Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in malignant peritoneal mesothelioma (MPM).

Kriti Ahuja, Vaishali Deenadayalan, Yongdong Ouyang, Mrinalini Ramesh, Kannan Thanikachalam
In: Journal of Clinical Oncology · 2026 · vol. 44(2_suppl) , pp. 816 · doi:10.1200/jco.2026.44.2_suppl.816 · W7122445577
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This retrospective single-institution study evaluated outcomes for 39 patients with malignant peritoneal mesothelioma treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) from 2001–2023, estimating overall and progression-free survival and testing associations with the HIPEC agent using Cox models adjusted for baseline factors. Median overall survival from diagnosis was not reached, with 1- and 5-year OS of 92.3% and 76.9%, while median PFS from diagnosis was 986 days with 1- and 5-year PFS of 76.9% and 38.2%. Carboplatin HIPEC was associated with a favorable trend toward OS and PFS compared with mitomycin C in adjusted models, and female sex and younger age predicted better survival outcomes; the study also noted that some patients had concurrent endometrial cancer or endometriosis and one patient was identified during infertility work-up. A key limitation is the small cohort and retrospective design, with some genomic data available only for a subset and risk estimates not reaching statistical significance. Relevance to endometriosis: endometriosis was mentioned among concurrent conditions in patients’ work-up/management prior to CRS–HIPEC, though the study’s primary focus is malignant peritoneal mesothelioma outcomes with CRS–HIPEC rather than endometriosis.

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Abstract

816 Background: MPM is a rare malignancy, with roughly 300 new cases in the United States annually. CRS-HIPEC has evolved as an important treatment nodality with demonstrated survival benefit. We studied the outcomes of MPM with CRS-HIPEC at a single institution. Methods: We studied a retrospective cohort of patients with malignant peritoneal mesothelioma who underwent CRS–HIPEC at Roswell Park from 2001 to 2023. Overall survival (OS) and progression-free survival (PFS) were estimated from diagnosis to describe the cohort, with one- and five-year rates calculated. Associations between HIPEC agent and OS/PFS were tested using Cox proportional hazards models with time 0 at CRS-HIPEC. Models adjusted for baseline characteristics, including age (y), sex, synchronous cancer, normal platelet count, prior therapy, completeness of cytoreduction (CC≤1), and time from diagnosis to CRS–HIPEC. Results: Thirty-nine patients were included (16 men, 23 women). Median age at diagnosis was 59y (19–79) with women being slightly younger (58 vs 62.5y). Among females, 6 were diagnosed at age < 50y, 9 underwent hysterectomy/salpingectomy/oophorectomy during work-up/management of MPM prior to CRS-HIPEC, occasionally with synchronous endometrial ca (2) or endometriosis (2) and 1 patient was diagnosed as part of infertility workup. Genomic testing was available for 9 cases (HER2 overexpression, alterations in BAP1, TP53, TERT, SETD2). Twenty-seven received mitomycin C and 12 received carboplatin. Three patients underwent repeat CRS–HIPEC. Baseline features were similar except for CC≤1. CC ≤ 1 was attained in 21 patients, not achieved in 11 patients and unknown in 7 patients. Synchronous cancer occurred in 8 patients. Histology was epithelioid in 23, unspecified in 8, Well-differentiated papillary in 5, biphasic in 2, and multicystic in 1. Twelve received prior therapy in the form of systemic therapy (8) or CRS without HIPEC (4). Median OS (from diagnosis) was not reached. 1- and 5-year OS were 92.3% and 76.9%. Median PFS (from diagnosis) was 986 days. 1- and 5-year PFS were 76.9% and 38.2%. Carboplatin was associated with more favorable OS (HR=0.37, 95%CI: 0.04-3.46) and PFS (HR=0.56, 95%CI: 0.16-1.91) in adjusted models (from HIPEC). Female sex and younger age predicted better OS and PFS. Absence of synchronous cancer, and normal platelet count at diagnosis were also associated with better PFS. Conclusions: In this cohort of MPM, CRS-HIPEC was associated with favorable outcomes, with patients occasionally eligible for repeat CRS-HIPEC. Although not statistically significant, our study demonstrated a trend towards improved OS and PFS with carboplatin. Female sex was independently associated with improved OS, despite concurrent endometrial cancers or endometriosis. Several clinical factors predicted PFS.
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Abstract

816

Background

MPM is a rare malignancy, with roughly 300 new cases in the United States annually. CRS-HIPEC has evolved as an important treatment nodality with demonstrated survival benefit. We studied the outcomes of MPM with CRS-HIPEC at a single institution. Methods: We studied a retrospective cohort of patients with malignant peritoneal mesothelioma who underwent CRS–HIPEC at Roswell Park from 2001 to 2023. Overall survival (OS) and progression-free survival (PFS) were estimated from diagnosis to describe the cohort, with one- and five-year rates calculated. Associations between HIPEC agent and OS/PFS were tested using Cox proportional hazards models with time 0 at CRS-HIPEC. Models adjusted for baseline characteristics, including age (y), sex, synchronous cancer, normal platelet count, prior therapy, completeness of cytoreduction (CC≤1), and time from diagnosis to CRS–HIPEC. Results: Thirty-nine patients were included (16 men, 23 women). Median age at diagnosis was 59y (19–79) with women being slightly younger (58 vs 62.5y). Among females, 6 were diagnosed at age < 50y, 9 underwent hysterectomy/salpingectomy/oophorectomy during work-up/management of MPM prior to CRS-HIPEC, occasionally with synchronous endometrial ca (2) or endometriosis (2) and 1 patient was diagnosed as part of infertility workup. Genomic testing was available for 9 cases (HER2 overexpression, alterations in BAP1, TP53, TERT, SETD2). Twenty-seven received mitomycin C and 12 received carboplatin. Three patients underwent repeat CRS–HIPEC. Baseline features were similar except for CC≤1. CC ≤ 1 was attained in 21 patients, not achieved in 11 patients and unknown in 7 patients. Synchronous cancer occurred in 8 patients. Histology was epithelioid in 23, unspecified in 8, Well-differentiated papillary in 5, biphasic in 2, and multicystic in 1. Twelve received prior therapy in the form of systemic therapy (8) or CRS without HIPEC (4). Median OS (from diagnosis) was not reached. 1- and 5-year OS were 92.3% and 76.9%. Median PFS (from diagnosis) was 986 days. 1- and 5-year PFS were 76.9% and 38.2%. Carboplatin was associated with more favorable OS (HR=0.37, 95%CI: 0.04-3.46) and PFS (HR=0.56, 95%CI: 0.16-1.91) in adjusted models (from HIPEC). Female sex and younger age predicted better OS and PFS. Absence of synchronous cancer, and normal platelet count at diagnosis were also associated with better PFS. Conclusions: In this cohort of MPM, CRS-HIPEC was associated with favorable outcomes, with patients occasionally eligible for repeat CRS-HIPEC. Although not statistically significant, our study demonstrated a trend towards improved OS and PFS with carboplatin. Female sex was independently associated with improved OS, despite concurrent endometrial cancers or endometriosis. Several clinical factors predicted PFS. Formats available You can view the full content in the following formats: Information & Authors Information Published In Copyright © 2026 by American Society of Clinical Oncology. History Published in print: January 10, 2026 Published online: January 12, 2026 Authors Funding Information None. Metrics & Citations Metrics Altmetric Citations Article Citation Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in malignant peritoneal mesothelioma (MPM).. J Clin Oncol 44, 816-816(2026). Download Citation If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu. Download article citation data for: Vaishali Deenadayalan, Yongdong Ouyang, Mrinalini Ramesh, Kannan Thanikachalam Journal of Clinical Oncology 2026 44:2_suppl, 816-816 Vaishali Deenadayalan, Yongdong Ouyang, Mrinalini Ramesh, Kannan Thanikachalam Journal of Clinical Oncology 2026 44:2_suppl, 816-816 View Options View options Login options Check and see if you have full access through your login credentials or institution. ASCO membership or a journal subscription may be required to download the PDF version of this article. Personal login Institutional Login

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