Aelony Yossef, Yao Janis F, King Randel R
Department of Internal Medicine, Kaiser Permanente Medical Center, Harbor City, Calif. 90275, USA.
Respiration. 2006;73(3):334-9. doi: 10.1159/000092085.
Current staging schemes for malignant mesothelioma are inadequate. The most accurate staging may require pneumonectomy - a procedure associated with many complications. The pH of pleural fluid (ppH) predicts survival in non-mesotheliomatous malignant pleural effusions, suggesting that this noninvasive test might be useful for prognostication in malignant mesothelioma.
It was the aim of this study to determine whether baseline ppH correlates with survival in malignant epithelial pleural mesothelioma.
We reviewed survival data in patients treated with thoracoscopic talc pleurodesis whose final diagnosis was epithelial malignant pleural mesothelioma and whose chart recorded a ppH determination performed just before thoracoscopy. We monitored 26 patients until April 2002 (25 of these patients died), identifying cutoff ppH values that discriminate best for survival; Cox proportional hazards models were recursively run by increasing the ppH cutoff value by 0.02 each time.
The mean follow-up time was 19+/-14 months. Mean ppH was 7.30+/-0.09, and median ppH was 7.32. Several cutoff points correlated with a statistically significant difference in survival, but ppH 7.32 was associated with the greatest value for the area under the curve. Patients with ppH>.32 lived a median of 21.2 months (95% confidence interval 16.5-30.0 months) after diagnosis compared with patients who had ppH <or=7.32 and lived a median of 13.4 months (95% confidence interval 4.5-16.2 months; p=0.0194).
Baseline ppH correlates with survival in epithelial mesothelioma patients treated palliatively with pleurodesis by thoracoscopic talc poudrage. This noninvasive test - ppH - should be included when staging patients with malignant mesothelioma.
目前恶性间皮瘤的分期方案并不完善。最准确的分期可能需要进行肺切除术——这是一种会引发多种并发症的手术。胸腔积液的pH值（ppH）可预测非间皮瘤性恶性胸腔积液患者的生存期，这表明这项非侵入性检测可能有助于恶性间皮瘤的预后评估。
本研究旨在确定基线ppH是否与恶性上皮性胸膜间皮瘤患者的生存期相关。
我们回顾了接受胸腔镜滑石粉胸膜固定术治疗的患者的生存数据，这些患者最终诊断为上皮性恶性胸膜间皮瘤，其病历记录了胸腔镜检查前进行的ppH测定。我们对26例患者进行监测直至2002年4月（其中25例患者死亡），确定最能区分生存期的ppH临界值；每次将ppH临界值提高0.02，递归运行Cox比例风险模型。
平均随访时间为19±14个月。平均ppH为7.30±0.09，中位ppH为7.32。几个临界值与生存期的统计学显著差异相关，但ppH 7.32与曲线下面积的最大价值相关。诊断后ppH>7.32的患者中位生存期为21.2个月（95%置信区间16.5 - 30.0个月），而ppH≤7.32的患者中位生存期为13.4个月（95%置信区间4.5 - 16.2个月；p = 0.0194）。
基线ppH与通过胸腔镜滑石粉喷洒进行胸膜固定术姑息治疗的上皮性间皮瘤患者的生存期相关。在对恶性间皮瘤患者进行分期时应纳入这项非侵入性检测——ppH。
