恶性胸膜间皮瘤的临床特征及预后分析  

Clinical characteristics and prognostic factors of malignant pleural mesothelioma

作　　者：刘孟嘉[1] 戴维[2] 王大力[1] 高树庚[1] 牟巨伟[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院胸外科,北京100021 [2]四川省肿瘤医院胸外科,成都610041

出　　处：《中国肿瘤临床与康复》2015年第5期580-583,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨恶性胸膜间皮瘤（MPM）的临床特征及预后因素。方法回顾性分析1990年1月至2013年12月间收治的151例MPM患者的临床资料，并分析其预后因素。结果患者中位年龄52岁（16～78岁），有石棉接触史4例（2．6％）。最常见的首发临床表现为胸痛（64例，42．4％）。根据侵犯范围分为局限型（43例，28．5％）和弥漫型（108例，71．5％）。治疗方式包括单纯手术23例（15．3％），单纯化疗63例（41．7％），手术＋辅助治疗57例（37．7％），化疗＋放疗8例（5．3％）。随访到133例患者，中位随访时间13．0个月（0．3～158个月），中位生存时间19．0个月（95％凹为11．5～26．5）。1、2、3及5年总生存率分别为60．0％、44．6％、36．0％和28．3％。单因素分析结果显示，性别（P=0．048）、侵犯范围（P=0．005）、肿瘤分期（P：0．002）与预后相关。多因素分析结果显示，性别（P=0．013）和肿瘤分期（P=0．001）是影响预后的独立因素。结论恶性胸膜问皮瘤预后差，手术、化疗、放疗及综合治疗的疗效均欠佳。性别及肿瘤分期是影响预后的独立因素。Objective The aim of this study is to investigate the clinical characteristics and prog- nostic factors of malignant peural mesothelioma （MPM）. Methods From January 1990 to December 2013, 151 consecutive patients diagnosed with MPM at our insititution were included in this study. The clinical and treatment characteristics were evaluated to determine predictors of survival, including gender, age, as- bestos exposure history, smoking history, family history of cancer, presence of chest pain, tumor stage and therapeutic methods. Results The median age was 52 years （range16-78 years ）. Asbestos exposure was found in four patients（2. 6% ）. The most common initial symptom was chest pain（ n = 64,42. 4% ）. Ac- cording to tumor extent, patients were categorized as having local（ n = 43,28.5 % ） or regional/distant （n = 108,71.5% ） disease. 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 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. O, 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 inde- pendent prognostic factors for suivival. Conclusions MPM is a highly malignant disease, and shows mod- est response to different treatments, including surgery, chemotherapy, radiotherapy or the combination of these therapies. Gender and tumor stage are independent prognostic factors of MPM.

关 键 词：恶性胸膜间皮瘤 临床特征 预后因素 

分 类 号：R734.3[医药卫生—肿瘤]