Muscle Loss May Predict Peritoneal Mesothelioma Survival

Age-related muscle loss appears to be an independent predictor of peritoneal mesothelioma survival after surgery. The news might help patients and doctors make better treatment decisions.

Researchers at the Lyon-Sud Hospital Center in Lyon say they have found a connection between sarcopenia—muscle loss associated with aging—and how long people with peritoneal mesothelioma (or another abdominal condition called pseudomyxoma peritonei) survive after cytoreductive surgery.

The bottom line: The less muscle loss, the longer a mesothelioma patient is likely to survive.

CRS/HIPEC Surgery for Mesothelioma Cancer

Both peritoneal mesothelioma and pseudomyxoma peritonei (PMP) are cancers that grow in the abdomen. Like other types of malignant mesothelioma, peritoneal mesothelioma is associated with exposure to asbestos. It is typically a fast-growing cancer for which there is no cure.

In recent years, cytoreductive surgery followed by a rinse of heated chemotherapy—a procedure known as CRS/HIPEC—has emerged at the standard of care for peritoneal mesothelioma. CRS/HIPEC has improved the prognosis for many people with this deadly cancer.

But not everyone responds well to this extensive and risky abdominal surgery. Predicting who is most likely to see long term benefit was the focus of the new French study, published this week in the European Journal of Surgical Oncology.

Sarcopenia and Mesothelioma Survival

Researchers analyzed the cases of 33 peritoneal mesothelioma patients and 82 PMP patients treated with CRS/HIPEC at their center between 2009 and 2017.

Each patient had undergone a preoperative CT scan to measure the muscle mass and the fatty tissue around their third lumbar vertebrae in order to assess for sarcopenia and abdominal fat composition.

The results were revealing. The mesothelioma and PMP patients with normal muscle mass lived a median of nearly a year and a half longer than those with sarcopenia—73.3 months compared to 57.2 months.

This did not mean that the longest-surviving patients had fewer complications, however. In fact, the researchers noted that there was no observable difference in the post-surgical complication rates among the patients with and without sarcopenia.

“CT-measured sarcopenia is an independent predictive factor for overall survival in patients treated for PMP and peritoneal mesothelioma with CRS-HIPEC, but cannot predict postoperative morbidity [complications],” conclude the researchers.

The report may offer another way to help doctors select the best candidates for mesothelioma surgery. Approximately 2,500 people are diagnosed with mesothelioma in the US each year. About 500 of them are peritoneal mesothelioma.

Source:

Galan, A, et al, “Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia”, August 11, 2018, European Journal of Surgical Oncology, Epub ahead of print