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Original Article |
1 Washington Hospital Center, Washington Cancer Institute, 106 Irving Street, NW, Suite 3900N, Washington, DC 20010, USA
2 Department of Pathology, Washington Hospital Center, Washington, DC, USA
3 Department of Radiology, Washington Hospital Center, Washington, DC, USA
4 Westat, Rockville, MD, USA
Correspondence: Address correspondence and reprint requests to: Paul H. Sugarbaker, MD; E-mail: Paul.Sugarbaker{at}medstar.net
Background: This study evaluates clinical, radiological and histopathological prognostic indicators for survival of patients undergoing cytoreductive surgery and perioperative intra-peritoneal chemotherapy for diffuse malignant peritoneal mesothelioma (DMPM).
Methods: Sixty-two consecutive patients with DMPM underwent cytoreduction and perioperative intraperitoneal chemotherapy at the Washington Cancer Institute. Twenty-six clinical, radiological and histopathological parameters were analyzed in univariate and multivariate analyses using overall survival as an endpoint.
Results: The overall survival was 79 months (range 1–143 months), with 1-, 3- and 5-year survival rates of 84%, 58% and 50%, respectively. The following 14 prognostic variables were significant for survival in the univariate analysis: gender (P = .045), peritoneal cancer index (P = .038), completeness of cytoreduction score (P = .010), interpretive CT findings of the small bowel and mesentery (P = .001), mesothelioma cell type (P < .001), mesothelioma nuclear size (P < .001), nuclear/cytoplasmic ratio (P < .001), mitotic count (P < .001), atypical mitosis (P < .001), chromatin pattern (P < .001), cellular necrosis (P < .001), perineural invasion (P = .037), stroma pattern (P < .001) and depth of invasion (P = .014). In the multivariate analysis, the only factor that was independently associated with an improved survival after cytoreduction and perioperative intraperitoneal chemotherapy was mesothelioma nuclear size.
Conclusions: Mesothelioma nuclear size was the dominant factor determining overall survival in patients with DMPM. A histopathological staging system based on measurement of the nuclear size was proposed.
Key Words: Peritoneal mesothelioma • Cytoreductive surgery • Intraperitoneal chemotherapy • Peritonectomy • Histopathology • Staging • Computed tomography
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