Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian, 1 20133 Milan, Italy.
Eur J Cancer. 2013 Oct;49(15):3140-8. doi: 10.1016/j.ejca.2013.05.027. Epub 2013 Jul 4.
Prognosis of diffuse malignant peritoneal mesothelioma (DMPM) has been recently improved by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). As with other peritoneal surface malignancies, the survival benefit is maximal when a complete surgical cytoreduction is achieved, but additional factors predicting long-term outcome are still poorly understood. We sought to investigate outcome and prognostic factors in patients with DMPM treated by complete cytoreduction and HIPEC.
From a prospective database, we selected 108 patients with DMPM undergoing complete cytoreduction (residual tumour nodules ≤2.5 mm) and closed-abdomen HIPEC with cisplatin and doxorubicin or mitomycin-C. Twenty-seven patient-, tumour- and treatment-related variables were assessed by multivariate analysis with respect to overall (OS) and progression-free (PFS) survival. A panel of immunohistochemical markers was tested.
Operative mortality was 1.9% and major morbidity 38.9%. Median follow-up was 48.8 months (95% confidence interval (CI) 37.1-60.6). Median OS and PFS were 63.2 months (95%CI 29.6-96.7) and 25.1 months (95%CI 5.1-45.1). The survival curve reached a plateau after 7 years, representing 19 actual survivors of 39 patients (43.6%) with potential follow-up ≥7 years. Cytokeratin 5/6, calretinin, Wilms tumour-1 (WT-1), podoplanin and epithelial growth factor receptor (EGFR) were mostly positive. At multivariate analysis, epithelial histological subtype, negative lymph-nodes, ≤10% Ki67-positive cells correlated with both increased OS and PFS. Positive podoplanin correlated to increased PFS.
After complete cytoreduction and HIPEC, prognosis of DMPM is primarily dependent on pathologic and biologic features. Patients with DMPM surviving ≥7 years appeared to be cured. Cure rate was 43.6%. Proliferative index and podoplanin may be used for prognostic stratification.
细胞减灭术和腹腔热灌注化疗（HIPEC）最近改善了弥漫性恶性腹膜间皮瘤（DMPM）的预后。与其他腹膜表面恶性肿瘤一样，当达到完全手术细胞减灭时，生存获益最大，但仍不清楚其他预测长期预后的因素。我们旨在研究接受完全细胞减灭术和 HIPEC 治疗的 DMPM 患者的结局和预后因素。
从前瞻性数据库中，我们选择了 108 例接受完全细胞减灭术（残留肿瘤结节≤2.5mm）和闭合腹部 HIPEC 的 DMPM 患者，使用顺铂和阿霉素或丝裂霉素 C。通过多变量分析评估了 27 个患者、肿瘤和治疗相关变量与总生存期（OS）和无进展生存期（PFS）的关系。还测试了一组免疫组化标志物。
手术死亡率为 1.9%，主要发病率为 38.9%。中位随访时间为 48.8 个月（95%置信区间[CI]37.1-60.6）。中位 OS 和 PFS 分别为 63.2 个月（95%CI29.6-96.7）和 25.1 个月（95%CI5.1-45.1）。生存曲线在 7 年后达到平台期，代表 39 例中有 19 例实际幸存者（43.6%）的潜在随访时间≥7 年。细胞角蛋白 5/6、钙视网膜蛋白、Wilms 肿瘤-1（WT-1）、足突蛋白和表皮生长因子受体（EGFR）大多为阳性。多变量分析显示，上皮组织学亚型、阴性淋巴结、Ki67 阳性细胞≤10%与 OS 和 PFS 增加相关。足突蛋白阳性与 PFS 增加相关。
在完全细胞减灭术和 HIPEC 后，DMPM 的预后主要取决于病理和生物学特征。DMPM 存活≥7 年的患者似乎已治愈。治愈率为 43.6%。增殖指数和足突蛋白可用于预后分层。
