恶性胸膜间皮瘤远期疗效的影响因素分析

Long-term Prognostic Analysis of Patients with Malignant Pleural Mesothelioma

背景与目的:恶性胸膜间皮瘤(malignant pleural mesothelioma,MPM)是一种少见的恶性肿瘤,但预后差。本文分析MPM的治疗效果,探讨影响其预后的因素。方法:1988年1月～2001年12月中山大学肿瘤医院收治的经病理组织学或细胞学确诊的MPM24例,其中12例单纯接受以DDP为基础的方案化疗1～6个疗程,7例接受手术治疗和以DDP为基础的术后化疗1～6个疗程,5例接受手术治疗和术后放射治疗。用Kaplan-Meier法计算生存率,用log-rank法比较各组的生存率,应用Cox模型进行多因素分析。结果:24例患者1、3、5年生存率分别为37.5%、20.8%和4.2%,中位生存期9.0个月。单纯化疗组12例患者的1、3、5年生存率分别为16.7%、0和0,中位生存期为5.0个月;手术加化疗组7例患者的1、3、5年生存率分别为28.6%、14.3%和0,中位生存期为10.0个月;手术加放疗组5例患者的1、3、5年生存率分别为100.0%、80.0%和20.0%,中位生存期为42.0个月。3组生存率比较有显著性差异(χ2=11.93,P=0.00)。影响MPM预后的因素有临床分型(P=0.04)和治疗方法(P=0.00)。结论:临床分型和治疗方法是影响MPM预后的独立因素。

BACKGROUND & OBJECTIVE: Malignant pleural mesothelioma (MPM) is a rare disease with poor prognosis. This study was to analyze long-term results, and prognostic factors of patients with MPM. METHODS: Records of 24 patients with MPM, proved by pathology or cytology, treated in our hospital from Jan. 1988 to Dec. 2001 were analyzed retrospectively. Of the 24 patients, 12 received chemotherapy alone (1-6 cycles of cisplatin-based regimens), 7 received surgery plus postoperative chemotherapy (1-6 cycles of cisplatin-based regimens), and 5 received surgery plus postoperative radiotherapy. Kaplan-Meier method and log-rank test were used to evaluate the survival rates. Cox regression model was used to explore prognostic factors of MPM. RESULTS: Of the 24 patients, 1-, 3-, and 5-year survival rates were 37.5%, 20.8%, and 4.2%, respectively,with a median survival time of 9 months; those in chemotherapy group were 16.7%, 0, and 0, respectively, with a median survival time of 5 months; in surgery plus chemotherapy group were 28.6%, 14.3%, and 0, respectively, with a median survival time of 10 months; in surgery plus radiotherapy group were 100.0%, 80.0%, and 20.0%, respectively, with a median survival time of 42 months. There were significant differences among 3 groups (χ2=11.93, P =0.002). Multivariate analysis showed that clinical classification (P=0.038), and mode of treatment (P=0.005) were independent prognostic factors of MPM. CONCLUSION: Mode of treatment, and clinical classification are independent prognostic factors for patients with MPM.