Epidemiology Unit, Department of Occupational Medicine, ISPESL (Italian National Institute for Occupational Safety and Prevention), Via Alessandria 220/E, 00198 Rome, Italy.
Occup Environ Med. 2010 Nov;67(11):760-5. doi: 10.1136/oem.2009.051466. Epub 2010 Aug 25.
The epidemiology of extrapleural malignant mesothelioma is rarely discussed and the risk of misdiagnosis and the very low incidence complicate the picture. This study presents data on extrapleural malignant mesothelioma from the Italian National Mesothelioma Register (ReNaM).
ReNaM works on a regional basis, searching for cases and interviewing subjects to investigate asbestos exposure. Classification and code criteria for certainty of diagnosis and exposure modalities are set by national guidelines. Between 1993 and 2004, 681 cases were collected. Incidence measures and exposure data refer to the ReNaM database. Age-standardised rates were estimated by the direct method using the Italian resident population in 2001. Correlations between the incidence of pleural and non-pleural malignant mesothelioma for the 103 Italian provinces were analysed.
Standardised incidence rates (Italy, 2004, per million inhabitants) were 2.1 and 1.2 cases for the peritoneal site (in men and women, respectively), 0.2 cases for the tunica vaginalis testis, and 0.1 in the pericardial site, varying widely in different parts of the country. Mean age at diagnosis for all extrapleural malignant mesothelioma cases was 64.4 years and the men/women ratio was 1.57:1. Median latency was over 40 years for all extrapleural sites combined. The correlation between pleural and peritoneal mesothelioma was 0.71 (Pearson's r coefficient, p<0.001). Modalities of exposure to asbestos fibres were investigated for 392 cases.
The rarity of the disease, the low specificity of diagnosis and difficulties in identifying the modalities of asbestos exposure call for caution in discussing aetiological factors other than asbestos.
胸膜外恶性间皮瘤的流行病学很少被讨论，误诊的风险和极低的发病率使情况更加复杂。本研究介绍了意大利国家间皮瘤登记处（ReNaM）胸膜外恶性间皮瘤的数据。
ReNaM 按地区运作，寻找病例并对患者进行访谈，以调查石棉暴露情况。诊断确定性和暴露方式的分类和编码标准由国家指南设定。在 1993 年至 2004 年间，共收集了 681 例病例。发病率衡量标准和暴露数据指的是 ReNaM 数据库。使用 2001 年意大利居民人口，采用直接法估计年龄标准化率。分析了意大利 103 个省份胸膜和非胸膜恶性间皮瘤发病率之间的相关性。
标准化发病率（意大利，2004 年，每百万居民）分别为腹膜部位（男性和女性分别为）2.1 和 1.2 例，睾丸鞘膜 0.2 例，心包 0.1 例，在该国不同地区差异很大。所有胸膜外恶性间皮瘤病例的平均诊断年龄为 64.4 岁，男女比例为 1.57:1。所有胸膜外部位的中位潜伏期均超过 40 年。胸膜和腹膜间皮瘤之间的相关性为 0.71（皮尔逊 r 系数，p<0.001）。对 392 例病例进行了石棉纤维暴露方式的调查。
该疾病的罕见性、诊断的低特异性和识别石棉暴露方式的困难，要求在讨论除石棉以外的病因因素时保持谨慎。
