Clinical Analysis Of 30 Cases With Malignant Pleural Mesothelioma And Literature Review

Objective: Malignant pleural mesothelioma has the characteristics of atypical clinical manifestations,strong invasiveness,high degree of malignancy and short natural survival.Current treatments are not effective.We aims to investigate the clinical features,diagnostic methods,treatment and prognosis of malignant pleural mesothelioma,providing a reference for clinical.Methods: We retrospectively studied 30 patients of the First Affiliated Hospital of Guang Xi Medical University between January 2012 to January 2019 including clinical features,auxiliary examinations,treatment and rognosis.All cases had obtained cytologic or pathologic diagnosis.Results: In the study,the male-female ratio was 2.75:1.Two patients(6.7%)had a clear history of asbestos exposured and 27(90.0%)patients had pleural effusion.The main clinical manifestations were chest pain,shortness of breath and cough.The levels of tumor markers in pleural effusion were higher than those in serum.Chest CT examination mainly showed pleural thickening,pleural nodules and pleural masses.The patients were diagnosed mainly by ultrasound guided and medical thoracoscopic pleural biopsy.Eight patients underwent surgery and the overall survival was 34 months.Nine patients underwent chemotherapy with a median progression-free survival of 6 months and a median overall survival of 21 months.The first-line chemotherapy was used pemetrexed combined with platinum,and the effective rate was 55.4%.One case used Endostar combined with chemotherapy.Thirteen cases used supportive therapy,with a median overall survival of 8 months.The median overall survival of the whole group was 12 months.The median overall survival of patients undergoing surgery or chemotherapy was 31 months,which was significantly higher than that of patients who chose supportive therapy.Univariate analysis showed that performance status and tumor stage were the factors affecting the prognosis of MPM.However,multivariate analysis showed that only PS was independent prognostic factor for MPM.Conclusions: The incidence of males in MPM patients was higher than that in females.In addition to asbestos exposure,there may be other pathogenic factors.The clinical manifestations of MPM are not typical.We should be alert to the possibility of MPM for patients with chest pain and shortness of breath,chest imaging findings of pleural effusion and pleural thickening.For unexplained pleural effusions,medical thoracoscopy may increase the positive rate of diagnosis.The prognosis of MPM is poor,and some patients can benefit from pemetrexed in combination with platinum-based chemotherapy.