| Background:Malignant pleural mesothelioma(MPM) is a rare cancer originated from pleural mesothelial cells.Most patients of MPM have the process of asbestos exposure. As China has become the largest country in the consumption of asbestos, it could give rise to a new surge of MPM in the future. MPM has a poor prognosis due to the difficulty in making diagnosis at the early stage, the rapid progression and invasion,and the diversity of clinical features.Owing to absence the knowledge of MPM in the stage, aretrospective study about the clinical date and conclusion the diagnosis, clinical manifestations, and treatments of this diseases,and provide a reference for the treatment of patients with malignant pleural mesothelioma.Objective:To investigate the clinical rule and advance in the diagnoses,clinical features,and treatment of malignant pleural mesothelioma, and improve understanding and diagnostic lead to extend the overall survival of malignant pleural mesothelioma.Material and MethodrAretrospective study was conducted in 28cases of malignant pleuralmesothelioma hospitalized from 2001 to 2013,and the clinical data was analysed including diagnoses,clinical features and treatment.Result:1.Of all the 28cases,18 cases were male and 10 cases were female, male:female=2: 1.The age of patients were from 43 to 82, and the expective of live were 54. The 5 cases had evident history of exposure to asbestos.2.The clinical manifestation were diversity, and the clinical features were mainly chest pain, chest depressed cough, dyspnea andpleural effusion. The other diseases including chest discomfort, weight loss and weakness. Some patients might have phrenic nerve paralysis, and spontaneous pneumothorax.The clinical features above were lack of specificity,and the clinical misdiagnosis rate was higher.Image results show that 25 cases (89.3%) had pleural effusion or irregular nodules in pleural cavity, and 17 cases (60.7%) acquired pleural thickening, and huge pleural bag piece (maximum diameter greater than 8 cm) in 6 patients (21.4%). All the cases have achieved pleural biopsy, pleural effusion cytology examination and surgical pathologic diagnosis.3.The pathological types of epithelium,sarcomatoid and biphasic, with a 1 and 2 year survival rate of 66.7%,53.3%; 20.0%,20.0%; 50.0%,37.5% respectively.4.The TNM staging system were stage Ⅰ, Ⅱ ,Ⅲ and Ⅳ,with a 1 and 2 year survival rate of 80.0%,60.0%; 57.1%,42.9%; 33.3%,16.7%; 20.0%,0.0% respectively.5.12 cases underwent surgical treatment and 10 cases accepted the treat of surgery, radiation and chemotherapy.6 cases accepted the treat of radiation and chemotherapy. The 1 and 2 year survival rate of those three management were 33.3%,16.7%; 58.3%, 41.7%; 50.0%,50.0% respectively.Conclusions:1. Although MPM occurs mainly in older men who have more opportunity exposed in asbestos,5 patients had a history of asbestos exposure.In the process of clinical diagnosis, we were not rely too much on the working environment and living areas to determine this disease.2. The clinical manifestations were diversity, and the clinical features were mainly the chest painandpleural effusion.3. The diagnosis of MPM was mainly rely on imaging, immunohistochemistry examination, clinical features, cytology and histopathological examination.4. The TNM staging system,significantly stratifies survival and provides an internationally accepted basis for the analysis of survival rates in prospective clinical trials. Surgical intervention is appropriate treatment for selected patients with malignant pleural mesothelioma. Pleurectomy/decortication or Extrapleural Pneumonectomy offer good survival results in patients with stage Ⅰ or Ⅱ disease, except those with stage IV. For patlents in stage Ⅲ, only those with local type, epithelial histology, radical resection are likely to prolong the survival.The current treatment of MPM was multimodality therapy including surgery, radiotherapy,chemotherapy and immunotherapy,especially benefit for earlier stages of the patients. |
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