Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry

Votanopoulos, Konstantinos I.; Sugarbaker, Paul H.; Deraco, Marcello; Morris, David L.; Gléhen, Olivier; Élias, Dominique; Simone, Michele De; Robella, Manuela; Heyd, Bruno; Kusamura, Shigeki; Baratti, Dario; Chouliaras, Konstantinos; Russell, Greg; Shen, Perry; Levine, Edward A.

doi:10.1245/s10434-017-6293-5

Cited by 29 publications

(27 citation statements)

References 9 publications

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“…Patients with epithelioid tumors had significantly longer survival than patients with other histological types. This result was not an unexpected finding because the current histological classification is a strong predictor of survival, with epithelioid MM having the best prognosis [ 13 – 15 ]. The epithelioid type was also the most frequently detected in our study population.…”

Section: Discussionmentioning

confidence: 92%

Evaluation of prognostic histological parameters proposed for pleural mesothelioma in diffuse malignant peritoneal mesothelioma. A short report

et al. 2021

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Introduction Diffuse malignant peritoneal mesothelioma (DMPM) is a rare malignant neoplasm with poor survival that shares some similarities with the best-known pleural variant, pleural mesothelioma. The recent European Reference Network on Rare Adult Cancers (EURACAN)/International Association for the Study of Lung Cancer (IASLC) proposals attempted to improve the histological diagnosis and patient risk stratification. Herein, we investigated whether the pathology recommendations and suggestions of the pleural proposals were applicable to diffuse malignant peritoneal mesothelioma. Methods Fifty multiple laparoscopic biopsies of DMPM were consecutively collected at the Pathology Unit of the University of Bari. A two-tier system, i.e., low, and high grade, was used to categorize 34 epithelioid DMPMs. Architectural patterns, cytological features and stromal changes were also reported. Immunohistochemistry was performed for BRCA1-associated protein 1 (BAP1), programmed death-ligand 1 (PD-L1), and Ki67, while fluorescence in situ hybridization (FISH) was performed for p16/cyclin-dependent kinase inhibitor 2A (CDKN2A). Results High-grade epithelioid mesothelioma, high Ki67, and p16/CDKN2A deletion were significantly associated with short survival (p = 0.004, p < 0.0001, and p = 0.002, respectively). BAP1 loss and PD-L1 negativity were the most common findings. Multivariate analysis revealed that the nuclear grading system and p16 deletion significantly correlated with survival (p = 0.003 each). Conclusions The present study examined the prognostic significance of several factors proposed for pleural mesothelioma in an extra pleural site. Notably, the introduction of a grading system may provide better risk stratification in epithelioid DMPM. Ki67, BAP1 and p16/CDKN2A should also be measured whenever possible. A detailed report with all supportive data would allow us to collect sufficient information for use in further studies on larger case series.

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Section: Discussionmentioning

confidence: 92%

Evaluation of prognostic histological parameters proposed for pleural mesothelioma in diffuse malignant peritoneal mesothelioma. A short report

et al. 2021

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“…Alexander and colleagues had similar findings, showing that patients with a CC of 2 or 3 had nearly twice the risk of death compared to those with a CC of 0 or 1 (HR 1.81, p =0.02) 61. In biphasic cohorts, survival depends so greatly on resection status that even a CC 1 resection has a shorter survival by 4 years 35. Thus, at many institutions, if a complete or near-complete cytoreduction cannot be obtained, CRS/HIPEC is considered contraindicated.…”

Section: Prognosismentioning

confidence: 82%

“…The sarcomatoid subtype carries such a dismal prognosis that most centers, including ours, consider it a contraindication to CRS/HIPEC, as there is no proven survival benefit 74. Recent work at our institution, however, has demonstrated that for the biphasic subtype, long-term survival can be achieved in patients with a complete cytoreduction (CC-0) and HIPEC 35. The previously nihilistic view of the biphasic subtype likely stemmed from its rarity and traditional practice to group it with the sarcomatoid subtype.…”

Section: Prognosismentioning

confidence: 94%

“…MPM is divided into three histopathological subtypes: epithelioid, sarcomatoid, and biphasic. Approximately 75% of MPM is epithelioid, 25% is biphasic, and sarcomatoid is rare and associated with very poor outcomes 35. Histologically, epithelioid MPM cells resemble normal mesothelial cells in a tubulopapillary or trabecular pattern with rare mitotic figures 31,36.…”

Section: Diagnosismentioning

confidence: 99%

“…At our institution, prior to CRS/HIPEC, we first confirm a histologic diagnosis of MPM with a pathologic second opinion. Patients with the sarcomatoid variant of MPM are not candidates for resection; however, epithelioid and highly selected biphasic cases are 35. Exclusion criteria for CRS/HIPEC include comorbid conditions that significantly decrease functional status, extra-abdominal metastasis, or poor performance status (ECOG >2).…”

Section: Treatmentmentioning

confidence: 99%

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<p>Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: patient selection and special considerations</p>

Enomoto¹,

Shen²,

Levine³

et al. 2019

CMAR

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Malignant peritoneal mesothelioma (MPM) is a rare, aggressive malignancy that typically presents with vague symptoms, ascites, and/or diffuse peritoneal studding. Despite findings of advanced disease within the peritoneal cavity, spread beyond the abdomen is uncommon. Although advances in systemic chemotherapy have been made, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remain the mainstay of treatment. Median overall survival of approximately 50 months with CRS/HIPEC has been demonstrated, with age, gender, histologic subtype, peritoneal carcinomatosis index, comorbidities, nodal and extra-abdominal metastases, and completeness of cytoreduction all playing a role in prognosis. In patients with refractory malignant ascites and unresectable disease, complete resolution of ascites and improvement in quality of life have been demonstrated with palliative HIPEC. In appropriately selected patients, CRS/HIPEC plays a critical role in the treatment and palliation of MPM.

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Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma: Canadian practices and outcomes

Deban

Taqi

Knapp

et al. 2023

Journal of Surgical Oncology

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IntroductionPeritoneal mesothelioma (PM) is a rare malignancy originating from the peritoneal lining. Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is the standard‐of‐care for patients with isolated PM. Due to a paucity of prospective data there are several different HIPEC protocols. The aims of this study are to describe the CRS and HIPEC protocols for PM and patient outcomes across Canada.MethodsA multicenter retrospective study was performed on patients diagnosed and treated for PM with CRS and HIPEC in four major peritoneal disease centers in Canada between 2000 and 2021. Data on patient characteristics, treatment patterns, postoperative morbidity, recurrence, and survival were collected.ResultsA total of 72 patients were identified. Mean age was 52 years (17–75) and 37.5% were male. Epithelioid (70.1%) and multicystic (13%) mesothelioma were the most common subtypes. Twenty‐one patients (30%) were treated with neoadjuvant chemotherapy. CRS and HIPEC was performed in 64 patients (91.4%). Of these, the mean PCI was 22 (2–39) and cisplatin+doxorubicin was the most common HIPEC regimen (n = 33, 51.6%). A semi‐closed coliseum technique was used in 68.8% of HIPECs and the mean duration of surgery was 486 min (90–1052). Clavien‐Dindo III or IV complications occurred in 12 patients (16.9%). With a median follow‐up of 24 months (0.2–104.4), we found a 5‐year overall survival of 61% and a 5‐year recurrence‐free survival of 35%.ConclusionCRS and HIPEC is a safe and effective treatment modality for well‐selected patients with PM, with some achieving prolonged survival.

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Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry

Cited by 29 publications

References 9 publications

Evaluation of prognostic histological parameters proposed for pleural mesothelioma in diffuse malignant peritoneal mesothelioma. A short report

Evaluation of prognostic histological parameters proposed for pleural mesothelioma in diffuse malignant peritoneal mesothelioma. A short report

<p>Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: patient selection and special considerations</p>

Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma: Canadian practices and outcomes

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