Cardiothoracic and Vascular Sciences Department, Thoracic Surgery Division, University of Padua, Padua, Italy.
Eur J Cardiothorac Surg. 2010 Jun;37(6):1464-9. doi: 10.1016/j.ejcts.2010.01.008. Epub 2010 Feb 12.
The effect of induction chemotherapy (IC) on lung function and exercise capacity in patients with malignant pleural mesothelioma (MPM) has not been largely examined. The aim of this study was to evaluate the changes in pulmonary function and oxygen consumption following IC in patients with MPM.
Between 2004 and 2009, 36 consecutive patients (mean age 62.1 + or - 1.5 years, M/F = 25/11) were prospectively investigated. Data concerning medical history, histology, staging and response to chemotherapy were collected. All patients underwent pulmonary function test before (in the absence of pleural effusion) and after chemotherapy (platinum-based agent plus pemetrexed); 23 out of 36 patients also performed a cardiopulmonary incremental exercise test.
An epithelioid histotype was documented in 88.8% of patients. A partial response to chemotherapy was observed in 44.5% of cases and 36.1% of patients experienced grade 2-3 toxicity. A significant improvement in forced expiratory volume in 1s (FEV(1)) (0.13 + or - 0.30 l; P = 0.01), in VO(2) peak (1.76 + or - 2.91 ml kg(-1) min(-1); P = 0.005), in PaO(2) at rest (4.76 + or - 9.84 mmHg; P = 0.03) and in PaO(2) at peak exercise (6.26 + or - 12.72 mmHg; P = 0.04) was detected. The diffusion capacity of the lung for carbon monoxide (DLCO) also increased (1.25 + or - 4.68 ml min(-1) mmHg(-1)), although not significantly (P = 0.20). The stratified analysis based on the response to IC showed a significant improvement in FEV(1), forced vital capacity (FVC) and vital capacity (VC) (both absolute and percentage of predicted values) only in patients with a partial response.
An improvement in lung function and exercise capacity was seen after IC in patients with MPM. These data suggest that IC does not compromise cardiopulmonary performance in this subset of patients.
诱导化疗（IC）对恶性胸膜间皮瘤（MPM）患者的肺功能和运动能力的影响尚未得到广泛研究。本研究旨在评估 MPM 患者接受 IC 后肺功能和耗氧量的变化。
2004 年至 2009 年，连续前瞻性纳入 36 例患者（平均年龄 62.1±1.5 岁，M/F=25/11）。收集病史、组织学、分期和化疗反应数据。所有患者均在化疗前（无胸腔积液时）和化疗后（铂类药物加培美曲塞）进行肺功能检查；36 例患者中有 23 例还进行了心肺递增运动试验。
88.8%的患者组织学类型为上皮样。44.5%的患者观察到部分缓解，36.1%的患者出现 2-3 级毒性。用力呼气量（FEV1）（0.13±0.30 l；P=0.01）、峰值摄氧量（VO2peak）（1.76±2.91 ml kg-1 min-1；P=0.005）、静息时 PaO2（4.76±9.84 mmHg；P=0.03）和峰值运动时 PaO2（6.26±12.72 mmHg；P=0.04）显著改善。肺一氧化碳弥散量（DLCO）也有所增加（1.25±4.68 ml min-1 mmHg-1），但无统计学意义（P=0.20）。基于 IC 反应的分层分析显示，仅在部分缓解的患者中，FEV1、用力肺活量（FVC）和肺活量（VC）（绝对值和预测值百分比）均显著改善。
MPM 患者接受 IC 后肺功能和运动能力得到改善。这些数据表明，在这组患者中，IC 不会损害心肺功能。
