Clinical Characteristics And Prognostic Factors Of Malignant Pleural Mesothelioma

Background Malignant Pleural Mesothelioma (Malignant Pleural instance, MPM) is a rare and highly aggressive and strong deadly primary pleura tumor. It is derived from four parts including the visceral pleura, parietal pleura, mediastinum and diaphragmatic. In recent years, the incidence rate of malignant pleural mesothelioma increased rapidly with the widely application of the global asbestos. Because of its atypical clinical manifestations, diagnosis is difficult, therefore, often easily lead to missed diagnosis and misdiagnosis. MPM is lack of effective and standardized treatment and has poor prognosis of different pathological types. Therefore, MPM is still a complicated medical problem. The aim of this study is to investigate the clinical characteristics and prognostic factors of malignant pleural mesothelioma (MPM).Methods From January 1990 to December 2013,151 consecutive patients diagnosed with MPM at our institution were included in this study. The clinical and treatment characteristics were evaluated to determine predictors of survival, including gender, age, asbestos exposure history, smoking history, family history of cancer, presence of chest pain, tumor extent, tumor stage and therapeutic methods.Results The median age was 52 years (range 16-78 years). Asbestos exposure was found in four patients (2.6%). The most common initial symptom was chest pain (n=64,42.4%). According to tumor extent, patients were categorized as having local (n=43,28.5%) or regional/distant (n=108,71.5%) disease. Eighty (53.0%) patients were diagnosed by postoperative pathology,40 (26.5%) patients were diagnosed based on open or closed pleural biopsy,18 (11.9%) patients were diagnosed by percutaneous puncture biopsy,13 (8.6%) patients were diagnosed by cytologic examination of hydrothorax. The course of disease was 0.3-48 months, the median duration was 3 months. The staging was determined according to the TNM-staging of International Mesothelioma Interest Group (IMIG),2 (1.3%) patients were stage I,22 (14.6%)patients were stage II,58(38.4%) patients were stage III,69(45.7%) patients were stage IV. Surgery alone was performed in 23 (15.3%) patients, chemotherapy alone in 63 (41.7%) patients, surgery plus adjuvant therapy in 57(37.7%) patients, chemotherapy plus radiotherapy in 8 (5.3%) patients. A total of 133(88.1%) patients were followed with a median follow-up of 13.0 months (range 0.3-158 months). Median survival time was 19.0 months (95% confidence interval,11.5-26.5), with a 1,2,3 and 5-year survival rate of 60.0,44.6,36.0 and 28.3%, respectively. On univariate analysis, gender (P=0.048), tumor extent (P=0.005) and tumor stage (P=0.002) were significantly associated with survival. On multivariate analysis, gender (P=0.013) and tumor stage (P=0.001)were the independent prognostic factors for survival.Conclusions MPM is a highly malignant and rare disease. It has atypical clinical manifestation and easy to be misdiagnosed to other disease. MPM shows modest response to different kinds of treatments, including surgery, chemotherapy, radiotherapy or the combination of these therapies. Gender and tumor stage are independent prognostic factors of MPM.