Boutin C, Rey F, Gouvernet J
Hôpital de la Conception, Marseille.
Bull Acad Natl Med. 1992 Jan;176(1):105-14; discussion 115-7.
A continuous series of 125 patients hospitalized between 1973 and 1987 with pleural malignant mesothelioma were the subjects of this stepwise analysis. A diagnostic thoracoscopy was carried out in every patient and the histopathological diagnosis confirmed by the French Mesothelioma Panel of Pathologists. The main characteristics of the patients were: mean age 64 +/- 1 year, 104 male, 21 female; previous asbestos exposure was present in 98. The histopathological type was epithelial in 90, mixed in 22, fibrosarcomatous in 13. The endoscopic aspect was analysed in the same manner from the beginning as follows: involvement of the parietal, diaphragmatic or visceral pleura; extension of the tumor into the pleural cavity, macroscopic aspects of the lesions. According to the Butchart's classification 56 patients were at stage I, 61 at stage II, 3 at stage III, 5 at stage IV. A multivariate analysis (Cox model) showed that the best prognostic factor is the stage I which can be divided in 2 subtypes: exclusive involvement of the parietal and diaphragmatic pleura without invasion of the visceral pleura: stage IA (median survival 31.2 months). It is 6.75 months as soon as the visceral pleura is invaded (stade IB).
本逐步分析的对象是1973年至1987年间住院的125例连续性胸膜恶性间皮瘤患者。每位患者均接受了诊断性胸腔镜检查，组织病理学诊断由法国间皮瘤病理学家小组确认。患者的主要特征为：平均年龄64±1岁，男性104例，女性21例；98例有石棉接触史。组织病理学类型为上皮型90例，混合型22例，纤维肉瘤型13例。从一开始就以同样的方式分析内镜表现：壁层、膈胸膜或脏层胸膜受累情况；肿瘤向胸腔内的扩展情况，病变的宏观表现。根据布查特分类，56例患者为I期，61例为II期，3例为III期，5例为IV期。多因素分析（Cox模型）显示，最佳预后因素是I期，I期可分为2个亚型：壁层和膈胸膜单独受累，无脏层胸膜侵犯：IA期（中位生存期31.2个月）。一旦脏层胸膜受侵犯（IB期），中位生存期为6.75个月。
