Effect of postoperative normothermic intraperitoneal chemotherapy on the prognosis of MPM patients receiving CRS+HIPEC: A single-center case-control study

Xin-Li Liang; Yan-Dong Su; Yu-Bin Fu; Xin-Bao Li; Ru Ma; Rui Yang; He-Liang Wu; Yan Li

doi:10.1016/j.ejso.2024.108692

Effect of postoperative normothermic intraperitoneal chemotherapy on the prognosis of MPM patients receiving CRS+HIPEC: A single-center case-control study

Eur J Surg Oncol. 2024 Nov;50(11):108692. doi: 10.1016/j.ejso.2024.108692. Epub 2024 Sep 14.

Authors

Xin-Li Liang¹, Yan-Dong Su², Yu-Bin Fu², Xin-Bao Li², Ru Ma³, Rui Yang², He-Liang Wu², Yan Li⁴

Affiliations

¹ Department of Surgical Oncology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, 102218, China; Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
² Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
³ Department of Surgical Oncology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, 102218, China.
⁴ Department of Surgical Oncology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, 102218, China; Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China. Electronic address: [email protected].

PMID: 39298871
DOI: 10.1016/j.ejso.2024.108692

Abstract

Background: The comprehensive treatment strategy, mainly cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), combined with systemic and intraperitoneal chemotherapy, is the standard treatment for malignant peritoneal mesothelioma (MPM), which can significantly prolong the survival of patients. The aim of this study is to investigate the clinical significance of postoperative normothermic intraperitoneal chemotherapy (NIPEC) in MPM patients.

Methods: Data of 152 MPM patients who underwent CRS + HIPEC and postoperative intravenous chemotherapy were retrospectively analyzed. Patients were divided into the Non-NIPEC group and the NIPEC group according to whether they received NIPEC after surgery. The baseline characteristics of the two groups were compared, and the survival outcome was analyzed in subgroups according to completeness of cytoreduction (CC) score. Multivariate survival analysis was used to determine the independent prognostic factors.

Results: In CC 0-1 and CC 2-3 subgroups, there was no significant difference in baseline characteristics between Non-NIPEC and NIPEC groups. Survival analysis showed that for CC 0-1 patients, there was no significant difference in overall survival (OS) between Non-NIPEC and NIPEC groups (P = 0.503). However, for CC 2-3 patients, the median OS of the NIPEC group was significantly longer than that of the Non-NIPEC group (24.5 vs. 10.3 months, P = 0.005). Pathological type, preoperative thrombosis and postoperative NIPEC (HR = 0.423, 95%CI: 0.228-0.786, P = 0.006) were independent prognostic factors for CC 2-3 patients.

Conclusions: For MPM patients receiving CRS + HIPEC, postoperative intraperitoneal combined with intravenous chemotherapy may improve the survival of CC 2-3 patients, but CC 0-1 patients do not seem to derive the same benefit.

Keywords: CC score; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Malignant peritoneal mesothelioma; Normothermic intraperitoneal chemotherapy; Prognosis.

MeSH terms

Adult
Aged
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Case-Control Studies
Cytoreduction Surgical Procedures*
Female
Humans
Hyperthermic Intraperitoneal Chemotherapy*
Lung Neoplasms / pathology
Lung Neoplasms / therapy
Male
Mesothelioma / pathology
Mesothelioma / therapy
Mesothelioma, Malignant / pathology
Mesothelioma, Malignant / therapy
Middle Aged
Peritoneal Neoplasms* / secondary
Peritoneal Neoplasms* / therapy
Prognosis
Retrospective Studies
Survival Rate