ANZ Journal of Surgery. 2007 May;77 Suppl 1:A88-9. [Link]

Yan TD, Sim J, Sugarbaker PH.

St. George Hospital, New South Wales, Australia.


Purpose: Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and invariably fatal neoplasm. Some studies have shown that cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) achieved an improved survival, as compared to historical controls. However, prognostic factors for survival have not been well defined.

Methodology: One hundred patients with DMPM underwent CRS and PIC at the Washington Center Institute. The inclusion criteria for surgery consisted of histological diagnosis of DMPM, age < 80 years, good performance status, and signed informed consent. All data were collected prospectively. Eight clinical and eight treatment-related prognostic factors were analyzed for survival.

Results: The overall median survival was 52 months (range 1 to 148 months), with 1-, 3-, 5- and 7-year survival of 78%, 55%, 46% and 39%, respectively. Univariate analysis showed that gender (p < 0.001), peritoneal cancer index (p = 0.009), lymph node status (p < 0.001), distant metastasis (p = 0.026), histological type (p < 0.001), intraoperative blood loss (p = 0.035), completeness of cytoreduction (p < 0.001), intraperitoneal chemotherapy regimen (p = 0.041), and redo cytoreductive surgery (p = 0.022) were significant for survival. Multivariate analysis demonstrated that female gender, absence of lymph node involvement, epithelial/multicystic type, and adequate cytoreduction were independently associated with an improved survival.

Conclusions: CRS and PIC showed an improved survival for DMPM, as compared to historical controls. Long-term survival was associated with female gender, absence of lymph node involvement, epithelial or multicystic type and adequate cytoreduction.