恶性胸膜间皮瘤术后预后因素分析

Analysis of prognostic factors influencing the postoperative survival of malignant pleural mesothelioma

目的:分析恶性胸膜间皮瘤(MPM)的临床病理特征、生存时间及手术方式并探讨影响术后生存的因素。方法:回顾性总结我院1998-2005年手术治疗的MPM患者51例,分析胸膜外全肺切除和胸膜切除两种不同手术方式和不同分期对预后的影响,对性别、年龄、手术方式、病理分型和分期等多个预后因素进行探讨。结果:总中位生存期为22个月,1、3和5年生存率分别为68.1%、25.2%和14.5%。胸膜外全肺切除术38例,胸膜切除术13例,不同手术方式之间术后生存期差异无统计学意义。不同TNM分期之间1、3和5年生存率差异有统计学意义,P=0.004。多因素分析结果显示,原发瘤侵袭程度(T)不是影响预后的因素,上皮型肿瘤(P=0.019)、临床分期(P=0.016)和淋巴结转移(N)情况(P=0.002),尤其是N2组淋巴结是影响预后的独立因素。结论:胸膜外全肺切除及胸膜切除两种手术方式对预后的影响差异无显著性,早期肿瘤预后较好;淋巴结转移,尤其是纵隔淋巴结转移是影响预后的的主要因素。早期诊断和尽早手术治疗是取得良好效果的关键。

OBJECTIVE：To the pleural cavity,therefore,surgical resection is considered the mainstay of treatment.Present study is to evaluate the the clinicopathological characteristics of MPM,different types of resection and to identify prognostic factors that influence the postoperative survival.METHODS：A retrospective review was conducted on the records of 51 patients with malignant pleural mesothelioma who had received surgical treatment from 1998 to 2005 in Beijing Chest Hospita.Data collected included sex,age,surgical procedures with extrapleural pneumonectomy （EPP） and pleurectomy/decortication （P/D）,pathological type and IMIG clinical stage,and survival.RESULTS：The 1-,3-,and 5-year overall survival rates were 68.1%,25.2% and 14.5%,respectively,with a median survival of 22 months.Of the 51 patients,38 underwent extrapleural pneumonectomy,and 13 underwent pleurectomy decortication.The survival rate was no significant difference between the two types of resection.However,there was significant difference between different TNM stages of the 1-,3-,and 5-year overall survival rates （P=0.004）.Multivariate analysis revealed that the epithelioid subtype （P=0.019）,IMIG clinical stage（P=0.016）,and nodal involvement （P=0.002） were independent prognostic factors,especially,N2 nodal involvement,but not tumor size（T）.CONCLUSIONS：Two types of resection lead to equal survival for suitable patients.Patients with early stages on the IMIG staging system seem to have the potential for prolonged survival following surgery.It is a poor survival incidence of nodal involvement,especially,mediastinal lymph nodes.Early diagnosis and surgical treatment are critical for patients to attain good results.