Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Int J Clin Oncol. 2021 Jan;26(1):95-103. doi: 10.1007/s10147-020-01780-0. Epub 2020 Sep 10.
We occasionally encounter malignant pleural mesothelioma (MPM) of no apparent tumor or pleural thickening that is radiological early MPM. This study aimed to examine the clinicopathological outcomes of radiological early MPM.
Patients with MPM treated with neoadjuvant chemotherapy and planned surgery at the time of diagnosis between July 2004 and December 2019 were retrospectively examined. Pretreatment maximal pleural thickness of all patients was measured on chest computed tomography. We extracted and investigated the patients who exhibited a lack of pleural thickening or visible tumor, which was defined as radiological early MPM. Survival was analyzed by the Kaplan-Meier method.
Of 296treated patients, 16 (5.4%) exhibited radiological early MPM. Fourteen (87.5%) of these patients underwent pleurectomy/decortication and 2 (12.5%) underwent extrapleural pneumonectomy. Pathological stage T1 disease was diagnosed in 14 (87.5%) patients; 2 (12.5%) exhibited pulmonary parenchymal invasion (pathological stage T2). Lymphatic invasion was detected in only 1 patient. Lymph node metastases and vascular invasion were not detected. Median follow-up was 42 months. Median progression-free survival and median overall survival were 40.7 and 56.1 months, respectively. The 3-year progression-free survival and overall survival rates were 84.8% and 83.6%, respectively.
Radiological early MPM occurs in approximately 1 of every 20 patients treated with neoadjuvant chemotherapy and surgery planned at the time of diagnosis in an experienced center. Radiological early MPM was associated with early pathological stage and long-term survival.
我们偶尔会遇到无明显肿瘤或胸膜增厚的恶性胸膜间皮瘤（MPM），即影像学早期 MPM。本研究旨在探讨影像学早期 MPM 的临床病理结局。
回顾性分析 2004 年 7 月至 2019 年 12 月期间因接受新辅助化疗和计划手术而确诊为 MPM 的患者。所有患者的胸部 CT 均测量了预处理时的最大胸膜厚度。我们提取并研究了表现出无胸膜增厚或可见肿瘤的患者，这些患者被定义为影像学早期 MPM。采用 Kaplan-Meier 法分析生存情况。
在 296 例接受治疗的患者中，有 16 例（5.4%）表现为影像学早期 MPM。其中 14 例（87.5%）患者行胸膜切除术/剥脱术，2 例（12.5%）行胸膜外全肺切除术。14 例（87.5%）患者的病理分期为 T1 期疾病；2 例（12.5%）患者表现为肺实质侵犯（病理分期 T2）。仅 1 例患者有淋巴管侵犯。未发现淋巴结转移和血管侵犯。中位随访时间为 42 个月。中位无进展生存期和总生存期分别为 40.7 个月和 56.1 个月。3 年无进展生存率和总生存率分别为 84.8%和 83.6%。
在经验丰富的中心，大约每 20 例接受新辅助化疗和计划手术治疗的患者中，就会有 1 例发生影像学早期 MPM。影像学早期 MPM 与早期病理分期和长期生存相关。
