Abstract:
Objective To investigate the clinicopathological features of malignant peritoneal mesothelioma (MPM) in correlation with prognosis and independent prognostic factors.
Methods One hundred MPM specimens were collected at Beijing Shijitan Hospital, Capital Medical University, from January 2013 to December 2021. Asbestos exposure, CA125, ascites, peritoneal cancer index (PCI) score, complete cell reduction (CC) score, tumor–node–metastasis (TNM) staging, histological type, vascular tumor thrombus, nerve invasion and Ki-67 proliferation index were studied. Clinical follow-up data were reviewed to correlate with pathological prognostic factors using a Kaplan–Meier estimator and Cox proportional hazards regression model for both univariate and multivariate analyses.
Results The study participants comprised 48 males and 52 females. The median age was 54 (24-72) years . There were 19 patients with asbestos exposure history (19%), 90 patients with ascites (90%), 58 patients with CA125 ≥35 U/mL (59%), 56 patients with PCI scores of ≥25 (56%), 49 patients with CC scores of 0-1 (49%), and 51 patients with CC scores of 2-3 (51%). There were 79 cases of epithelioid type (79%) and 21 cases of non-epithelioid type (21%) MPM. There were 10 patients (10%) with stage Ⅰ disease, and 45 patients (45%) had stages Ⅱ or Ⅲ disease, respectively. Univariate analysis revealed that the survival-related parameters included asbestos exposure, PCI score, CA125, histological type, Ki-67 proliferation index, and TNM stage. Multivariate analysis results revealed that the risk of death in patients with asbestos exposure history was 2.3 times higher than that in patients with no asbestos exposure history (95% confidence interval CI: 0.233-0.806, P=0.008), the risk of death in patients with PCI scores of ≥25 was 2.9 times higher than that in patients with scores of <25(95% CI: 0.200-0.612, P<0.001), and the risk of death in patients with Ki-67 >10% was 5.9 times higher than that in patients with Ki-67 ≤10% (95% CI: 0.072-0.401, P<0.001). There was significant difference in Ki-67 index between epithelioid and non-epithelioid MPM.
Conclusions Asbestos exposure history, PCI score, and Ki-67 proliferation index are independent prognostic factors in MPM patients.