Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma
Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma
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DOI：
10.1183/09031936.00063109
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发表时间：
2010-03-01
影响因子：
24.3
通讯作者：
Weder, W.
中科院分区：
文献类型：
--
作者：
Scherpereel, A.;Astoul, P.;Weder, W.
恶性胸膜间皮瘤(MPM)是一种罕见的肿瘤，但发病率呈上升趋势，预后较差。2008年，欧洲呼吸学会/欧洲胸科外科学会工作组召集专家，就MPM的管理提出了实用和最新的指南。为了获得MPM的早期和可靠的诊断，专家们建议进行胸腔镜检查，但术前禁忌症或胸膜联合的情况除外。在大约10%的病例中，标准的染色程序是不够的。因此，我们建议在胸膜活检中使用特异性免疫组织化学标记物。在缺乏统一、稳健和有效的分期系统的情况下，我们建议使用最新的基于TNM的分类，并建议进行三步治疗前评估。目前，在MPM的治疗中，患者的表现状态和组织学亚型是唯一具有临床重要性的预后因素。其他可能的参数应记录在基线上，并在临床试验中报告。MPM表现出对化疗的高度耐药性，只有少数患者适合进行根治性手术。我们回顾了新的治疗方法和策略。由于最佳联合治疗的数据有限，我们强调，被认为是多模式方法候选的患者应该包括在专门中心的前瞻性试验中。
Malignant pleural mesothelioma (MPM) is a rare tumour but with increasing incidence and a poor prognosis. In 2008, the European Respiratory Society/European Society of Thoracic Surgeons Task Force brought together experts to propose practical and up-to-dated guidelines on the management of MPM.To obtain an earlier and reliable diagnosis of MPM, the experts recommend performing thoracoscopy, except in cases of pre-operative contraindication or pleural symphysis. The standard staining procedures are insufficient in similar to 10% of cases. Therefore, we propose using specific immunohistochemistry markers on pleural biopsies. In the absence of a uniform, robust and validated staging system, we advice use of the most recent TNM based classification, and propose a three step pre-treatment assessment. Patient's performance status and histological subtype are currently the only prognostic factors of clinical importance in the management of MPM. Other potential parameters should be recorded at baseline and reported in clinical trials. MPM exhibits a high resistance to chemotherapy and only a few patients are candidates for radical surgery. New therapies and strategies have been reviewed.Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach should be included in a prospective trial at a specialised centre.