Impact of Histological Subtype on Outcomes of Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: A Systematic Review and Meta-Analysis
A partir d'une revue systématique de la littérature publiée jusqu'en avril 2026 (22 études, 7 017 patients), cette méta-analyse évalue l'efficacité, chez des patients présentant un mésothéliome non épithélioïde, d'une chirurgie cytoréductrice associée ou non à une chimiothérapie hyperthermique intrapéritonéale
Background: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) has transformed survival in peritoneal mesothelioma (PeM), but is still often withheld from non-epithelioid patients on histological grounds.
Objective: To quantify the prognostic impact of non-epithelioid histology on overall survival after CRS ± HIPEC in PeM.
Methods: We searched PubMed/MEDLINE, Embase and Cochrane CENTRAL to 7 April 2026 for studies reporting survival after CRS ± HIPEC in PeM by histological subtype. Screening and extraction were duplicated. The primary analysis pooled multivariable-adjusted hazard ratios (HRs) from the institution-unique surgical cohorts; adding the two population registries was secondary (PROSPERO: CRD420261360349).
Results: Twenty-two studies (7,017 patients) were included; six reported a multivariable-adjusted HR on an institution-unique series, four surgical. In the primary analysis, non-epithelioid histology was associated with worse overall survival (HR 3.38; 95% CI 1.22-9.35; p = 0.032; I2 = 50.3%), but the estimate is fragile: every leave-one-out iteration crossed unity (2.63 to 4.24), the prediction interval ran 0.33-34.23, and only 39 non-epithelioid patients contribute. Adding the two population registries gave 2.30 (1.21-4.37). Publication bias was not assessable at k = 4; trim-and-fill gave 2.71 (0.98-7.53). Reported whole-cohort five-year survival ranged from 39% to 52.4%, not pooled. GRADE certainty was very low.
Conclusions: Non-epithelioid histology is associated with worse overall survival after CRS ± HIPEC in every analysis performed. The direction is consistent; the magnitude is not, resting on very few patients and not surviving removal of any single study. Histological subtype should inform selection for surgery rather than decide it.
European Journal of Surgical Oncology , résumé, 2026