恶性胸膜间皮瘤的临床特征及预后分析

发布时间：2018-05-17 03:34

  本文选题：恶性胸膜间皮瘤 + 临床特征　； 参考：《北京协和医学院》2015年硕士论文

【摘要】：背景 恶性胸膜间皮瘤(Malignant Pleural Mesothelioma,MPM)是一种较为罕见且具有高度侵袭性及强致死性的胸膜原发肿瘤,其来源于脏层、壁层、纵隔或横膈四部分胸膜。近年来,恶性胸膜间皮瘤的发病率随全球石棉的广泛应用而迅速增加。其临床表现不典型,故诊断较为困难,常易漏诊、误诊。MPM尚缺乏有效、规范的治疗方法,不同的病理分型预后均较差。因此,恶性胸膜间皮瘤目前仍是医疗界较为棘手的难题。本研究的目的是探讨恶性胸膜间皮瘤(Malignant Pleural Mesothelioma,MPM)的临床特征及预后因素。方法 回顾性分析我院1990年1月至2013年12月收治的151例MPM患者的临床资料,总结其临床特征,并对性别、年龄、吸烟史、石棉接触史、肿瘤家族史、有无胸痛、侵犯范围、肿瘤分期、治疗方式等进行单及多因素预后分析。结果 151例患者中男95例(62.91%),女56例(37.09%),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%)。病程0.3～48个月,中位病程3个月。根据侵犯范围分为局限型(43例,28.5%)和弥漫型(108例,71.5%)。确诊方式包括术后病理确诊80例(53.0%),开胸/胸腔镜活检40例(26.5%),经皮穿刺肿物活检18例(11.9%),胸水细胞学检查13例(8.6%)。采用国际间皮瘤学会(International Mesothelioma Interest Group,IMIG)提出的TNM分期法对肿瘤进行分期：Ⅰ期2例(1.3%),Ⅱ期22例(14.6%),Ⅲ期58例(38.4%),Ⅳ期69例(45.7%)。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月(0.3～158月),中位生存时间19.0月(95%置信区间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 恶性胸膜间皮瘤发病率低,临床表现不典型,易漏诊、误诊,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。
[Abstract]:Background malignant pleural mesothelioma Malignant Pleural Mesothelioma (MPM) is a rare, highly invasive and highly lethal primary pleural tumor originating from the four parts of pleura, including the visceral layer, the parietal layer, the mediastinum or the diaphragm. In recent years, the incidence of malignant pleural mesothelioma has increased rapidly with the wide application of asbestos worldwide. Its clinical manifestation is not typical, so it is difficult to diagnose, it is easy to miss diagnosis, misdiagnosis. MPM is still lack of effective, standardized treatment methods, the prognosis of different pathological classification is poor. Therefore, malignant pleural mesothelioma is still a difficult problem in medical field. The purpose of this study was to investigate the clinical features and prognostic factors of malignant pleural mesothelioma (Malignant Pleural Mesothelioma). Methods the clinical data of 151 patients with MPM from January 1990 to December 2013 were analyzed retrospectively, and the clinical features were summarized, including sex, age, history of smoking, history of asbestos exposure, family history of tumor, chest pain and the extent of invasion. Single and multivariate prognostic analysis was performed for tumor staging and treatment. Results among 151 patients, 95 males (62.91%) and 56 females (37.09%) had a median age of 52 years (1678 years), and 4 cases had a history of asbestos exposure (2.6%). The most common initial clinical manifestation was chest pain in 64 cases. The course of disease was 0.3 ~ 48 months and the median course was 3 months. According to the range of invasion, there were 43 cases of localized type and 108 cases of diffuse type. The methods of diagnosis included pathological diagnosis in 80 cases, thoracoscopic biopsy in 40 cases, percutaneous biopsy in 18 cases, and cytological examination of pleural effusion in 13 cases. The TNM staging method proposed by the International Mesothelioma Society (Imig) was used to stage the tumor: stage 鈪，

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