Abstract
Simple SummaryMesotheliomas arising from the lining of the mesothelial cells of the peritoneum are rare. However, they are strongly linked to asbestos exposure, similar to the relatively well-known pleural mesotheliomas. It is slightly more common in men than in women, with the majority of cases seen in Caucasians older than 50 years. Distant spread of tumor, size > 4 cm, and negative lymph node status were observed in our study among the patients with evaluable data. Optimal outcomes are achieved when patients are treated in specialized centers with surgical debulking followed by heated chemotherapy administered intraoperatively. Systemic chemotherapy and radiation are options for the selected patient groups. Patients with poorly differentiated large tumors (>4 cm), Caucasian race, and distant spread of disease outside the abdominal cavity have worse prognosis.Background: Primary peritoneal mesothelioma (PPM) is a rare and aggressive tumor arising from the visceral and parietal peritoneum. The diagnosis and treatment of PPM are often delayed because of non-specific clinical presentation, and the prognosis is worse. The current study investigated the demographic, clinical, and pathological factors affecting patient prognosis and survival in PPM. Methods: Demographic and clinical data of 1998 patients with PPM were extracted from the Surveillance Epidemiology and End Results (SEER) database (1975–2016). The chi-square test, paired t-test, and multivariate analysis were used to analyze the data. Results: The majority of PPM patients were male (56.2%, p < 0.005) and Caucasian (90.4%, p < 0.005, with a mean age of diagnosis was 69 ± 13 years. The grading, histological, and tumor size information were classified as “Unknown” in most of the cases, but when available, poorly differentiated tumors (8.7%), malignant mesothelioma, not otherwise specified (63.4%) and tumors > 4 cm in size (8%), respectively, were most common, p < 0.005. Chemotherapy was administered to 50.6% of patients, followed by resection (29.2%) and radiation (1.5%), p < 0.001. The cohort of PPM had a five-year overall survival of 20.3% (±1.1), compared to 43.5% (±5.9), 25.9% (± 8.4), and 18.7% (±1.6) for those with surgery, radiation, or chemotherapy alone, respectively. Poor differentiation (OR = 4.2, CI = 3.3–4.9), tumor size > 4 cm (OR = 3.9, CI = 3.2–4.5), Caucasian race (OR = 2.9, CI = 2.6–4.4), and distant SEER stage (OR = 2.5, CI = 1.1–3.2) were all linked with increased mortality (p < 0.001). Conclusion: An extremely rare and aggressive peritoneal tumor, PPM may be difficult to identify at the time of diagnosis. Radiation therapy likely to have a limited function in the treatment of this condition, with surgery and chemotherapy being the primary choices. All PPM patients should be enrolled in a nationwide registry to improve our understanding of the pathogenesis and identify factors affecting survival.
Highlights
Malignant mesothelioma (MM) is an aggressive and lethal disease
Demographical Characteristics of Entire Cohort With an overall mean age at diagnosis of 69 ± 13 years, primary peritoneal mesothelioma (PPM) patients were more likely to be male (n = 1122; 56.2%), followed by women (n = 876; 43.8%), with a male: female (M: F) ratio of 1:3; p < 0.005
Our study showed that patients receiving surgical intervention had a more favorable five-year survival rate than those receiving either chemotherapy or radiation therapy alone; no statistical significance was observed after analyzing the data
Summary
Malignant mesothelioma (MM) is an aggressive and lethal disease. It affects pleural and peritoneal membranes and is associated with asbestos exposure [1,2]. Due to nonspecific clinical features and an indolent course, diagnosis is often delayed; if an adequate tumor specimen is not available, such as that obtained by ascitic fluid sampling, it may be mistaken for other benign or malignant abdominal processes [6]. Primary peritoneal mesothelioma (PPM) is a rare and aggressive tumor arising from the visceral and parietal peritoneum. The current study investigated the demographic, clinical, and pathological factors affecting patient prognosis and survival in PPM. Conclusion: An extremely rare and aggressive peritoneal tumor, PPM may be difficult to identify at the time of diagnosis. All PPM patients should be enrolled in a nationwide registry to improve our understanding of the pathogenesis and identify factors affecting survival
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