23: Socioeconomic Status and Outcomes in Peritoneal Mesothelioma Treated with Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy (CRS and HIPEC)

Saturday, February 17, 2024

1:00 PM - 1:10 PM AST

Location: Miramar I & II

Abstract Presenter(s)

Kathrine A. Kelly, DO

Fellow
UPMC
Pittsburgh, Pennsylvania, United States

Submitter(s)

Kathrine A. Kelly, DO

Fellow
UPMC
Pittsburgh, Pennsylvania, United States

Author(s)

EB

Erin Bayley, MD

Breast Fellow
UPMC, United States
JD

Joshua Derby, n/a

Research
UPMC, United States
GN

Geoffrey Nunns, MD

Faculty
UPMC, United States
Steven Ahrendt, MD

Professor
University of Colroado
Aurora, Colorado, United States
David L. Bartlett, MD

Faculty
AHN
Pittsburgh, Pennsylvania, United States
Haroon A. Choudry, MD

Faculty
UPMC
Pittsburgh, Pennsylvania, United States
JP

James F. Pingpank, Jr., MD

Faculty
UPMC
Pittsburgh, PA, United States
MH

Matthew Holtzmann, MD

Faculty
UPMC, United States
Melanie Ongchin, MD

Faculty
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States

Disclosure(s):

Kathrine A. Kelly, DO: No financial relationships to disclose

Melanie Ongchin, MD: No financial relationships to disclose

Introduction: Many patient factors can impact surgical and oncologic outcomes after CRS and HIPEC for peritoneal mesothelioma. Socioeconomic status (SES) has been demonstrated to impact all aspects of care in the surgical patient undergoing CRS and HIPEC with many advanced malignancies.

Methods: This was a retrospective study, at a single institution, of all patients with peritoneal mesothelioma who underwent CRS and HIPEC from 2000 to 2023. Area deprivation index (ADI) was used as a measure of SES. ADI is a composite score (1-100, 100 being most disadvantaged) of income, education, housing quality and employment. Univariable and multivariable analysis were used to identify factors associated with overall survival after CRS and HIPEC. The Kaplan-Meier method was used to estimate survival outcomes. Our primary outcome of interest was survival from CRS and HIPEC.

Results: A total of 190 patients underwent CRS and HIPEC for peritoneal mesothelioma during the timeframe. There was no difference in overall survival when examining the four groups of ADI quartiles (p=0.28) (Figure 1). Median survival in the top quartile was 84 months (95% CI, 39-NR) as compared to 33 months (95% CI, 24-51) for the remaining patients in the cohort (p=0.088).
In a multivariable analysis, ADI quartile was not associated with survival. Factors noted to be associated with survival included in-state residence (HR, 1.60; p=0.028), preoperative BMI (HR, 1.04; p=0.013), ECOG score 2 (HR 8.19; p< 0.001), PCI score (HR, 1.04; p=0.011), presence of symptoms (HR, 1.71; p=0.014), Biphasic Mixed and Well-Differentiated Papillary Tumors (HR, 2.14; p=0.018; HR, 7.90; p=0.014, respectively).

Conclusions: Socioeconomic status defined by ADI was not associated with survival. Although, not statistically significant, survival was 84 months vs 33 months when comparing the top quartile to the remaining cohort. ECOG score, PCI, symptoms, and aggressive pathology were factors associated with worse survival in peritoneal mesothelioma treated with CRS and HIPEC.

Learning Objectives:

Upon completion participants will be able to define treatment for peritoneal carcinomatosis from mesothelioma
Upon completion participants will be able to define risk factors for poor outcomes after surgery for peritoneal mesothelioma
Upon completion participants will be able to discuss the impact of socioeconomic status on cancer outcomes and surgery