Predictors Of Survival In Malignant Pleural Mesothelioma Patients Undergoing Thoracoscopy And Tumor Markers

BackgroundMalignant pleural mesothelioma(MPM)is a rare invasive tumor with diverse clinical manifestations,high degree of malignancy,difficulty in early diagnosis,rapid progression,low survival rate and poor prognosis.The incidence of MPM is mostly related to asbestos exposure or related occupational environments.In recent years,the incidence of MPM has increased rapidly with the widespread use of asbestos.Patients with malignant mesothelioma usually go to the hospital for treatment of chest tightness and chest pain caused by pleural effusion.Because of atypical clinical symptoms,clinicians are often prone to missed diagnosis.MPM is still a thorny issue in medicine.With the increasing asbestos consumption in China,the incidence of malignant mesothelioma is set to increase.Therefore,we need to raise our awareness of the disease and master relevant prevention and treatment strategies.MPE often indicates advanced disease and poor prognosis.Medical thoracoscopy(MT)is an effective and safe method for diagnosing pleural effusion and has been widely used in clinical practice.However,it is still not clear whether different manifestations under thoracoscopic examination are reliable prognostic indicators for patients with malignant pleural mesothelioma.Tumor markers play an important role in the diagnosis,treatment evaluation and prognosis of pulmonary diseases,but few studies have been conducted on the prognosis of MPM patients.The purpose of this study was to explore the influence factors of thoracoscopic manifestations and pulmonary tumor markers on the prognosis of MPM patients,so as to provide reference for clinical diagnosis and treatment.MethodsWe reviewed the medical records of 856 undiagnosed patients who underwent medical thoracoscopy from June 2006 to June 2018 in Shandong Provincial Hospital.We collected the data including baseline data,clinical characteristics,pathological type,laboratory examination,Imaging Features and Thoracoscopic presentation.Patients with malignant pleural mesothelioma confirmed by thoracoscopy pleural biopsy were included in this study.We determined the survival status of each patient by telephone follow-up.If the patient's survival status was uncertain,or if they died from other causes,they were excluded.Kaplan-Meier survival analysis was used to assess the single prognostic factors of MPM patients,including gender,age,smoking status,clinical symptoms(chest tightness,chest pain),PS score,histopathological type,tumor stage,types of pleural effusion,pleural fluid cytology,Cytological examination of the pleural brush,degree of adhesion,pleural lesion grading,EPC score,serum tumor marker detection,etc.The 95%confidence intervals were calculated.Log-rank tests were used for comparison.We applied Cox regression for multi-factor survival analysis.Results63 patients were followed up by telephone totally.59 patients died of pleural mesothelioma.they were included in the analysis.1.30 of the 59 patients were male(50.8%)and 29 were female(49.2%).They were 19-79 years old,with a median age of 56 years.The minimum survival time was 0.8 months,and the 12-month and 24-month survival rates were 54.2%and 22.0%,respectively.We came to the conclusion that baseline data such as gender,age,clinical symptoms,smoking history,and PS score of MPM patients had no significant effect on overall survival(P>0.05).Tumor clinical stage(P=0.023)is a predictor of the overall survival time of MPM.2.Thoracoscopic presentation might indicate a poor prognosis for patients with MPM.The EPC score,the results of thoracoscopic pleural brushing and the nature of pleural effusion were the single factors which affected the prognosis of patients with MPM.The higher the EPC score,the more positive the cytology of pleural brushing and the bloody pleural effusion was,the worse prognosis of patients with MPM had.P values were<0.001,0.008,0.008 respectively.Pleural effusion cytology,degree of pleural adhesion and volume of pleural fluid were not factors which influenced the prognosis of MPM.3.We found that serum CA125 and CYFRA211 were the single predictors of prognosis in patients with MPM by studying of tumor markers in serum and pleural fluid.P values were 0.028 and 0.025,respectively.Serum CEA,NSE,and pleural fluid tumor markers did not affect the survival of malignant mesothelioma.4.We analyzed EPC scores,pleural effusion properties,pleural brushing cytology tests,serum CA125,serum CYFRA211,and clinical stages of tumors which was the single predictive factor for malignant mesothelioma patients by cox regression analysis.We found that EPC score(HR 2.43,95%CI 1.16�18.69,P=0.033),pleural brushing cytology(HR 3.64,95%CI 1.08 � 5.47,P=0.013),serum CA125(HR 4.65,95%CI 0.71 � 4.28,P=0.030)and tumor stage(HR 2.15,95%CI 1.11�3.59,P=0.027)were significant independent predictors for patients with malignant mesothelioma.ConclusionEPC score(P=0.033),pleural brushing cytology(P=0.013),serum CA125(P=0.030)and tumor stage(P=0.027)were independent predictors of overall survival of MPM.Medical thoracoscopy had a high positive rate in the diagnosis of MPM and it is very safe.A variety of clinical characteristics could affect the survival of MPM patients.Considering these factors,doctors could make more accurate predictions when providing personal treatment.