Department of Respiratory and Critical Care Medicine; Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China.
BMC Pulm Med. 2018 Apr 3;18(1):56. doi: 10.1186/s12890-018-0619-3.
Malignant pleural mesothelioma (MPM) is marked by its difficult diagnosis and poor prognosis. Medical thoracoscopy (MT) is an effective and safe procedure for the diagnosis of exudative pleural effusions and many factors associated with poor prognosis of MPM. We conducted this study to investigate the value of MT for diagnosing of MPM and to identify prognostic factors for MPM patients.
From July 2005 through June 2014, a total of 833 patients with undiagnosed pleural effusions underwent MT and pleural biopsies were taken. Clinical data of all patients with MPM were retrospectively analyzed, and those with complete follow-up data were analyzed for prognostic factors.
Eventually, MPM was the final diagnosis in 40 patients. Diagnostic efficiency of MT for MPM was 87.5%, since diagnosis of MPM failed to be established in 5 patients during the initial MT. Median survival was 17.1 mo (95% confidence interval: 13.6-20.7 mo). MT findings of pleural adhesion and plaques were adverse prognostic factors for MPM. In addition, old age, male gender, smoking history, histological type, poor staging, no treatment, low total protein level in pleural fluid, and computed tomographic findings such as pulmonary consolidation or infiltration, mediastinal lymphopathy, pulmonary mass or nodules, and pleural nodularity were also poor prognostic factors for MPM.
MT is safe with a high positive rate in the diagnosis of MPM, and pleural adhesion and plaques seen under MT may be the adverse prognostic factors for MPM. Multiple clinical characteristics can affect the survival of MPM patients.
恶性胸膜间皮瘤（MPM）的诊断困难，预后不良。内科胸腔镜（MT）是诊断渗出性胸腔积液的有效且安全的方法，许多因素与 MPM 的预后不良有关。我们进行这项研究是为了探讨 MT 对 MPM 的诊断价值，并确定 MPM 患者的预后因素。
2005 年 7 月至 2014 年 6 月，共 833 例不明原因胸腔积液患者接受 MT 检查和胸膜活检。回顾性分析所有 MPM 患者的临床资料，对具有完整随访资料的患者进行预后因素分析。
最终，40 例患者被确诊为 MPM。MT 对 MPM 的诊断效率为 87.5%，因为在初始 MT 时未能确诊 5 例 MPM。中位生存期为 17.1 个月（95%置信区间：13.6-20.7 个月）。MT 发现胸膜粘连和斑块是 MPM 的不良预后因素。此外，年龄较大、男性、吸烟史、组织学类型、分期差、未治疗、胸腔积液总蛋白水平低、胸部 CT 发现肺部实变或浸润、纵隔淋巴结病、肺部肿块或结节、胸膜结节等也是 MPM 的不良预后因素。
MT 诊断 MPM 的阳性率高，安全性好，MT 下见到的胸膜粘连和斑块可能是 MPM 的不良预后因素。多种临床特征可影响 MPM 患者的生存。
