Delourme J, Dhalluin X, Cortot A B, Lafitte J-J, Scherpereel A
Service de pneumologie et d'oncologie thoracique, hôpital Calmette, CHRU de Lille, boulevard Professeur-Jules-Leclercq, 59037 Lille cedex, France.
Rev Pneumol Clin. 2013 Feb;69(1):26-35. doi: 10.1016/j.pneumo.2012.12.003. Epub 2013 Jan 14.
Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor issued from the mesothelial surface of the pleural space. A previous exposure to asbestos is the main risk factor of mesothelioma. Clinical signs are most of the time late and unspecific. Chest CT-scan, a key imaging procedure, usually shows a (unilateral) pleurisy associated with pleural nodular thickening. PET-scan associated with CT-scan may help to differenciate MPM from pleural benign tumors but it is not recommended for the diagnosis of MPM, as well as chest resonance magnetic imaging and blood or pleural fluid biomarkers, including soluble mesothelin still under investigation. The diagnosis of MPM is based on histology using essentially immunohistochemistry on pleural biopsies best obtained by thoracoscopy. The treatment of MPM relies mostly on chemotherapy. Surgery, pleurectomy/decortication or extrapleural pneumonectomy, is not recommended outside a clinical trial, as well as adjuvant chest radiotherapy. Prophylactic irradiation of chest scars and drains, validated by the French guidelines in 2005, is however highly discussed at the international level. Finally, numerous research studies presently assess the value of targeted therapies and biomarkers in MPM, opening new perspectives in the management of this cancer.
恶性胸膜间皮瘤（MPM）是一种起源于胸膜腔间皮表面的罕见且侵袭性强的肿瘤。既往接触石棉是间皮瘤的主要危险因素。临床症状大多出现较晚且不具有特异性。胸部CT扫描作为关键的影像学检查，通常显示为（单侧）胸膜炎伴胸膜结节状增厚。PET扫描联合CT扫描可能有助于鉴别MPM与胸膜良性肿瘤，但不推荐用于MPM的诊断，胸部磁共振成像以及血液或胸腔积液生物标志物（包括仍在研究中的可溶性间皮素）也不推荐用于MPM诊断。MPM的诊断主要基于组织学检查，本质上是对通过胸腔镜获取的胸膜活检组织进行免疫组化。MPM的治疗主要依赖化疗。在临床试验之外，不推荐进行手术，如胸膜剥脱术/去皮质术或胸膜外全肺切除术，辅助性胸部放疗也不推荐。然而，2005年法国指南认可的胸部瘢痕和引流管预防性放疗在国际上备受争议。最后，目前众多研究正在评估靶向治疗和生物标志物在MPM中的价值，为这种癌症的治疗开辟了新的前景。
