Clinical-pathological characteristics and prognostic factors for malignant peritoneal mesothelioma in the elderly

Abstract

Background Malignant peritoneal mesothelioma (MPM) is a rare disease characterized by atypical symptoms, difficult diagnosis, variable course and poor prognosis, and it develops mainly in elderly individuals. The authors aimed to identify the clinical-pathological characteristics, prognosis, and prognostic factors in elderly MPM patients. Methods From the National Cancer Institute Surveillance Epidemiology End Results (SEER) database, 1492 patients with MPM from 1975 to 2016 were selected and divided into the elderly group (≥ 65) and the adult group (< 65). We compared the clinical-pathological characteristics and treatment methods of the elderly group (N = 665) and the adult group (N = 827). At the same time, we analysed specific selected clinicopathological parameters and prognostic factors for elderly MPM patients. Results Compared with the adult group, the elderly group had higher percentages of male patients (P = 0.017) and white patients (P = 0.043) and lower proportions of insured patients (P < 0.001) married patients (P < 0.001), patients with peritoneal tumours (P = 0.006) and patients who underwent surgery (P < 0.001) and chemotherapy (P < 0.001). There was a significant difference in the differentiation grade between the two groups (P = 0.003). Elderly patients had a shorter median survival time than adult patients (6 months vs. 19 months). Uninsured (hazard ratio (HR): 5.187, P = 0.005), sarcomatoid type (HR 3.913, P < 0.001), poorly differentiated (HR 3.900, P < 0.001), distant metastasis (HR 1.735, P = 0.001), no cancer-directed surgery (HR 1.733, P < 0.001), and no chemotherapy (HR 1.532, P < 0.001) were independently associated with poorer prognosis in elderly MPM patients. Conclusion Compared with adult patients, elderly MPM patients had a higher male ratio, poor differentiation and relatively conservative treatment. The cancer-specific survival (CSS) rate of elderly MPM patients was significantly lower than that of adult patients. Insurance status, histology type, differentiation grade, stage, surgery status, and chemotherapy status were all independent prognostic factors for elderly MPM patients.

[Retracted] Diagnostic and Prognostic Value of DACH1 Methylation in the Sensitivity of Esophageal Cancer to Radiotherapy

“…Further multifactorial Cox analysis revealed that TNM stage (stage III-IV), tumor hypofractionation, presence of lymph node metastasis, and DACH1 methylation may all increase the risk of radiation therapy insensitivity and poor prognosis in esophageal cancer patients, suggesting that the methylation status of DACH1 may be used as a predictor of chemotherapy sensitivity and prognosis in esophageal cancer, which may be related to the inhibition of transforming DACH1 by methylation This may be related to the fact that the methylated DACH1 inhibits the transmission of the transforming growth factor- β signaling pathway, resulting in the downregulation of the expression of downstream signaling target molecules, which in turn fails to regulate the expression of factors that promote cell division and proliferation [ 20 ]. However, the exact mechanism of the effect needs to be confirmed by further in-depth studies and verified in clinical practice [ 21 ].…”

Consensus Guideline for the Management of Patients with Peritoneal Mesothelioma

“…Pathological review remains difficult and should be performed by an expert pathologist to ensure accurate diagnosis 7, 28 . Histological subtype and nuclear grade have been shown to be independent predictors for patient outcomes, therefore these determinations are imperative for proper patient assessment 9, 29, 30 . In addition, immunohistochemistry (IHC) for Ki-67, programmed death ligand-1 (PD-L1), and anaplastic lymphoma kinas (ALK) translocation is recommended, as these markers have also been associated with patient outcomes and may influence treatment recommendations.…”

“…Intermediate-Risk designation comprises patients with similar histology but with patient factors associated with more aggressive disease. These patients are typically of male sex and at least 75 years old, patient prognostic factors associated with overall worse survival 4, 29, 73, 75, 87, 91 . Preoperative baseline thrombocytosis has been established as a poor prognostic marker associated with decreased overall survival 67, 78, 92 .…”

“…Intermediate-Risk designation comprises patients with similar histology but with patient factors associated with more aggressive disease. These patients are typically of male sex and at least 75 years old, patient prognostic factors associated with overall worse survival 4,29,73,75,87,91 .…”