| Background and objective:Malignant pleural mesothelioma is a rare primary tumor originating from the pleural mesothelial cells,and exposure to asbestos is the main pathogenic factor.The early symptoms are not obvious,and owning to the lack of specific symptoms,easy to be misdiagnosed,so it depends on histopathological examination and immunohistochemistry to confirm the diagnosis.The malignancy is extremely high,the treatment is difficult,the prognosis is poor,and the survival time is short.So only a few patients can undergo radical surgeries.The current treatment is mainly chemotherapy.The aim of this study is to investigate the clinical characteristics,diagnosis,treatment and prognosis of malignant pleural mesothelioma for improving the recognization of this disease and providing the reference for clinical diagnosis and treatment.Methods:Clinical data of 60 cases of MPM was analyzed retrospectively in the Shengjing Hospital of China Medical University from January 2012 to December 2018,the diagnostic methods and treatment of MPM were reviewed,and the survival,recurrence and prognosis of patients were analyzed.The TNM staging is based on the American Joint Committee on Cancer(AJCC)malignant pleural mesothelioma staging(eighth edition)updated on January 1,2018.Results:1.Among the 60 patients,33(55%)were males and 27(45%)were females.The male to female ratio was 1.22:1.The median age was 60.5 years,and there were 3 cases of clear asbestos exposure history.The clinical stage was divided into 8 cases(13.3%)in stage I and stage II,and 52 cases(86.7%)in stage III and stage IV.2.25 patients were misdiagnosed(41.7%)at the initial diagnosis,misdiagnosed as 14 cases of tuberculous pleurisy,13 cases of lung cancer.The most common first clinical manifestation was chest pain(28 cases,46.7%).The imaging examination showed mainly pleural thickening in 55 cases(91.7%)and pleural effusion in 38 cases(63.3%).According to the scope of the violation,it was divided into limited type(28 cases,46.7%)and diffuse type(32 cases,53.3%).3.One case of radical surgery by thoracic surgery,7 cases of cytoreductive surgery,and 5 cases of squamous surgery.There were 41 patients with intravenous chemotherapy,9with palliative radiotherapy,and 4 with oral targeted drugs.55 patients were followed up.The median survival time was 12 months(95% CI: 8.0 to 16.0)at the end of the follow-up period.The overall survival rates at 1,2,and 3 years were 43.6%,16.4%,and10.9%,respectively.Univariate analysis showed that age(P = 0.008),range of invasion(P < 0.001),tumor stage(P = 0.046),and chemotherapy(P < 0.001)were associated with prognosis.Multivariate analysis using Cox regression model showed that the extent of invasion(P = 0.003)and chemotherapy(P = 0.001)were independent prognostic factors.Conclusions:1.Malignant pleural mesothelioma is insidious onset,hidden specific symptoms,and easy to be misdiagnosed,so it depends on histopathological examination and immunohistochemistry to confirm the diagnosis.2.MPM has a very high degree of malignancy and poor prognosis.Most of the patients are locally advanced.Only a few patients can undergo radical surgery.The current treatment is mainly pemetrexed combined with platinum-based chemotherapy,which can significantly prolong the survival period of patients.Independent factors that influence prognosis are the extent of invasion and chemotherapy.3.MPM treatment should be based on the combined treatment of surgery,chemotherapy and radiotherapy,and supplemented by targeted therapy.At present,there are still few studies on MPM,and further large-scale clinical research is needed to provide more effective treatments.At the same time,more new technologies and new drugs are expected to be developed to improve the quality of life of patients and prolong their survival. |
PDF Full Text Request