Huncharek Michael
Department of Clinical Oncology, Marshfield Clinic, WI 54481, USA.
Tumori. 2002 Jan-Feb;88(1):1-9.
The association between asbestos exposure and the development of malignant mesothelioma is well known. Nonetheless, a proportion of patients suffering from this disease do not appear to have documented exposure to asbestos fibers from any known source. Available information suggests that a true "background" incidence of this disease exits raising the possibility that other factors contribute to its etiology. This paper will review existing data related to non-asbestos related mesothelioma and suggest avenues for further research.
A comprehensive electronic MEDLARS search of the literature pertinent to non-asbestos related malignant mesothelioma was performed including the years 1996-2001. Hand searches were also carried out to supplement electronically derived information and literature pre-dating 1996. The resulting references were stratified into the following categories and reviewed; (1) radiation associated mesothelioma, (2) familial mesothelioma, (3) dietary factors, (4) childhood mesothelioma and (5) the role or SV40.
Available information suggests that genetic factors may play a larger role in the etiology of this disease than currently appreciated. The interplay of genes and environment require further elucidation in the pathogenesis of mesothelioma. The role of diet is poorly understood with few studies directly addressing this issue. Whether other environmental or infectious agents are involved in mesothelioma development remains speculative.
The biology of mesothelioma is an enigma. Although this disease appears to occur in the absence of asbestos exposure, the genetic and biological differences between asbestos related and non-asbestos related tumors is unclear. Additional epidemiological and laboratory studies are needed to provide a better understanding of the relationship between environmental and non-environmental causes of mesothelioma.
石棉暴露与恶性间皮瘤发生之间的关联已为人熟知。然而，一部分罹患此病的患者似乎并无接触任何已知来源石棉纤维的记录。现有信息表明，该病存在真实的“背景”发病率，这增加了其他因素对其病因有影响的可能性。本文将回顾与非石棉相关间皮瘤有关的现有数据，并提出进一步研究的方向。
对1996年至2001年期间与非石棉相关恶性间皮瘤相关的文献进行了全面的医学文献分析和检索系统（MEDLARS）电子检索。还进行了手工检索，以补充电子检索所得信息及1996年以前的文献。所得参考文献被分为以下几类并进行综述：（1）辐射相关间皮瘤，（2）家族性间皮瘤，（3）饮食因素，（4）儿童间皮瘤，以及（5）猴空泡病毒40（SV40）的作用。
现有信息表明，遗传因素在该病病因中可能比目前所认识到的发挥更大作用。基因与环境的相互作用在间皮瘤发病机制中需要进一步阐明。饮食的作用了解甚少，很少有研究直接探讨这一问题。其他环境或传染因子是否参与间皮瘤的发生仍属推测。
间皮瘤的生物学特性是一个谜。尽管该病似乎在无石棉暴露的情况下发生，但石棉相关和非石棉相关肿瘤之间的遗传和生物学差异尚不清楚。需要更多的流行病学和实验室研究，以更好地理解间皮瘤的环境和非环境病因之间的关系。
