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Background <p>Selected diffuse malignant peritoneal mesothelioma (DMPM) patients may be radically treated with complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Two thirds of them recur with the possibility of iterative CRS-HIPEC and/or systemic chemotherapy. The postoperative follow-up management is based on scarce data. The recurrence profile was explored in a large national database to challenge the standard follow-up protocol.</p> Methods <p>Consecutive, pathologically proven, epithelioid DMPM patients from the RENAPE database, treated with complete CRS-HIPEC were included in this analysis. Patients with more than 5&#xa0;years of follow-up were divided into long-term control group (event-free), early relapse group (event within 2&#xa0;years), and intermediate relapse group. Survival distributions were estimated by the Kaplan-Meier method.</p> Results <p>Overall, 288 patients met the inclusion criteria (95% epithelioid, median PCI 18) with 197 followed-up more than 5&#xa0;years, divided into long-term control (57 patients), intermediate relapse (34 patients), and early relapse (106 patients). After a median follow-up time of 71&#xa0;months, the median relapse-free survival (RFS) was 37.2&#xa0;months (95% confidence interval 26.4–52.8&#xa0;months). The recurrence risk was highest during the first 2&#xa0;years (36.8% of patients recurred) and remained around 10% per year until year 8. In the multivariate analysis, age &lt;60 and PCI &lt;17 were independent factors of better RFS. Interestingly, 27% of recurring patients presented distant metastases.</p> Conclusions <p>These results strengthen current follow-up guidelines, while also suggesting a close follow-up between years 5 and 8. No subgroup of patients or biomarkers have been identified to personalize follow-up.</p>

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Assessing the Annual Risk of Recurrence Following Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Diffuse Malignant Peritoneal Mesothelioma Patients

  • 期刊论文

  • 发表日期：

    2025年9月26日

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  • Julien Péron,
  • Ismail Essadi,
  • Pascal Rousset,
  • Laurent Villeneuve,
  • Nazim Benzerdjeb,
  • Diane Goéré,
  • Isabelle Sourrouille,
  • Olivia Sgarbura,
  • Gwenaël Ferron,
  • Marc Pocard,
  • Frédéric Dumont,
  • Jean-Marc Bereder,
  • Cécile Brigand,
  • Olivier Glehen,
  • Vahan Kepenekian,
  • Julio Abba,
  • Karine Abboud,
  • Adeline Aimé,
  • Koceila Amroun,
  • Thierry André,
  • Catherine Arvieux,
  • Gerlinde Averous-Lang,
  • Naoual Bakrin,
  • Armelle Bardier,
  • Houda Ben Rejeb,
  • Jean-Louis Bernard,
  • Frédéric Bibeau,
  • Valérie Boige,
  • Pierre-Emmanuel Bonnot,
  • Olivier Bouché,
  • Fatiha Bouhidel,
  • Marie-Dominique Bouzard,
  • Chloé Broudin,
  • Bertrand Celerier,
  • Cécilia Ceribelli,
  • Aurélie Charissoux,
  • Anne Chevallier,
  • Elise Clément,
  • Julien Coget,
  • Thomas Courvoisier-Clément,
  • Peggy Dartigues,
  • Marie Dazza,
  • Cécile de Chaisemartin,
  • Frédéric Di Fiore,
  • Sylvaine Durand-Fontanier,
  • Clarisse Eveno,
  • Anne-Cécile Ezanno,
  • Olivier Facy,
  • Juliette Fontaine,
  • Johann Gagnière,
  • Alexandre Galan,
  • Maximiliano Gelli,
  • Laurent Ghouti,
  • Laurence Gladieff,
  • Jean-Marc Guilloit,
  • Frédéric Guyon,
  • Bruno Heyd,
  • Marie-Françoise Heymann,
  • Claire Illac-Vauquelin,
  • Sylvie Isaac,
  • Rachid Kaci,
  • Lakhdar Khellaf,
  • Reza Kianmanesh,
  • Marie-Hélène Laverrière,
  • Jérémie H. Lefevre,
  • Bernard Lelong,
  • Anne-Isabelle Lemaistre,
  • Agnès Leroux-Broussier,
  • Brice Malgras,
  • Frédéric Marchal,
  • Pascale Mariani,
  • Antoine Mariani,
  • Clémentine Mazoyer,
  • Pierre Meeus,
  • Eliane Mery,
  • Fabrice Narducci,
  • Stéphanie Nougaret,
  • David Orry,
  • Pablo Ortega-Deballon,
  • Ariadna Paliichuk,
  • Brice Paquette,
  • Patrice Peyrat,
  • Denis Pezet,
  • Nicolas Pirro,
  • Flora Poizat,
  • François Quenet,
  • Thomas Rabel,
  • Judith Raimbourg,
  • Patrick Rat,
  • Pauline Ries,
  • Brigitte Roche,
  • Pierre-Yves Sage,
  • Cristina Smolenschi,
  • Magali Svrcek,
  • Abdelkader Taibi,
  • Emilie Thibaudeau,
  • Yann Touchefeu,
  • Bertrand Trilling,
  • Jean-Jacques Tuech,
  • Séverine Valmary-Degano,
  • Sharmini Varatharajah,
  • Véronique Verriele-Beurrier,
  • Guillaume Vogin,
  • Romuald Wernert,
  • Benoit You

摘要

Background

Selected diffuse malignant peritoneal mesothelioma (DMPM) patients may be radically treated with complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Two thirds of them recur with the possibility of iterative CRS-HIPEC and/or systemic chemotherapy. The postoperative follow-up management is based on scarce data. The recurrence profile was explored in a large national database to challenge the standard follow-up protocol.

Methods

Consecutive, pathologically proven, epithelioid DMPM patients from the RENAPE database, treated with complete CRS-HIPEC were included in this analysis. Patients with more than 5 years of follow-up were divided into long-term control group (event-free), early relapse group (event within 2 years), and intermediate relapse group. Survival distributions were estimated by the Kaplan-Meier method.

Results

Overall, 288 patients met the inclusion criteria (95% epithelioid, median PCI 18) with 197 followed-up more than 5 years, divided into long-term control (57 patients), intermediate relapse (34 patients), and early relapse (106 patients). After a median follow-up time of 71 months, the median relapse-free survival (RFS) was 37.2 months (95% confidence interval 26.4–52.8 months). The recurrence risk was highest during the first 2 years (36.8% of patients recurred) and remained around 10% per year until year 8. In the multivariate analysis, age <60 and PCI <17 were independent factors of better RFS. Interestingly, 27% of recurring patients presented distant metastases.

Conclusions

These results strengthen current follow-up guidelines, while also suggesting a close follow-up between years 5 and 8. No subgroup of patients or biomarkers have been identified to personalize follow-up.