恶性腹膜间皮瘤26例临床特点及预后影响因素分析

Clinical characteristics and prognostic factors of patients with malignant peritoneal mesothelioma:An analysis of 26 cases

目的探讨恶性腹膜间皮瘤的临床特点及影响该病预后的相关因素。方法收集解放军总医院2005-2013年收治的26例恶性腹膜间皮瘤患者的临床资料,回顾性分析预后影响因素。结果 26例患者平均年龄57岁,3例男性患者有石棉接触史,主要临床表现为腹胀、腹痛、腹水及腹部肿块。CT示腹膜或大网膜增厚/占位性肿块。组织分型：上皮型20例,肉瘤型/双相型6例。TMN分期：Ⅰ~Ⅱ期12例,Ⅲ~Ⅳ期14例。8例手术及腹腔热灌注化疗,14例手术及全身化疗,4例仅手术治疗。全部患者中位生存期为20个月,6个月、12个月、18个月及24个月的生存率分别为96.15%、80.27%、52.90%及26.45%。单因素分析显示,年龄（P〈0.001）、组织分型（P〈0.001）、TMN分期（P=0.016）及治疗方法（P=0.019）是预后的影响因素,而性别、大体分型与预后关系不大,多因素分析显示,组织分型（P=0.002）及TMN分期（P=0.021）是独立的预后影响因素。结论病理分型为上皮型,TMN分期为Ⅰ~Ⅱ期时预后较好,早期诊断及综合治疗对提高恶性腹膜间皮瘤患者的生存率有重要意义。

Objective To analyze the clinical characteristics and potential prognostic factors of patients with malignant peritoneal mesothelioma （MPM）. Methods Clinical data about 26 MPM patients who admitted to Chinese PLA General Hospital from 2005 to 2013 were retrospectively analyzed. Results The mean age of 26 patients was 57 years old. Of the 26 cases, 3 male patients had a history of asbestos exposure. The main clinical symptoms of the patients were abdominal distension, abdominal pain, ascites and peritoneal cavity mass. Peritoneum or omentum thickening and spaceoccupying mass were the main signs on CT scans. There were 20 epithelioid patterns and 6 sarcomatoid/mixed patterns in MPM. There were 12 patients in Stage Ⅰ - Ⅱ and 14 patients in Stage Ⅲ- Ⅳ. Surgery plus hyperthermic intraperitoneal chemotherapy （HIPEC） were performed in 8 patients, surgery plus chemotherapy in 14 patients, and single surgery in 4 patients. The median survival time was 20 months, with a 6-, 12-, 18-, and 24-month survival rate of 96.15%, 80.27%, 52.90% and 26.46%, respectively. Significant prognostic factors were age （P 〈 0.001）, histologic subtype （P 〈 0.001）, TMN staging （P=0.016） and treatment strategy （P=0.019）, while gender and general classification were uncorrelated with prognosis by univariate analysis, only histologic subtype （P=0.002） and TMN staging （P=0.021） showed statistical significance by multivariate analysis. Conclusion Patients with epithelioid patterns and TMN staging in stage Ⅰ - Ⅱ have positive prognosis, so early diagnosis and comprehensive treatment can improve the survival rate in PMP patients.