Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center.

BACKGROUND: Malignant peritoneal mesothelioma (MPM) is a rare diagnosis with a dismal prognosis if untreated. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is shown to significantly improve survival. Our institution is uniquely positioned to report long-term outcomes in MPM with CRS-HIPEC, due to our robust peritoneal surface disease program existing over the past three decades. METHODS: Our prospectively maintained, single-institution database of CRS-HIPEC cases was reviewed, identifying 111 consecutive patients with MPM over 28 years (1993-2021). Prognostic, operative, and pathologic factors were reviewed. Overall survival (OS) and conditional survival (CS) analyses were performed. RESULTS: The average age was 55.1 years; 58.6% of patients were male; 17 of 111 patients (15.3%) had a second CRS-HIPEC. At first CRS-HIPEC, the average PCI score was 18.7, and the perfusate drugs were platinum-based (72.1%) and mitomycin C (27.9%). The resection status at first CRS-HIPEC was R2a (46.4%), followed by R0-1 (29.1%), and R2b-c (24.5%). Median OS was 3.3 years for the entire cohort, with 75th and 25th percentiles at 10.7 months and 10.6 years. Median CS was improved if patients survived to the 1-year postoperative mark (4.9 years, p < 0.01) and trended toward further improvement with each passing year. If 3-year postoperative survival was achieved, the median CS improved to 6.1 years. CONCLUSIONS: This represents one of the largest and lengthiest, single-center, longitudinal, case series of peritoneal mesothelioma treated with CRS-HIPEC. The OS suggests efficacy for CRS-HIPEC for MPM. Long-term survival improves significantly after patients achieve the 1-year, postoperative mark.

Re-operative Parathyroidectomy in Patients With Mild Primary Hyperparathyroidism.

BACKGROUND: Surgery is the definitive management of primary hyperparathyroidism and the only curative therapy. However, many surgeons are hesitant to operate on individuals with mild primary hyperparathyroidism, with an even greater reluctance to operate on those who underwent a previous parathyroidectomy. We hypothesize that patients with mild primary hyperparathyroidism who undergo a re-operation have equivalent outcomes compared with those who undergo a first-time (FT) operation. METHODS: We reviewed a prospective database of 459 patients with mild primary hyperparathyroidism who underwent surgery by one endocrine surgeon. Of these patients, 59 had a re-operative (RE-OP) parathyroid surgery. We compared these patients to those with mild primary hyperparathyroidism who had FT surgery (n = 400) using either the Pearson chi-square, Fisher's exact test, or Student's t-test where appropriate. RESULTS: The mean age of our cohort was 60 ± 14 y, with 86% females. Patients in the RE-OP group had similar preoperative calcium and parathyroid hormone levels compared with those in the FT group. Most patients who underwent a RE-OP surgery had four gland hyperplasia on pathology (49.2%). Patients in the RE-OP and FT groups both had high and similar cure rates (100% versus 99.8%, P = 0.70). RE-OP patients had a higher rate of recurrent hyperparathyroidism (10.3% versus 3.3%, P = 0.025). CONCLUSIONS: In patients with mild primary hyperparathyroidism, those who undergo RE-OP parathyroidectomy have a high cure rate that is similar to FT surgery. Therefore, we recommend that these patients with recurrence of mild hyperparathyroid disease be considered for parathyroidectomy.

Variants in immune-related genes and genital HPV 16 persistence in men.

OBJECTIVES: While most human papillomavirus (HPV) infection clears on its own, persistent HPV infection can cause genital warts and anal, penile and oropharyngeal cancers in men. We conducted genetic analysis in a sub-cohort of the HPV infection in men (HIM) study to test the hypothesis that differences in host genes influence HPV persistence in men. METHODS: Baseline and longitudinal genital HPV status at the genitals was measured every 6-months using the Linear Array assay amplified HPV L1 gene fragment using the PGMY09/11 L1 consensus primer system. DNA was extracted from peripheral blood and single nucleotide polymorphisms (SNPs) in the customized genome-wide genotyping array, the "TxArray," were examined using logistic regression in a case-control study design to assess the association with HPV16 persistence/clearance. RESULTS: Of the total of 737,742 autosomal SNPs in the array, 605,885 passed basic quality control and were examined between 40 men (cases) with > 18 months persistent genital HPV 16 infection vs. 151 controls who were HPV 16-positive, but whose infections cleared in < 18 months. The logistic regression analysis from this case-control study showed variants in several gene regions associated with genital HPV 16 persistence, with the strongest association detected with SNPs on chromosomes 20 (p < 5.72 × 10-6) and 15 (p < 5.89 × 10-6), after adjusting for age, smoking status, number of sex partners and four principal components (ancestral background). CONCLUSIONS: Our results provide a preliminary basis for understanding the biological mechanism of oncogenic HPV 16 pathogenesis at the genitals in men. Some of the genes flanking the top hit SNPs are consistent with previous findings in both HPV related and non-related cancers but further genetic studies in larger cohorts are warranted to confirm these and identify novel major susceptibility genes involved in the pathogenesis of genital HPV persistence in men.