Lucian R. Chirieac, Justine A. Barletta, William G. Richards, Tamara Tilleman, Raphael Bueno, Elizabeth H. Baldini, John Godleski, and David J. Sugarbaker, Brigham and Women's Hospital; Beow Y. Yeap, Massachusetts General Hospital; and William G. Richards, Tamara Tilleman, Raphael Bueno, Elizabeth H. Baldini, and David J. Sugarbaker, Harvard Medical School, Boston, MA.
J Clin Oncol. 2013 Dec 20;31(36):4544-9. doi: 10.1200/JCO.2013.49.9616. Epub 2013 Nov 18.
Studies have reported an association between pleural diffuse malignant mesothelioma (PDMM) and chest radiation for lymphoma. The clinicopathologic characteristics of malignant mesotheliomas arising in these patients have not been established.
We studied 1,618 consecutive patients diagnosed with pleural PDMM from July 1993 to February 2008 and identified patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma. We evaluated the histology in the surgical resection specimens and compared clinicopathologic features with overall survival.
We identified 22 patients who developed PDMM after chest radiation as part of their treatment for lymphoma (mean latency time, 21.4 years; 95% CI, 17.0 to 25.8 years). Asbestos bodies in lymphoma-associated PDMM were lower than in asbestos-associated PDMM (median count, 15 v 325 bodies, respectively; P < .001) and similar to an unexposed control group (median count, 15 v 10 bodies, respectively; P = .6). Seventeen lymphoma-associated PDMMs (77%) were epithelioid and five (23%) were biphasic. Seven PDMMs (32%) had unusual histologies (pleomorphic, myxoid, clear cell, and signet ring cell). Patients with lymphoma-associated PDMM were younger than patients with asbestos-associated PDMM (median age, 45 v 64 years, respectively; P < .001) and had a significantly longer overall survival time (median, 32.5 v 12.7 months, respectively; P = .018). In multivariate analysis, independent favorable predictors for overall survival were history of prior radiation (P = .022), female sex (P < .001), age ≤ 65 years (P = .005), cytoreductive surgery (P < .001), and epithelioid histology (P < .001).
Patients with lymphoma-associated PDMM are likely to have unusual histologic features, are significantly younger, and seem to have a longer overall survival compared with patients with asbestos-associated PDMM.
已有研究报道胸膜弥漫性恶性间皮瘤（PDMM）与淋巴瘤胸部放疗之间存在关联。然而，这些患者中发生的恶性间皮瘤的临床病理特征尚未确定。
我们研究了 1993 年 7 月至 2008 年 2 月期间连续诊断为胸膜 PDMM 的 1618 例患者，并确定了有霍奇金和非霍奇金淋巴瘤放射治疗史的患者。我们评估了手术切除标本中的组织学，并将临床病理特征与总生存进行了比较。
我们发现 22 例患者在接受淋巴瘤放射治疗后出现 PDMM（平均潜伏期 21.4 年；95%CI，17.0 至 25.8 年）。与石棉相关的 PDMM 中的石棉体数量低于淋巴瘤相关 PDMM（中位数分别为 15 个和 325 个；P <.001），与未暴露的对照组相似（中位数分别为 15 个和 10 个；P =.6）。17 例淋巴瘤相关 PDMM（77%）为上皮样，5 例（23%）为双相型。7 例 PDMM（32%）具有不常见的组织学特征（多形性、黏液样、透明细胞和印戒细胞）。与石棉相关的 PDMM 患者相比，淋巴瘤相关 PDMM 患者更年轻（中位数年龄分别为 45 岁和 64 岁；P <.001），总生存时间明显更长（中位数分别为 32.5 个月和 12.7 个月；P =.018）。在多变量分析中，总生存的独立有利预测因素包括既往放疗史（P =.022）、女性（P <.001）、年龄≤65 岁（P =.005）、细胞减灭性手术（P <.001）和上皮样组织学（P <.001）。
与石棉相关的 PDMM 患者相比，淋巴瘤相关 PDMM 患者可能具有不常见的组织学特征，更年轻，总生存时间似乎更长。
