Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
Oncology, Ospedale SS Antonio e Biagio, Alessandria, Italy.
Br J Cancer. 2014 Jul 15;111(2):220-6. doi: 10.1038/bjc.2014.312. Epub 2014 Jun 10.
The incidence of malignant pleural mesothelioma (MPM) in elderly patients is increasing. There are no specific guidelines for their management.
The clinical records of elderly patients (⩾70 years old) with MPM referred from January 2005 to November 2011 to six Italian Centres were reviewed. Age, gender, histology, International Mesothelioma Interest Group (IMIG) stage, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Charlson Comorbidity Index (CCI) and treatment modalities were analysed and correlated to overall survival (OS).
In total, 241 patients were identified. Charlson Comorbidity Index was ⩾1 in 92 patients (38%). Treatment was multimodality therapy including surgery in 18, chemotherapy alone in 180 (75%) and best supportive care in 43 cases (18%). Chemotherapy was mainly pemetrexed based. Median OS was 11.4 months. Non-epithelioid histology (HR 2.32; 95% CI 1.66-3.23, P<0.001), age ⩾75 years (HR 1.44; 95% CI 1.08-1.93, P=0.014), advanced (III-IV) stage (HR 1.47; 95% CI 1.09-1.98, P=0.011) and CCI⩾1 (HR 1.38; 95% CI 1.02-1.85, P=0.034) were associated to a shorter OS. Treatment with pemetrexed was associated with improved OS (HR 0.40; 95% CI 0.28-0.56, P<0.001).
Non-epithelioid histology, age ⩾75 years, advanced IMIG stage and presence of comorbidities according to CCI were significant prognostic factors in elderly patients with MPM. Treatment with pemetrexed-based chemotherapy was feasible in this setting. Prospective dedicated trials in MPM elderly patients selected according to prognostic factors including comorbidity scales are warranted.
老年恶性胸膜间皮瘤（MPM）的发病率正在增加，但其治疗尚无专门的指南。
回顾了 2005 年 1 月至 2011 年 11 月期间来自意大利 6 个中心的 241 例老年（年龄≥70 岁）MPM 患者的临床资料，分析了患者的年龄、性别、组织学类型、国际间皮瘤兴趣组（IMIG）分期、东部肿瘤协作组体能状态（ECOG-PS）评分、Charlson 合并症指数（CCI）和治疗方式，并与总生存（OS）相关联。
共纳入 241 例患者，92 例（38%）患者的 Charlson 合并症指数（CCI）≥1。治疗方式为多模式治疗，包括 18 例手术、180 例化疗（75%）和 43 例最佳支持治疗。化疗主要采用培美曲塞为基础。中位 OS 为 11.4 个月。非上皮样组织学（HR 2.32；95%CI 1.66-3.23，P<0.001）、年龄≥75 岁（HR 1.44；95%CI 1.08-1.93，P=0.014）、晚期（III-IV 期）（HR 1.47；95%CI 1.09-1.98，P=0.011）和 CCI≥1（HR 1.38；95%CI 1.02-1.85，P=0.034）与较短的 OS 相关。培美曲塞治疗与 OS 改善相关（HR 0.40；95%CI 0.28-0.56，P<0.001）。
非上皮样组织学、年龄≥75 岁、IMIG 晚期和 CCI 存在合并症是老年 MPM 患者的显著预后因素。在此人群中，培美曲塞为基础的化疗是可行的。需要针对根据预后因素（包括合并症量表）选择的老年 MPM 患者进行前瞻性专门试验。
