Astoul P
Department of Pulmonology, Hôpital de La Conception, Marseille, France.
Curr Opin Pulm Med. 1999 Jul;5(4):259-68. doi: 10.1097/00063198-199907000-00015.
The increasing incidence of malignant pleural mesothelioma (MPM), better knowledge of its pathogenesis with a strong implication of asbestos fibers, and some promising therapeutic results have led to a new interest in the management of patients with this disease. The diagnosis of MPM is easier because of new immunohistochemical markers that recognize the mesothelial cells with good specificity and sensitivity on pleural biopsy samples ideally obtained by thoracoscopy. Moreover, this endoscopic procedure allows the physician to make the diagnosis of MPM at an early stage, which is the key of the therapeutic management of this disease. If radiotherapy is necessary in preventing the malignant seeding after pleural procedures in patients, the lack of comparative studies did not show the superiority of a given treatment against another. A new international staging of the disease, however, allows physicians to discriminate several groups of patients for such comparative studies--in particular, for testing the efficacy of intrapleural therapy, e.g., cytokines--for early-stage MPM and multimodal management, i.e., extrapleural pneumonectomy, radiotherapy, and chemotherapy for more advanced diseases, has led to prolonged survival in carefully selected patients. To reach this target, all patients must be enrolled in protocols. The usual pessimism for the management of patients with malignant pleural mesothelioma is over.
恶性胸膜间皮瘤（MPM）发病率不断上升，人们对其发病机制有了更深入的了解，且强烈认为石棉纤维与之相关，同时一些治疗结果令人鼓舞，这些因素使得人们对这种疾病患者的管理产生了新的兴趣。由于新的免疫组织化学标志物能够在理想情况下通过胸腔镜获取的胸膜活检样本中以良好的特异性和敏感性识别间皮细胞，MPM的诊断变得更加容易。此外，这种内镜检查程序使医生能够在早期诊断出MPM，这是该疾病治疗管理的关键。如果放疗对于预防患者胸膜手术后的恶性播散是必要的，那么缺乏对比研究并未显示出某种治疗相对于另一种治疗的优越性。然而，该疾病的一种新的国际分期使医生能够区分几组患者进行此类对比研究——特别是用于测试胸膜内治疗（如细胞因子）对早期MPM的疗效，以及多模式管理（即对更晚期疾病进行胸膜外全肺切除术、放疗和化疗），这已使经过精心挑选的患者生存期延长。为实现这一目标，所有患者都必须纳入方案。以往对恶性胸膜间皮瘤患者管理的悲观态度已经过去。
