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Recurrence of Optimally Treated Malignant Peritoneal Mesothelioma with Cytoreduction and Heated Intraperitoneal Chemotherapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prognosis for patients with diffuse malignant peritoneal mesothelioma has dramatically improved with cytoreductive surgery and intraperitoneal chemotherapy. Little is known about disease recurrence after treatment. We analyzed the time to and predictors of recurrence in a large cohort of optimally treated patients.

Methods

We examined 113 patients completing a two-stage cytoreduction and intraperitoneal chemotherapy protocol. All patients achieved optimal surgical resection with completeness of cytoreduction (CC) score ≤ 1 and were divided into two groups based on absence (Group A) or presence (Group B) of gross disease at the outset of the second operation. Predictors of disease recurrence and recurrence-free survival (RFS) were determined using Cox proportional hazard regression modeling, and estimates were obtained by using the Kaplan–Meier method.

Results

Forty-six percent of patients had no gross evidence of disease at the second operation; the remaining 54% were cytoreduced to CC ≤ 1 (Group B). Forty-two percent of patients developed disease recurrence with a median recurrence-free survival of 38.5 months for the cohort; 79% of these received a form of iterative treatment. There was no statistically significant difference in recurrence-free survival between Group A (median RFS: 44.6 months) and B (median RFS: 35.5 months) (log-rank test, p = 0.06). Additionally, the only variable significantly associated with RFS was male gender (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.16–3.38).

Conclusions

Absence of gross disease at the second operation was not statistically protective against recurrence compared with presence of quantifiable residual disease (Group B) that was effectively cytoreduced. Long-term disease surveillance is recommended, because recurrence continues years after treatment. Where a question of recurrence arises on surveillance, males may benefit from a higher degree of suspicion.

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Authors and Affiliations

  1. Gastrointestinal & Endocrine Surgery, Department of Surgery, Columbia College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Danielle R. Heller MD, Joshua C. Leinwand MD, Allison M. Greene BA, John A. Chabot MD & Michael D. Kluger MD, MPH

  2. Department of Biostatistics, Mailman School of Public Health, New York, NY, USA

    Cody Chiuzan PhD

  3. Medical Oncology, Department of Medicine, Columbia College of Physicians and Surgeons, New York, NY, USA

    Robert N. Taub MD, PhD & Gleneara E. Bates MSW

Authors
  1. Danielle R. Heller MD
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  2. Cody Chiuzan PhD
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  3. Robert N. Taub MD, PhD
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  4. Joshua C. Leinwand MD
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  5. Allison M. Greene BA
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  6. Gleneara E. Bates MSW
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  7. John A. Chabot MD
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  8. Michael D. Kluger MD, MPH
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Corresponding author

Correspondence to Michael D. Kluger MD, MPH.

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Heller, D.R., Chiuzan, C., Taub, R.N. et al. Recurrence of Optimally Treated Malignant Peritoneal Mesothelioma with Cytoreduction and Heated Intraperitoneal Chemotherapy. Ann Surg Oncol 24, 3818–3824 (2017). https://doi.org/10.1245/s10434-017-6106-x

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  • DOI: https://doi.org/10.1245/s10434-017-6106-x

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