Significance of lymph node
metastasis in patients with diffuse malignant peritoneal
mesothelioma
Significance of lymph node metastasis in patients with diffuse malignant
peritoneal mesothelioma
Yan TD, Yoo D, Sugarbaker PH.
Peritoneal Surface Malignancy Program, 106 Irving Street, NW, Suite 3900N,
Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010,
USA.
BACKGROUND: 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, the significance
of lymph node involvement in this disease has never been well defined
METHODS: One hundred patients with DMPM underwent CRS and PIC at the
Washington Hospital Center. The inclusion criteria for surgery consisted of
histological diagnosis of DMPM, age <80 years and good performance status.
All data were collected prospectively. Lymph node status, seven clinical
variables and eight treatment-related prognostic factors were analyzed for
survival.
RESULTS: Seven patients were lymph node positive and they all died
of their disease within 2 years after the surgery. The remaining 93 patients had
5- and 7-year survival of 50% and 43%, respectively. Univariate analysis showed
that gender (p<0.001), peritoneal cancer index (p=0.009), lymph node status
(p<0.001), extra-abdominal invasion (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, lymph node metastasis not detected,
epithelial 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. Lymph node status along with three other
prognostic variables was significant in the multivariate analysis.