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The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
- Source :
- Annals of surgical oncology. 23(5)
- Publication Year :
- 2015
-
Abstract
- We conducted a prognostic analysis of preoperative parameters and Ki-67 determination to develop selection criteria for cytoreductive surgery (CRS) and HIPEC in patients with diffuse malignant peritoneal mesothelioma (DMPM). DMPM patients treated with CRS and HIPEC at NCI of Milan participated in this study. Multivariate analysis was conducted using Cox proportional hazard model and conditional inference tree method to select independent predictors of overall survival (OS) from the followings pre-cytoreduction parameters: age, sex, ECOG performance status, Charlson comorbidity index, previous systemic chemotherapy, CA-125, histological subtype (epithelioid vs. biphasic/sarcomatoid), Ki-67 (determined with immunohistochemistry), and peritoneal cancer index (PCI). A total of 117 patients (male/female: 67/50) with median age of 60.5 (range 22–75) years were included. Eighty-three patients had ECOG performance status = 0, median Charlson comorbidity index was 4 (range 2–9), and 102 cases had epithelioid subtype. Median Ki-67 was 5 % (range 1–60). Ninety-four (80.3 %) cases were optimally cytoreduced. The Cox analysis identified Ki-67, PCI, and histological subtype as independent prognosticators of OS. Conditional inference tree method identified three prognostic subsets: (I) Ki-67 ≤ 9 %; (II) Ki-67 > 9 % and PCI ≤ 17; and (III) Ki-67 > 9 % and PCI > 17. The median OS for subsets I, II, and III were, 86.6, 63.2, and 10.3 months, respectively. Ki-67 is a powerful prognosticator that allows, along with PCI, and histological subtype, a good prediction of OS in patients with DMPM. Patients with Ki-67 > 9 % and PCI > 17 are unlikely to benefit from the procedure and should be considered for other treatment protocols.
- Subjects :
- Oncology
Adult
Male
Mesothelioma
medicine.medical_specialty
Lung Neoplasms
Risk Assessment
Immunoenzyme Techniques
03 medical and health sciences
Peritoneal Neoplasm
Young Adult
0302 clinical medicine
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Biomarkers, Tumor
Medicine
Humans
Prospective Studies
Survival rate
Peritoneal Neoplasms
Aged
Neoplasm Staging
Proportional Hazards Models
Retrospective Studies
business.industry
Proportional hazards model
Mesothelioma, Malignant
Cytoreduction Surgical Procedures
Hyperthermia, Induced
Middle Aged
medicine.disease
Prognosis
Combined Modality Therapy
Survival Rate
Pemetrexed
Ki-67 Antigen
030220 oncology & carcinogenesis
Chemotherapy, Cancer, Regional Perfusion
Conventional PCI
Peritoneal Cancer Index
030211 gastroenterology & hepatology
Surgery
Hyperthermic intraperitoneal chemotherapy
Female
business
medicine.drug
Follow-Up Studies
Subjects
Details
- ISSN :
- 15344681
- Volume :
- 23
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Annals of surgical oncology
- Accession number :
- edsair.doi.dedup.....9c696d67c7834ae7c5571b3e3721cfe1