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New Study Links Platelet Count and Mesothelioma Survival

A new study conducted by researchers at the University of Maryland (UM) School of Medicine has established a link between platelet count and malignant peritoneal mesothelioma (MPM) survival. MPM is a rare aggressive tumor of the peritoneum (abdominal lining) that accounts for one fifth to one third of all mesotheliomas. Like the most common type of mesothelioma (pleural mesothelioma), peritoneal mesothelioma is caused by exposure to asbestos.

The UM study was designed to “determine the clinical significance of preoperative thrombocytosis [disorder in which the body produces too many platelets] in patients with malignant peritoneal mesothelioma (MPM) undergoing operative cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC),” per the National Institutes of Health (NIH). The CRS-HIPEC procedure is an aggressive combination of surgery and chemotherapy that has been associated with prolonged survival in patients with MPM.

Though it is the “preferred treatment in select patients,” says the study, “patient selection criteria remain ill-defined for this operation that is also associated with significant morbidity and mortality.”

Per the study, between January 2006 and December 2015, 100 patients with high-grade epithelioid MPM were evaluated and selected for CRS and HIPEC at the UM Marlene and Stewart Greenebaum Comprehensive Cancer Center. Patients had a mean age of 54 years with a range of 17-81 years. Lead author Yue Li writes, “we analyzed various patient and treatment related factors potentially associated with overall survival (OS).” The results showed:

The median actuarial overall survival was 32.8 months; the actuarial 1-, 3-, 5-year survivals were 70, 49, and 36%, respectively. On multivariate analysis, suboptimal resection (CCR > 1), high tumor burden (PCI > 20), and elevated preoperative platelet count (>367,000/mm3) were independently associated with shortened OS (P < 0.05). Median OS in patients with elevated versus normal platelet counts were 13 and 58 months, respectively (P < 0.001). Compared with patients with normal platelet counts, patients with elevated counts had significantly greater residual disease after operation (P = 0.008).

In short, researchers concluded, “elevated preoperative platelet count is independently associated with poor outcome. Notably, thrombocytosis reflects aggressive tumor biology and should be considered a factor in patient selection for CRS and HIPEC.” The findings in this study are significant as they suggest refining the criteria for CRS-HIPEC patient selection. This could lead to improved outcomes for MPM patients who undergo this innovative and potentially lifesaving treatment.

Sources

Ahmed, Ishtiaq, Salman Ahmed Tipu, and Sundas Ishtiaq. "Malignant Mesothelioma." Pakistan Journal of Medical Sciences. Professional Medical thrombocytosis cations, 2013. Web. 26 June 2017.

Bridda, Alessio, Ilaria Padoan, Roberto Mencarelli, and Mauro Frego. "Peritoneal Mesothelioma: A Review." Medscape General Medicine. Medscape, 10 May 2007. Web. 26 June 2017.

Li, Yue C., Tamara Khashab, Julia Terhune, Richard L. Eckert, Nader Hanna, Allen Burke, and H. Richard Alexander. "Preoperative Thrombocytosis Predicts Shortened Survival in Patients with Malignant Peritoneal Mesothelioma Undergoing Operative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy." Annals of Surgical Oncology (2017): n. pag. SpringerLink. Web. 26 June 2017.