Osteopontin, GLUT1 and Ki-67 expression in malignant peritoneal mesothelioma: prognostic implications.

BACKGROUND: Malignant peritoneal mesothelioma is the most common primary peritoneal neoplasm. The only universally recognised pathological prognostic factor is histopathological subtype. Prognostic markers based on patient features and clinical stages have been disappointing. AIMS: To assess the prognostic role of several clinicopathological features in a retrospective cohort of 60 patients diagnosed with peritoneal mesothelioma. METHODS: Sixty patients were centrally collected and were immunohistochemically analysed for the expression of osteopontin (OPN), GLUT1 and Ki-67. Labelling was assessed by two pathologists. Complete clinical information and follow-up were obtained from patients' records. RESULTS: OPN expression was identified in 52 (86.6%) of 60 specimens, and GLUT1 in 39 (65%) of 60 specimens. Univariate Cox regression analysis showed that a lower peritoneal carcinomatosis index (PCI), tumour-directed treatment (chemotherapy or surgery alone or in any combination), lower Ki-67, GLUT1 and lower OPN expression had a statistically significant positive effect on overall survival (OS). PCI (hazard ratio (HR) = 1.032 (95% confidence interval (CI): 1.000-1.067); P = 0.054) and tumour-directed treatment (HR = 0.211 (95% CI: 0.104-0.430); P < 0.001), Ki-67 (HR = 22.326 (95% CI: 3.523-141.498); P = 0.003) and OPN (HR = 7.268 (95% CI: 1.771-29.811); P = 0.009) retained independent prognostic significance in the multivariate analysis, all with a positive effect on OS with the exception of GLUT1. CONCLUSIONS: OPN, Ki-67, treatment and PCI were independent indicators for OS, and a higher level of OPN expression correlated significantly with poorer OS.