Clinical Analysis Of 47 Cases With Malignant Pleural Mesothelioma

Background and purpose: Malignant pleural mesothelioma is a rare disease with an extremely high aggressiveness.With the development of industry,especially the widespread use of asbestos, the incidence is rising year on year.With the insidious onset,difficulty of early diagnosis and lack of effective therapy in clinic,malignant pleural mesothelioma has a short survival period.This paper mainly discusses the clinical features,diagnosis,treatment and prognosis of malignant pleural mesothelioma for improving the recognization of the disease and providing the reference for the clinic.Methods:We studied retrospectively of 47 patients of the First Hospital Affiliated to Dalian Medical University between January 2012 and January 2015,including clinical features,auxiliary examinations,treatment and prognosis.All cases had obtained cytologic or pathologic diagnosis.The TNM of the tumor is based on International Mesothelioma Interest Group staging system.Results:1.For 47 patients,the male-to-female ratio was 1.2:1 and the mean age was 63 years.Only 3 patients have a history of asbestos. 29 patients(62%) had a lower scores of performance status which are less than or equal to 2. 29 patients(62%) were stage IV.2.The main clinical manifestations were chest pain,chest tightness,shortness of breath and cough.53% patients have pleural effusion.CT showed pleural effusion,pleural thickening,pleural tumor and pleural nodes.17 cases(36%) obtained pathologic diagnosis by thoracoscopy.8 cases(17%) were epithelial type,and 6 cases(13%) had sarcomoid type.33 patients(70%) did not have definite pathologic type.62% cases received immunohistochemistry test.3.10 patients undergone surgery after they were diagnosed,with median progression-free survival 18 months and median overall survival 28 months.22 patients received chemotherapy,with median progression-free survival 6 months and medianoverall survival 19 months.Disease control rate of first-line chemotherapy was 77% and82% had pemetrexed plus platinum chemotherapy.5 patients received second-line chemotherapy.2 patients took thalidomide orally and 12 cases received supportive treatment.For 47 patients,median progression-free survival was 18 months and 1-year,2-year and 3-year survivals were 63%,38%,23%.4.Among the obstinate cases,2 patients had treatment of pemetrexed,cisplatin combined with endostar.One patient had a median progression-free survival of 8months,overall survival of 71 months,and got an efficacy evaluation of partial remission after 2 cycles of chemotheropy.Another one had a median progression-free survival of11 months and was alive after the end of follow-up with a survival of 44 months.Conclusions:1.The clinical manifestations of MPM lack specificity.Cytologic or pathologic diagnosis should combine with immunohistochemistry test.2.Treatments of MPM are maily operation and chemotherapy.Neither single therapy nor combined therapy can get satisfactory effects.3.For obstinate cases,the treatment of pemetrexed,cisplatin combined with endostar showed longer progression-free survival and overall survival.And this provided new thought and method for MPM.