Advertisement

Annals of Surgical Oncology

, Volume 24, Issue 13, pp 3818–3824 | Cite as

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

  • Danielle R. Heller
  • Cody Chiuzan
  • Robert N. Taub
  • Joshua C. Leinwand
  • Allison M. Greene
  • Gleneara E. Bates
  • John A. Chabot
  • Michael D. KlugerEmail author
Gastrointestinal Oncology

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.

Notes

Disclosures

None.

References

  1. 1.
    Robinson BWS, Lake RA. Advances in malignant mesothelioma. N Engl J Med. 2005;353:1591–603.CrossRefPubMedGoogle Scholar
  2. 2.
    Larson T, Melnikova N, Davis SI, Jamison P. Incidence and descriptive epidemiology of mesothelioma in the United States, 1999-2002. Int J Occup Environ Health. 2007;13(4):398–403.CrossRefPubMedGoogle Scholar
  3. 3.
    Delgermaa V, Takahashi K, Park EK, Le GV, Haraa T, Sorahan T. Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008. Bull World Health Organ. 2011;89:716–24.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Sebbag G, Yan H, Shmookler, HM, Chang D, Sugarbaker PH. Results of treatment of 33 patients with peritoneal mesothelioma. Br J Surg. 2000;87(11):1587–93.CrossRefPubMedGoogle Scholar
  5. 5.
    Yan TD, Edwards G, Alderman R, Marquardt CE, Sugarbaker PH. Morbidity and mortality assessment of cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma: a prospective study of 70 consecutive cases. Ann Surg Oncol. 2007;14(2):515–25.CrossRefPubMedGoogle Scholar
  6. 6.
    Alexander HR Jr, Bartlett DL, Pingpank JF, Libutti SK, Royal R, Hughes MS, Holtzman M, Hanna N, Turner K, Beresneva T, Zhu Y. Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma. Surgery. 2013;153(6):779–86.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Yan TD, Deraco M, Baratti D, Kusamura S, Elias D, Glehen O, Gilly FN, Levine EA, Shen P, Mohamed F, Moran BJ, Morris DL, Chua TC, Piso P, Sugarbaker PH. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27(36):6237–42.CrossRefPubMedGoogle Scholar
  8. 8.
    Kluger MD, Taub RN, Hesdorffer M, Jin Z, Chabot JA. Two-stage operative cytoreduction and intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma: operative morbidity and mortality in phase I and II trials. Eur J Surg Oncol. 2010;36:997–1003.CrossRefPubMedGoogle Scholar
  9. 9.
    Baratti D, Kusamura S, Cabras AD, Dileo P, Laterza B, Deraco M. Diffuse malignant peritoneal mesothelioma: Failure analysis following cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol. 2009;16:463–72.CrossRefPubMedGoogle Scholar
  10. 10.
    Deraco M, Baratti D, Hutanu I, Bertuli R, Kusamura S. The role of perioperative systemic chemotherapy in diffuse malignant peritoneal mesothelioma patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2013; 20:1093–100.CrossRefPubMedGoogle Scholar
  11. 11.
    Feldman AL, Libutti SK, Pingpank JF, Bartlett DL, Beresnev TH, Mavroukakis SM,Steinberg SM, Liewehr DJ, Kleiner DE, Alexander HR. Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. J Clin Oncol. 2003;21(24):4560–67.CrossRefPubMedGoogle Scholar
  12. 12.
    Schaub NP, Alimchandani M, Quezado M, et al. A novel nomogram for peritoneal mesothelioma predicts survival. Ann Surg Oncol. 2013;20:555–61.CrossRefPubMedGoogle Scholar
  13. 13.
    Hesdorffer ME, Chabot JA, Keohan ML, Fountain K, Talbot S, Gabay M, Valentin C, Lee SM, Taub RN. Combined resection, intraperitoneal chemotherapy and whole abdominal radiation for the treatment of malignant peritoneal mesothelioma. Am J Clin Oncol. 2008;31(1):49–54.CrossRefPubMedGoogle Scholar
  14. 14.
    Harrell FE, et al. Tutorial in Biostatistics: multivariable prognosis model: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.CrossRefPubMedGoogle Scholar
  15. 15.
    Pencina MJ, D’Agostino RB. Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation. Stat Med. 2004;23:2109–23.CrossRefPubMedGoogle Scholar
  16. 16.
    Faig J, Howard S, Levine EA, Casselman G, Hesdorffer M, Ohar JA. Changing pattern in malignant mesothelioma survival. Transl Oncol. 2015;8(1):35–39.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Huang Y, Alzahrani NA, Liauw W, Morris DL. Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma. Eur J Surg Oncol. 2015;41(10):1373–78.CrossRefPubMedGoogle Scholar
  18. 18.
    Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S. Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience. Ann Surg Oncol. 2014;21(5):1480–86.CrossRefPubMedGoogle Scholar
  19. 19.
    Ihemelandu C, Bijelic L, Sugarbaker PH. Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome. Ann Surg Oncol. 2015;22(5):1680–85.CrossRefPubMedGoogle Scholar
  20. 20.
    Krasinskas AM, Borczuk AC, Hartman DJ, Chabot JA, Taub RN, Mogal A, Pingpank J, Bartlett D, Dacic S. Prognostic significance of morphological growth patterns and mitotic index of epithelioid malignant peritoneal mesothelioma. Histopathology. 2016;68(5):729–37.CrossRefPubMedGoogle Scholar
  21. 21.
    Borczuk AC, Taub RN, Hesdorffer M, Hibshoosh H, Chabot JA, Keohan ML, Alsberry R, Alexis D, Powell CA. P16 loss and mitotic activity predict poor survival in patients with peritoneal malignant mesothelioma. Clin Cancer Res. 2005;11(9):3303–08.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Danielle R. Heller
    • 1
  • Cody Chiuzan
    • 2
  • Robert N. Taub
    • 3
  • Joshua C. Leinwand
    • 1
  • Allison M. Greene
    • 1
  • Gleneara E. Bates
    • 3
  • John A. Chabot
    • 1
  • Michael D. Kluger
    • 1
    Email author
  1. 1.Gastrointestinal & Endocrine Surgery, Department of SurgeryColumbia College of Physicians and Surgeons, Columbia UniversityNew YorkUSA
  2. 2.Department of BiostatisticsMailman School of Public HealthNew YorkUSA
  3. 3.Medical Oncology, Department of MedicineColumbia College of Physicians and SurgeonsNew YorkUSA

Personalised recommendations