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.
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