Ribak J, Lilis R, Suzuki Y, Penner L, Selikoff I J
Department of Community Medicine, Mount Sinai School of Medicine of the City University of New York, NY 10029.
Br J Ind Med. 1988 Mar;45(3):182-7. doi: 10.1136/oem.45.3.182.
Malignant mesothelioma has been rare in the general population. In recent decades its incidence has risen dramatically, parallel to the increasing use of asbestos in industry since 1930. Altogether 17,800 asbestos insulation workers, members of the International Association of Heat and Frost Insulators and Asbestos Workers (AFL-CIO-CLC) in the United States and Canada, were enrolled for prospective study on 1 January 1967 and followed up to the present. Every death that occurs is investigated by our laboratory. One hundred and seventy five deaths from mesothelioma occurred among the 2221 men who died in 1967-76 and 181 more such deaths in the next eight years. Altogether, 356 workers had died of malignant mesothelioma (pleural or peritoneal) by 1984. Diagnosis of mesothelioma was accepted only after all available clinical, radiological, and pathological material was reviewed by our laboratory and histopathological confirmation by the pathology unit made in each case. One hundred and thirty four workers died of pleural and 222 of peritoneal mesothelioma. Age at onset of exposure, age at onset of the disease, and age at death were similar in both groups of patients. Significant difference was noted only in the time elapsed from onset of exposure to the development of first symptoms, which was longer in the group with peritoneal mesothelioma. Shortness of breath, either new or recently increased, and chest pain were the most frequent presenting symptoms in the group with pleural mesothelioma; abdominal pain and distension were frequent in the patients with peritoneal mesothelioma. Pleural effusion or ascites were found in most patients. The most effective approach to the diagnosis of malignant pleural mesothelioma in these cases was by open lung biopsy; exploratory laparotomy was best for diagnosing peritoneal mesothelioma. Patients with pleural mesothelioma died principally from pulmonary insufficiency whereas those with peritoneal mesothelioma succumbed after a period of pronounced wasting.
恶性间皮瘤在普通人群中一直较为罕见。近几十年来，其发病率急剧上升，这与自1930年以来工业中石棉使用量的增加平行。1967年1月1日，美国和加拿大国际热与霜绝缘材料及石棉工人协会（劳联产联-加拿大劳工大会）的17800名石棉绝缘工人被纳入前瞻性研究，并随访至今。我们实验室对每一例死亡病例进行调查。在1967 - 1976年死亡的2221名男性中，有175人死于间皮瘤，在接下来的八年中又有181人死于间皮瘤。到1984年，共有356名工人死于恶性间皮瘤（胸膜或腹膜）。只有在我们实验室对所有可用的临床、放射学和病理学资料进行审查，并由病理科对每例病例进行组织病理学确认后，间皮瘤的诊断才被接受。134名工人死于胸膜间皮瘤，222名死于腹膜间皮瘤。两组患者的接触起始年龄、疾病起始年龄和死亡年龄相似。仅在从接触开始到出现首发症状的时间间隔上存在显著差异，腹膜间皮瘤组的时间间隔更长。胸膜间皮瘤组最常见的首发症状是新发或近期加重的气短和胸痛；腹膜间皮瘤患者中腹痛和腹胀较为常见。大多数患者出现胸腔积液或腹水。在这些病例中，诊断恶性胸膜间皮瘤最有效的方法是开胸肺活检；诊断腹膜间皮瘤最好的方法是剖腹探查术。胸膜间皮瘤患者主要死于肺功能不全，而腹膜间皮瘤患者在经历一段时间的明显消瘦后死亡。
