Deraco Marcello, Nonaka Daisuke, Baratti Dario, Casali Paolo, Rosai Juan, Younan Rami, Salvatore Andreola, Cabras Ad Antonello D, Kusamura Shigeki
Department of Surgery, National Cancer Institute, Via Venezian, 1, 20133, Milan, Italy.
Ann Surg Oncol. 2006 Feb;13(2):229-37. doi: 10.1245/ASO.2006.03.045. Epub 2006 Jan 18.
Diffuse malignant peritoneal mesothelioma (DMPM) is a subset of peritoneal mesothelioma with a poor clinical outcome. We performed a prognostic analysis in a cohort of DMPM patients treated homogeneously by cytoreductive surgery and intraperitoneal hyperthermic perfusion (IPHP).
Forty-nine DMPM patients who underwent 52 consecutive procedures were enrolled onto the study. Cytoreductive surgery was performed according to the peritonectomy technique, and the IPHP was performed with cisplatin plus doxorubicin or cisplatin plus mitomycin C. We assessed the correlation of the clinicopathologic variables (previous surgical score, age, sex, performance status, previous systemic chemotherapy, carcinomatosis extension, completeness of cytoreduction, IPHP drug schedule, mitotic count [MC], nuclear grade, and biological markers [epidermal growth factor receptor, p16, matrix metalloproteinase 2 and matrix metalloproteinase 9]) with overall and progression-free survival.
The mean age was 52 years (range, 22-74 years). The mean follow-up was 20.3 months (range, 1-89 months). Regarding the biological markers, the rates of immunoreactivity of epidermal growth factor receptor, p16, matrix metalloproteinase 2, and matrix metalloproteinase 9 were 94%, 60%, 100%, and 85%, respectively. The strongest factors influencing overall survival were completeness of cytoreduction and MC, whereas those for progression-free survival were performance status and MC. No biological markers were shown to be of prognostic value.
Completeness of cytoreduction, performance status, and MC seem to be the best determinants of outcome. These data warrant confirmation by a further prospective formal trial. No biological markers presented a significant correlation with the outcome. The overexpression of epidermal growth factor receptor, matrix metalloproteinase 2, and matrix metalloproteinase 9 and absent or reduced expression of p16 might be related to the underlining tumor kinetics of DMPM and warrant further investigation with other methods.
弥漫性恶性腹膜间皮瘤（DMPM）是腹膜间皮瘤的一个亚型，临床预后较差。我们对一组接受了减瘤手术和腹腔内热灌注化疗（IPHP）的DMPM患者进行了预后分析。
49例接受了52次连续手术的DMPM患者被纳入本研究。减瘤手术按照腹膜切除术技术进行，IPHP采用顺铂加阿霉素或顺铂加丝裂霉素C。我们评估了临床病理变量（既往手术评分、年龄、性别、体能状态、既往全身化疗、癌灶播散范围、减瘤的彻底性、IPHP药物方案、有丝分裂计数[MC]、核分级以及生物标志物[表皮生长因子受体、p16、基质金属蛋白酶2和基质金属蛋白酶9]）与总生存和无进展生存的相关性。
平均年龄为52岁（范围22 - 74岁）。平均随访时间为20.3个月（范围1 - 89个月）。关于生物标志物，表皮生长因子受体、p16、基质金属蛋白酶2和基质金属蛋白酶9的免疫反应率分别为94%、60%、100%和85%。影响总生存的最强因素是减瘤的彻底性和MC，而影响无进展生存的因素是体能状态和MC。没有生物标志物显示出具有预后价值。
减瘤的彻底性、体能状态和MC似乎是预后的最佳决定因素。这些数据有待进一步的前瞻性正式试验予以证实。没有生物标志物与预后存在显著相关性。表皮生长因子受体、基质金属蛋白酶2和基质金属蛋白酶9的过表达以及p16的缺失或表达降低可能与DMPM潜在的肿瘤动力学有关，需要用其他方法进行进一步研究。
