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Published on: December 21, 2019
Risk factors and prognosis of malignant peritoneal mesothelioma with paraneoplastic syndrome
Xin-Li Liang1, Yan-Dong Su1, Xin-Bao Li1
1Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No. 10 Tieyi Road, Yangfangdian Street, Beijing, 100038, China.
Background:
Malignant peritoneal mesothelioma (MPM) is a rare and highly aggressive tumor. Its clinical manifestations are diverse, and the symptoms are not specific. Some patients will develop paraneoplastic syndrome (PS) during the disease course. This study aims to analyze the risk factors of PS in patients with MPM and their impacts on prognosis.
Methods:
The clinical data of MPM patients who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) at our center from June 2015 to May 2023 were retrospectively analyzed. MPM patients were divided into PS group and non-PS group according to the diagnostic criteria. Univariate and multivariate analyses were performed to explore the risk factors of PS in MPM patients, and to analyze the impact of PS on prognosis.
Results:
There were 146 MPM patients in this study, including 60 patients (41.1%) with PS and 86 patients (58.9%) without PS. The highest incidence of PS was thrombocytosis (33.6%), followed by neoplastic fever (9.6%). Univariate analysis revealed 8 factors (P < 0.05) with statistically significant differences between the two groups: prior surgical scores, targeted therapy history, Karnofsky performance status score, preoperative carbohydrate antigen (CA) 125 level, vascular tumor embolus, peritoneal cancer index, completeness of cytoreduction (CC) score and intraoperative ascites. Multivariate analysis identified 3 independent factors associated with PS: preoperative CA 125 level, vascular tumor embolus, and CC score. Survival analysis demonstrated that MPM patients with PS had worse prognosis, although PS was not an independent prognostic factor.
Conclusions:
PS is not rare in patients with MPM, and is independently associated with preoperative CA 125 level, vascular tumor embolus and CC score. PS often indicates advanced disease and poor prognosis.
Insights
Paraneoplastic syndrome (PS) affects nearly half of malignant peritoneal mesothelioma (MPM) patients and is linked to poorer outcomes. Key risk factors include high CA 125 levels, tumor emboli, and incomplete cytoreduction.
Area of Science:
- Oncology
- Surgical Oncology
- Cancer Research
Background:
- Malignant peritoneal mesothelioma (MPM) is a rare, aggressive cancer with varied symptoms.
- Paraneoplastic syndrome (PS) can occur in MPM patients, complicating diagnosis and treatment.
- Understanding PS risk factors and prognostic impact is crucial for managing MPM.
Purpose of the Study:
- To identify risk factors for developing paraneoplastic syndrome (PS) in MPM patients.
- To evaluate the impact of PS on the prognosis of MPM patients undergoing CRS + HIPEC.
Main Methods:
- Retrospective analysis of 146 MPM patients treated with CRS + HIPEC.
- Patients categorized into PS and non-PS groups based on diagnostic criteria.
- Univariate and multivariate analyses to determine PS risk factors and prognostic significance.
Main Results:
- 60 patients (41.1%) developed PS, most commonly thrombocytosis and neoplastic fever.
- Independent risk factors for PS included elevated preoperative CA 125, vascular tumor emboli, and CC score.
- MPM patients with PS exhibited a worse prognosis, though PS was not an independent prognostic factor.
Conclusions:
- PS is a significant clinical feature in MPM, occurring in over 40% of cases.
- Preoperative CA 125, vascular tumor emboli, and CC score are independent predictors of PS.
- The presence of PS suggests advanced disease and is associated with poorer survival in MPM.
