Effects of sex hormones on survival of peritoneal mesothelioma

Background: Previous studies have suggested the presence of steroid receptors as a favourable prognostic factor in peritoneal mesothelioma (PM). This study aims to investigate possible hormonal effects on survival of PM. Methods: This is a retrospective study of prospectively collected data of 52 consecutive patients with PM who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by the same surgical team at St George Hospital in Sydney, Australia, between April 1996 and April 2013. Females were arbitrarily divided into assumed premenopausal (<51years old; n=15) and assumed postmenopausal (≥51years old, n=9). In each gender group, patients were furthered divided into three age groups (<40, 40-60, >60). A significant statistical difference was defined as p<0.05. Results: Females with epithelial mesothelioma had a significantly higher survival than males (p=0.023). They also had a better overall median survival (>60months) than males (43months), although this difference was not statistically significant (p=0.098). Survival of postmenopausal females became similar to males after excluding benign cystic mesothelioma. Conclusions: The better survival in premenopausal females could probably be explained by higher levels of oestradiol and progesterone. Also, our data suggests that higher rates of benign cystic mesothelioma in females was not the key reason for the better survival in female patients, further supporting the hypothesis of hormonal links with survival of PM. Therapeutic effects of sex steroid hormones on PM may be a valuable area to explore.