Cytoreductive Surgery Plus HIPEC With and Without NIPEC for Malignant Peritoneal Mesothelioma: A Propensity-Matched Analysis

Annals of Surgical Oncology 2021 May 3 [Link]

Paul H Sugarbaker, David Chang


Background: Malignant peritoneal mesothelioma is a rare and often fatal disease. Dissemination is confined to the abdominal and pelvic peritoneal spaces in a great majority of patients.

Methods: Standardized cytoreductive surgery and perioperative chemotherapy was used in all patients. Long-term normothermic intraperitoneal chemotherapy (NIPEC) was added to the treatment of our most recent group of patients. Survival with and without NIPEC was compared using a propensity-matched analysis.

Results: In a uniform group of 74 patients, the clinical- and treatment-related features that had an impact on survival were age (hazard ratio [HR] 1.99, 95% confidence interval [CI] 0.929-4.238, p = 0.0766), completeness of cytoreduction (HR 2.356, 95% CI 1.113-4.989, p = 0.0251), and treatments administered (HR 3.497, 95% CI 1.199-10.20, p = 0.0219). In the Cox proportional hazards multivariant model, sex and age were borderline significant. Treatments administered were significant (HR 3.549, 95% CI 1.157-10.888, p = 0.0268). Using five features to match 29 patients in the control group (no NIPEC) to 29 patients in the experimental group (with NIPEC), the propensity-matched survival was significantly different (p = 0.0263).

Conclusions: The addition of NIPEC was associated with long-term survival in this cohort of patients. A multi-institutional randomized trial may be the next step.