Advertisement

Annals of Surgical Oncology

, Volume 20, Issue 2, pp 555–561 | Cite as

A Novel Nomogram for Peritoneal Mesothelioma Predicts Survival

  • Nicholas P. Schaub
  • Meghna Alimchandani
  • Martha Quezado
  • Phil Kalina
  • John S. Eberhardt
  • Marybeth S. Hughes
  • Tatiana Beresnev
  • Raffit Hassan
  • David L. Bartlett
  • Steven K. Libutti
  • James F. Pingpank
  • Richard E. Royal
  • Udai S. Kammula
  • Prakash Pandalai
  • Giao Q. Phan
  • Alexander Stojadinovic
  • Udo RudloffEmail author
  • H. Richard Alexander
  • Itzhak Avital
Gastrointestinal Oncology

Abstract

Background

Malignant peritoneal mesothelioma (MPM) is a rare disease treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Estimation of personalized survival times can potentially guide treatment and surveillance.

Methods

We analyzed 104 patients who underwent CRS and cisplatin-based HIPEC for MPM. By means of 25 demographic, laboratory, operative, and histopathological variables, we developed a novel nomogram using machine-learned Bayesian belief networks with stepwise training, testing, and cross-validation.

Results

The mean peritoneal carcinomatosis index (PCI) was 15, and 66 % of patients had a completeness of cytoreduction (CC) score of 0 or 1. Eighty-seven percent of patients had epithelioid histology. The median follow-up time was 49 (1–195) months. The 3- and 5-year overall survivals (OS) were 58 and 46 %, respectively. The histological subtype, pre-CRS PCI, and preoperative serum CA-125 had the greatest impact on OS and were included in the nomogram. The mean areas under the receiver operating characteristic curve for the 10-fold cross-validation of the 3- and 5-year models were 0.77 and 0.74, respectively. The graphical calculator or nomogram uses color coding to assist the clinician in quickly estimating individualized patient-specific survival before surgery.

Conclusions

Machine-learned Bayesian belief network analysis generated a novel nomogram predicting 3- and 5-year OS in patients treated with CRS and HIPEC for MPM. Pre-CRS estimation of survival times may potentially individualize patient care by influencing the use of systemic therapy and frequency of diagnostic imaging, and might prevent CRS in patients unlikely to achieve favorable outcomes despite surgical intervention.

Keywords

Overall Survival Bayesian Belief Network Malignant Peritoneal Mesothelioma Early Postoperative Intraperitoneal Chemotherapy Peritoneal Carcinomatosis Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Supported by an NIH intramural grant.

Disclaimer

The views expressed in this manuscript are those of the authors and do not reflect the official policy of the NIH/NCI or Department of the Army, the Department of Defense or the United States Government.

References

  1. 1.
    Yan TD, Brun EA, Cerruto CA, Haveric N, Chang D, Sugarbaker PH. Prognostic indicators for patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma. Ann Surg Oncol. 2007;14:41–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Acherman YI, Welch LS, Bromley CM, Sugarbaker PH. Clinical presentation of peritoneal mesothelioma. Tumori. 2003;89:269–73.PubMedGoogle Scholar
  3. 3.
    Alexander HR, Hanna N, Pingpank JF. Clinical results of cytoreduction and HIPEC for malignant peritoneal mesothelioma. Cancer Treat Res. 2007;134:343–55.PubMedGoogle Scholar
  4. 4.
    Antman KH. Current concepts: malignant mesothelioma. N Engl J Med. 1980;303:200–2.PubMedCrossRefGoogle Scholar
  5. 5.
    Antman KH, Osteen RT, Klegar KL, et al. Early peritoneal mesothelioma: a treatable malignancy. Lancet. 1985;2(8462):977–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Eltabbakh GH, Piver MS, Hempling RE, Recio FO, Intengen ME. Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma. J Surg Oncol. 1999;70:6–12.PubMedCrossRefGoogle Scholar
  7. 7.
    Sugarbaker PH. Management of peritoneal-surface malignancy: the surgeon’s role. Langenbecks Arch Surg. 1999;384:576–87.PubMedCrossRefGoogle Scholar
  8. 8.
    Katz MH, Barone RM. The rationale of perioperative intraperitoneal chemotherapy in the treatment of peritoneal surface malignancies. Surg Oncol Clin N Am. 2003;12:673–88.PubMedCrossRefGoogle Scholar
  9. 9.
    Sticca RP, Dach BW. Rationale for hyperthermia with intraoperative intraperitoneal chemotherapy agents. Surg Oncol Clin N Am. 2003;12:689–701.PubMedCrossRefGoogle Scholar
  10. 10.
    Feldman AL. Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. J Clin Oncol. 2003;21:4560–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Sugarbaker P, Welch L, Mohamed F, Glehen O. A review of peritoneal mesothelioma at the Washington Cancer Institute. Surg Oncol Clin N Am. 2003;12:605–21.CrossRefGoogle Scholar
  12. 12.
    Yan TD, Deraco M, Baratti D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27:6237–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Deraco M, Nonaka D, Baratti D, et al. prognostic analysis of clinicopathologic factors in 49 patients with diffuse malignant peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion. Ann Surg Oncol. 2006;13:229–37.PubMedCrossRefGoogle Scholar
  14. 14.
    Sugarbaker PH, Acherman YI, Gonzalez-Moreno S, et al. Diagnosis and treatment of peritoneal mesothelioma: the Washington Cancer Institute experience. Semin Oncol. 2002;29:51–61.PubMedCrossRefGoogle Scholar
  15. 15.
    Gail MH, Greene MH. Gail model and breast cancer. Lancet. 2000;355(9208):1017.PubMedCrossRefGoogle Scholar
  16. 16.
    Dawy Z, Goebel B, Hagenauer J, Andreoli C, Meitinger T, Mueller JC. Gene mapping and marker clustering using Shannon’s mutual information. IEEE/ACM Trans Comput Biol Bioinform. 2006;3:47–56.PubMedCrossRefGoogle Scholar
  17. 17.
    Berry DA, Inoue L, Shen Y, et al. Modeling the impact of treatment and screening on U.S. breast cancer mortality: a Bayesian approach. J Natl Cancer Inst Monogr. 2006:30–6.Google Scholar
  18. 18.
    Berry SM, Broglio KR, Berry DA. Addressing the incremental benefit of histamine dihydrochloride when added to interleukin-2 in treating acute myeloid leukemia: a Bayesian meta-analysis. Cancer Invest. 2011;29:293–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.PubMedCrossRefGoogle Scholar
  20. 20.
    Nash G, Otis CN. Protocol for the examination of specimens from patients with malignant pleural mesothelioma: a basis for checklists. Cancer Committee, College of American Pathologists. Arch Pathol Lab Med. 1999;123:39–44.PubMedGoogle Scholar
  21. 21.
    Husain AN, Colby TV, Ordonez NG, et al. Guidelines for pathologic diagnosis of malignant mesothelioma: a consensus statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med. 2009;133:1317–31.PubMedGoogle Scholar
  22. 22.
    Yan TD, Deraco M, Elias D, et al. A novel tumor–node–metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database. Cancer. 2011;117:1855–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Theriault C, Pinard M, Comamala M, et al. MUC16 (CA125) regulates epithelial ovarian cancer cell growth, tumorigenesis and metastasis. Gynecol Oncol. 2011;121:434–43.PubMedCrossRefGoogle Scholar
  24. 24.
    Baratti D, Kusamura S, Deraco M. Circulating CA125 and diffuse malignant peritoneal mesothelioma. Eur J Surg Oncol. 2009;35:1198–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Rump A, Morikawa Y, Tanaka M, et al. Binding of ovarian cancer antigen CA125/MUC16 to mesothelin mediates cell adhesion. J Biol Chem. 2004;279:9190–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Kadota K, Suzuki K, Sima CS, Rusch VW, Adusumilli PS, Travis WD. Pleomorphic epithelioid diffuse malignant pleural mesothelioma: a clinicopathological review and conceptual proposal to reclassify as biphasic or sarcomatoid mesothelioma. J Thorac Oncol. 2011;6:896–904.PubMedCrossRefGoogle Scholar
  27. 27.
    Yan TD, Haveric N, Carmignani CP, Chang D, Sugarbaker PH. Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Cancer. 2005;103:839–49.PubMedCrossRefGoogle Scholar
  28. 28.
    Laterza B, Kusamura S, Baratti D, Oliva GD, Deraco M. Role of explorative laparoscopy to evaluate optimal candidates for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal mesothelioma. In Vivo. 2009;23:187–90.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Nicholas P. Schaub
    • 1
  • Meghna Alimchandani
    • 2
  • Martha Quezado
    • 2
  • Phil Kalina
    • 4
  • John S. Eberhardt
    • 4
  • Marybeth S. Hughes
    • 1
  • Tatiana Beresnev
    • 1
  • Raffit Hassan
    • 3
  • David L. Bartlett
    • 5
  • Steven K. Libutti
    • 6
  • James F. Pingpank
    • 5
  • Richard E. Royal
    • 7
  • Udai S. Kammula
    • 1
  • Prakash Pandalai
    • 1
  • Giao Q. Phan
    • 1
  • Alexander Stojadinovic
    • 8
  • Udo Rudloff
    • 1
    Email author
  • H. Richard Alexander
    • 9
  • Itzhak Avital
    • 1
    • 10
  1. 1.GI and Hepatobiliary Malignancies Section, Surgery BranchNational Cancer Institute/NIHBethesdaUSA
  2. 2.Laboratory of PathologyNational Cancer Institute/NIHBethesdaUSA
  3. 3.Solid Tumor Immunotherapy Section, Laboratory of Molecular BiologyNational Cancer Institute/NIHBethesdaUSA
  4. 4.DecisionQ CorporationWashingtonUSA
  5. 5.Division of Surgical OncologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  6. 6.Department of SurgeryMontefiore Medical Center/Albert Einstein College of MedicineNew YorkUSA
  7. 7.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  8. 8.Department of Surgery, Division of Surgical OncologyWalter Reed National Military Medical CenterBethesdaUSA
  9. 9.Division of Surgical Oncology, Department of Surgery and the Marlene and Stewart Greenebaum Cancer CenterUniversity of Maryland School of MedicineBaltimoreUSA
  10. 10.Bon Secours Cancer InstituteRichmondUSA

Personalised recommendations