Opitz Isabelle, Scherpereel Arnaud, Berghmans Thierry, Psallidas Ioannis, Glatzer Markus, Rigau David, Astoul Philippe, Bölükbas Servet, Boyd Jeanette, Coolen Johan, De Bondt Charlotte, De Ruysscher Dirk, Durieux Valerie, Faivre-Finn Corinne, Fennell Dean A, Galateau-Salle Francoise, Greillier Laurent, Hoda Mir Ali, Klepetko Walter, Lacourt Aude, McElnay Phil, Maskell Nick A, Mutti Luciano, Pairon Jean-Claude, Van Schil Paul, van Meerbeeck Jan P, Waller David, Weder Walter, Putora Paul Martin, Cardillo Giuseppe
Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Pulmonary and Thoracic Oncology, French National Network of Clinical Expert Centers for Malignant Pleural Mesothelioma Management (Mesoclin), Lille, France.
Eur J Cardiothorac Surg. 2020 Jul 1;58(1):1-24. doi: 10.1093/ejcts/ezaa158.
The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
欧洲呼吸学会（ERS）/欧洲胸外科医师学会（ESTS）/欧洲心胸外科学会（EACTS）/欧洲放射治疗与肿瘤学会（ESTRO）特别工作组召集专家，在对2009 - 2018年文献进行系统回顾后，更新了2009年ERS/ESTS关于恶性胸膜间皮瘤（MPM）管理的指南。MPM是一种罕见癌症，全球预后较差。采用推荐分级、评估、制定与评价方法对证据进行评估。该多学科专家小组讨论了证据综合情况并制定了建议。诊断：胸膜活检仍是确诊的金标准，通常通过胸腔镜获取，但在胸膜粘连或身体状况较差的情况下，偶尔也可通过影像引导下经皮穿刺针吸活检获取。病理学：约10%的病例中标准染色程序不足，因此有理由使用特定标志物，包括BAP - 1和CDKN2A（p16），以区分非典型间皮细胞增生与MPM。分期：由于缺乏统一、可靠且经过验证的分期系统，我们建议使用最新的2016年第8版TNM（肿瘤、淋巴结、转移）分类，并采用一种用于治疗前评估的算法。监测：患者的身体状况、组织学亚型和肿瘤体积是MPM常规管理中具有临床重要性的主要预后因素。其他潜在参数应在基线时记录，并在临床试验中报告。治疗：（化疗）对MPM患者疗效有限，只有部分患者适合进行根治性手术。已对新的有前景的靶向治疗、免疫治疗和策略进行了综述。由于关于最佳联合治疗的数据有限，我们强调，被认为适合采用多模式方法（包括根治性手术）的患者，应在MPM专科中心作为临床试验的一部分进行治疗。
