductive surgery and HIPEC [ 11 ]. Even with optimum treatment, the overall survival of PPM is dismal [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Incidence, Survival Analysis and Future Perspective of Primary Peritoneal Mesothelioma (PPM): A Population-Based Study from SEER Database

Ullah

Waheed

Khan

et al. 2022

Cancers

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Background: Primary peritoneal mesothelioma (PPM) is a rare and aggressive tumor arising from the visceral and parietal peritoneum. The diagnosis and treatment of PPM are often delayed because of non-specific clinical presentation, and the prognosis is worse. The current study investigated the demographic, clinical, and pathological factors affecting patient prognosis and survival in PPM. Methods: Demographic and clinical data of 1998 patients with PPM were extracted from the Surveillance Epidemiology and End Results (SEER) database (1975–2016). The chi-square test, paired t-test, and multivariate analysis were used to analyze the data. Results: The majority of PPM patients were male (56.2%, p < 0.005) and Caucasian (90.4%, p < 0.005, with a mean age of diagnosis was 69 ± 13 years. The grading, histological, and tumor size information were classified as “Unknown” in most of the cases, but when available, poorly differentiated tumors (8.7%), malignant mesothelioma, not otherwise specified (63.4%) and tumors > 4 cm in size (8%), respectively, were most common, p < 0.005. Chemotherapy was administered to 50.6% of patients, followed by resection (29.2%) and radiation (1.5%), p < 0.001. The cohort of PPM had a five-year overall survival of 20.3% (±1.1), compared to 43.5% (±5.9), 25.9% (± 8.4), and 18.7% (±1.6) for those with surgery, radiation, or chemotherapy alone, respectively. Poor differentiation (OR = 4.2, CI = 3.3–4.9), tumor size > 4 cm (OR = 3.9, CI = 3.2–4.5), Caucasian race (OR = 2.9, CI = 2.6–4.4), and distant SEER stage (OR = 2.5, CI = 1.1–3.2) were all linked with increased mortality (p < 0.001). Conclusion: An extremely rare and aggressive peritoneal tumor, PPM may be difficult to identify at the time of diagnosis. Radiation therapy likely to have a limited function in the treatment of this condition, with surgery and chemotherapy being the primary choices. All PPM patients should be enrolled in a nationwide registry to improve our understanding of the pathogenesis and identify factors affecting survival.

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“…Malignant mesothelioma (MM) is a rare cancer originating from mesothelial cells forming the linings of the pleura (65% to 90% of MM cases 1,2 ), peritoneum (10% to 35% of cases 2,3 ), and pericardium (<5% of cases 4 ). 5,6 Typically, the pathophysiology of MM is believed to occur in patients with asbestos exposure leading to chronic inflammation of the pleura.…”

Section: Introductionmentioning

confidence: 99%

An Unpleasant Surprise: Abdominal Presentation of Malignant Mesothelioma

Uhlenhopp

Saliares

Gaduputi

et al. 2020

Journal of Investigative Medicine High Impact Case Reports

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Malignant mesothelioma is an aggressive cancer associated with asbestos exposure with median survival time of 8 to 14 months following diagnosis. Given that mesothelial cells also line the peritoneum and pericardium, malignant mesothelioma can present in unusual sites and in patients with nonrespiratory complaints. A 73-year-old male presented to the emergency department for worsening intermittent diffuse abdominal pain for the past 3 months with associated unintentional 40-pound weight loss, early satiety, and diarrhea. He denied exposure to asbestos. Computed tomography imaging revealed multiple masses concerning for malignancy including the primary retroperitoneal mass, a mass involving the terminal ileum, and a mass in the right upper lung. Esophagogastroduodenoscopy demonstrated significant mass effect within the stomach without signs of endoluminal infiltration. Computed tomography–guided biopsy of the retroperitoneal abdominal and intramuscular paraspinal masses was performed. Stage IV epithelioid mesothelioma was confirmed when hematoxylin and eosin staining revealed pleomorphic malignancy nuclei containing a vesicular chromatin pattern and prominent nucleoli and immunohistochemical staining was positive for CK Oscar, cytokeratin 7, GATA3, calretinin, EMA, and CK5/6. He was started on cisplatin, pemetrexed, and bevacizumab but developed severe abdominal pain with pneumoperitoneum and bowel perforation 1 month later and expired shortly thereafter. To our knowledge, this represents a highly atypical presentation of malignant mesothelioma considering the involvement of the retroperitoneum with diffuse lesions in the abdominopelvic cavity and thorax (sparing the lung pleurae). This case also calls attention to the occurrence of malignant mesothelioma in patients without known asbestos exposure and the crucial role of pathology in diagnosing atypical presentations.

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Treatment of Malignant Peritoneal Mesothelioma

Cited by 14 publications

References 9 publications

Survivin expression as an independent predictor of overall survival in malignant peritoneal mesothelioma

Survivin expression as an independent predictor of overall survival in malignant peritoneal mesothelioma

Incidence, Survival Analysis and Future Perspective of Primary Peritoneal Mesothelioma (PPM): A Population-Based Study from SEER Database

An Unpleasant Surprise: Abdominal Presentation of Malignant Mesothelioma

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