Abstract
BackgroundMalignant mesothelioma (MM) is a rare and fatal neoplasm. For diffuse malignant mesothelioma (DMM) patients that were not suitable for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, systemic chemotherapy is the main treatment. There are no convenient tumor markers to predict the efficacy of treatment and disease progression. This study aimed to evaluate serum CA125 level as a biochemical marker of response to therapy and prognosis in patients with DMM.MethodsA retrospective study was performed in a single medical institution from April 2008 to April 2014. Overall survival (OS) and prognostic factors were assessed.ResultsForty-one patients were included with a median age of 53 years. The median OS of all patients was 10 months. Patients with baseline CA125 > 280 U/ml had worse OS compared with the patients that baseline CA125 ≤ 280 U/ml. Baseline level of CA125, stage of disease, primary tumor location and systemic chemotherapy were independent prognostic factors associated with OS. In patients who received systemic chemotherapy, the decline in serum CA125 was associated with favorable OS and objective response according to modified Response Evaluation Criteria in Solid Tumors criteria.ConclusionsThe baseline level of serum CA125, accompanied with stage of disease, primary tumor location and systemic chemotherapy, could be regarded as independent prognostic factors for DMM patients. Otherwise, the change in serum CA125 can predict OS and response to systemic chemotherapy.
Highlights
Malignant mesothelioma (MM) is a rare and fatal neoplasm
Published paper demonstrated that cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a potentially curative treatment for malignant peritoneal mesothelioma (MPeM) (Alexander et al 2013).But because of the difficulty in early diagnosing, most patients are initially diagnosed in advanced stage that is not candidate for curative surgery (Grigoriu et al 2007; Kao et al 2011)
In subgroup analysis to evaluate the change in serum CA125 as the indicator for the efficacy of systemic chemotherapy, we selected candidates from overall patients by following inclusive criteria: received at least one cycle of systemic chemotherapy; monitored the levels of serum CA125 at least every one or two cycles of chemotherapy and had corresponding efficacy evaluated by CT or MRI according to Response Evaluation Criteria in Solid Tumors criteria
Summary
For diffuse malignant mesothelioma (DMM) patients that were not suitable for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, systemic chemotherapy is the main treatment. This study aimed to evaluate serum CA125 level as a biochemical marker of response to therapy and prognosis in patients with DMM. Treatment strategy for MM including palliative cytoreductive surgery (CRS), systemic chemotherapy and intrapeural or intraperitoneal chemotherapy does not obtain satisfactory results (Nonaka et al 2005; Hadi et al 2006; Herndon et al 1998; Vogelzang et al 2003; Mineo and Ambrogi 2012), with the median survival of less than 12 months (Creaney et al 2013; Robinson and Lake 2005; Robinson et al 2003; Zucali et al 2011). Previous studies demonstrated that soluble mesothelin, with a sensitivity of 50 % and a specificity of 95 % (Robinson et al 2003; Creaney et al 2007), could be a relevant tumor marker
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