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Diffuse mesothelioma of the peritoneum: correlation between histological and clinical parameters and survival in 73
Sandy Liu1, Paul Staats, Michael Lee
1University of Maryland Medical Center, Baltimore, MD, United States.
Abstract:
There are few studies addressing survival of diffuse peritoneal mesotheliomas (DPM).In this study, survival data were obtained retrospectively from 73 patients treated with intended cytoreductive surgery for DPM, with a mean follow-up of 42 months. Mesotheliomas were classified as well differentiated papillary (WDPM, n = 2), multicystic (MCM, n = 4), and epithelioid mesotheliomas were subclassified as tubulopapillary (TPM, n = 27), solid/deciduoid (S/DM, n = 34), and or biphasic mesothelioma (BPM, n = 6). Invasion was characterised as absent (grade 0), into stroma (grade 1), into fat (grade 2), and into adjacent structures (grade 3). Peritoneal cancer index (PCI) and completeness of cytoreduction (CCR) were assessed surgically.There were no deaths in the WDPM, MCM, and epithelioid DPM with ≤ grade 1 invasion. There was a stepwise decrease in overall survival from invasive TPM, S/DM, and BPM (p < 0.0001). By univariate analysis, advanced age (p = 0.01), incomplete CCR (p < 0.001), PCI (p = 0.004), mitotic count (p < 0.001), nuclear grade (p < 0.0001), stromal inflammation (p = 0.013), depth of invasion (p < 0.0001), necrosis (p = 0.002), and sarcomatoid growth (p < 0.0001) were associated with decreased overall survival. By multivariate analysis, only sarcomatoid growth (p = 0.0006), depth of invasion (p = 0.02), elevated CCR (CCR 2-3) (p = 0.02), and presence of inflammatory stroma (p = 0.04) were significant variables associated with decreased overall survival.DPM form a spectrum of indolent to highly aggressive tumours. Solid epithelioid/deciduoid tumours have a prognosis intermediate between biphasic mesotheliomas and invasive TPM. The presence and degree of invasion, sarcomatoid features, and inflammatory stroma are poor prognostic indicators.
Insights
Diffuse peritoneal mesotheliomas (DPM) survival varies by subtype and invasion depth. Sarcomatoid features, deep invasion, and inflammatory stroma indicate poor prognosis in DPM patients.
Area of Science:
- Oncology
- Surgical Pathology
- Cancer Research
Background:
- Diffuse peritoneal mesotheliomas (DPM) have limited survival data.
- Understanding prognostic factors is crucial for patient management.
Purpose of the Study:
- To analyze survival data for diffuse peritoneal mesotheliomas (DPM).
- To identify clinicopathological factors influencing DPM patient survival.
Main Methods:
- Retrospective analysis of survival data from 73 DPM patients.
- Classification of mesotheliomas by subtype, invasion grade, Peritoneal Cancer Index (PCI), and completeness of cytoreduction (CCR).
Main Results:
- No deaths observed in well-differentiated papillary (WDPM) or multicystic (MCM) mesotheliomas with grade ≤1 invasion.
- Overall survival decreased significantly with increasing invasion, sarcomatoid features, and inflammatory stroma.
- Multivariate analysis identified sarcomatoid growth, depth of invasion, incomplete CCR, and inflammatory stroma as significant negative prognostic indicators.
Conclusions:
- DPM represent a spectrum of tumors from indolent to aggressive.
- Solid epithelioid/deciduoid tumors have an intermediate prognosis.
- Invasion depth, sarcomatoid features, and inflammatory stroma are key poor prognostic indicators for DPM.
