Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
CA Cancer J Clin. 2019 Sep;69(5):402-429. doi: 10.3322/caac.21572. Epub 2019 Jul 8.
Mesothelioma affects mostly older individuals who have been occupationally exposed to asbestos. The global mesothelioma incidence and mortality rates are unknown, because data are not available from developing countries that continue to use large amounts of asbestos. The incidence rate of mesothelioma has decreased in Australia, the United States, and Western Europe, where the use of asbestos was banned or strictly regulated in the 1970s and 1980s, demonstrating the value of these preventive measures. However, in these same countries, the overall number of deaths from mesothelioma has not decreased as the size of the population and the percentage of old people have increased. Moreover, hotspots of mesothelioma may occur when carcinogenic fibers that are present in the environment are disturbed as rural areas are being developed. Novel immunohistochemical and molecular markers have improved the accuracy of diagnosis; however, about 14% (high-resource countries) to 50% (developing countries) of mesothelioma diagnoses are incorrect, resulting in inadequate treatment and complicating epidemiological studies. The discovery that germline BRCA1-asssociated protein 1 (BAP1) mutations cause mesothelioma and other cancers (BAP1 cancer syndrome) elucidated some of the key pathogenic mechanisms, and treatments targeting these molecular mechanisms and/or modulating the immune response are being tested. The role of surgery in pleural mesothelioma is controversial as it is difficult to predict who will benefit from aggressive management, even when local therapies are added to existing or novel systemic treatments. Treatment outcomes are improving, however, for peritoneal mesothelioma. Multidisciplinary international collaboration will be necessary to improve prevention, early detection, and treatment.
间皮瘤主要影响曾接触石棉的老年人群。由于发展中国家继续大量使用石棉，因此缺乏数据，因此全球间皮瘤发病率和死亡率尚不清楚。澳大利亚、美国和西欧的间皮瘤发病率已下降，这些国家在 20 世纪 70 年代和 80 年代禁止或严格监管石棉的使用，这证明了这些预防措施的价值。但是，在这些国家，由于人口增加和老年人比例增加，间皮瘤的总死亡人数并未减少。此外，随着农村地区的发展，环境中存在的致癌纤维被干扰时，可能会出现间皮瘤的热点。新型免疫组织化学和分子标志物提高了诊断的准确性；但是，约有 14%（高资源国家）至 50%（发展中国家）的间皮瘤诊断不正确，导致治疗不足并使流行病学研究复杂化。发现种系 BRCA1 相关蛋白 1（BAP1）突变会导致间皮瘤和其他癌症（BAP1 癌症综合征），阐明了一些关键的发病机制，目前正在测试针对这些分子机制和/或调节免疫反应的治疗方法。尽管当将局部疗法与现有或新型全身治疗相结合时，手术在胸膜间皮瘤中的作用存在争议，但很难预测谁将从积极的管理中受益。然而，对于腹膜间皮瘤，治疗结果正在改善。需要多学科的国际合作来改善预防，早期发现和治疗。
