DIFFUSE MALIGNANT MESOTHELIOMA OF THE PLEURA IN ONTARIO AND QUEBEC - A RETROSPECTIVE STUDY OF 332 PATIENTS
DIFFUSE MALIGNANT MESOTHELIOMA OF THE PLEURA IN ONTARIO AND QUEBEC - A RETROSPECTIVE STUDY OF 332 PATIENTS
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DOI：
10.1200/jco.1989.7.8.1157
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发表时间：
1989-08-01
影响因子：
45.3
通讯作者：
KREISMAN, H
中科院分区：
文献类型：
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作者：
RUFFIE, P;FELD, R;KREISMAN, H
回顾性分析了1965年至1984年在安大略和魁北克大型中心发现的332例胸膜弥漫性恶性间皮瘤（DMM）。在44%的患者中发现了既往石棉暴露。诊断最常见的是开胸探查术，胸膜活检或细胞学很少作出贡献。诊断延迟时间通常较长（中位时间为3.5个月），血小板增多（血小板≥ 1.5）。400，000/μ L）是常见的（41%的病例）。中位生存期（MS）仅为9个月。分析了11个临床变量的预后意义。采用单变量分析的三个最重要的预后因素是分期、体重减轻和组织学类型。对于118例有完整资料的患者，多因素分析显示疾病分期、高血小板计数和石棉暴露是最重要的预后因素。DMM无法治愈，我们也没有发现接受不同治疗措施的患者组之间的生存率有任何显著差异。根治性手术和放射治疗无效，我们证实化疗药物的反应率低。这项大型回顾性试验可以作为该领域未来研究的基线。特别是，它提供了在未来的治疗试验中使用适当的分层变量的基础。
Three-hundred thirty-two cases of pleural diffuse malignant mesothelioma (DMM) seen at large centers in Ontario and Quebec from 1965 to 1984 were reviewed retrospectively. Previous asbestos exposure was found in 44% of patients. Diagnosis was most often made by exploratory thoracotomy; pleural biopsy or cytology were rarely contributory. The delay in diagnosis was often long (median time, 3.5 months) and thrombocytosis (platelets .gtoreq. 400,000/.mu.L) was common (41% of cases). The median survival (MS) was only 9 months. Eleven clinical variables were analyzed for prognostic significance. The three most important prognostic factors using a univariate analysis were stage, weight loss, and histologic type. For 118 patients with complete data, multivariate analysis showed that the stage of disease, high platelet count, and asbestos exposure were the most important prognostic factors. There was no cure of DMM, and we did not find any drastic differences in survival among groups of patients subjected to the different therapeutic measures. Radical surgery and radiotherapy were ineffective and we confirmed the low response rate to chemotherapeutic agents. This large retrospective trial can serve as a baseline for future studies in this field. In particular, it provides the basis for appropriate stratification variables to be used in future therapeutic trials.