Department of Respiratory Disease, Aalborg University Hospital, Aalborg, Denmark.
Department of Oncology, Regional Hospital West Jutland, Herning, Danmark.
Acta Oncol. 2021 Apr;60(4):521-527. doi: 10.1080/0284186X.2021.1876246. Epub 2021 Jan 27.
This study aims to investigate patient- and disease characteristics associated with survival in malignant pleural mesothelioma (MPM) patients with anti-tumor treatment or with best supportive care (BSC).
Consecutive MPM cases diagnosed in North Denmark Region from 1972 to 2015 were reevaluated and verified by two pathologists using modern immunohistochemical techniques. Danish registries and hospital records were used to gather patient-, asbestos exposure-, and disease information.
Of the 279 patients, anti-tumor treatment was administered to 184 patients (66.0%). All of those received chemotherapy alone or as part of a multimodal treatment, where pemetrexed was given to 126 (68.5%) patients. Asbestos exposure was documented in 92.5% of all patients. In the treated group, mean age was lower (66 years versus 74 years, < 0.01), rate of occupational asbestos exposure was higher (74.5 versus 54.7%, < 0.01), more patients had better performance score (98.4 versus 60%, < 0.01) and stage was lower (81 versus 63.2%, < 0.01) compared to the BSC group. Multivariate analysis showed that epithelioid subtype was the only common prognostic factor for OS in both groups. In BSC patients, good PS and female gender was associated with improved OS. Median overall survival (OS) was 17 versus 4 months ( < 0.01), and independently of the histopathological subtype, the median and 2-year survival was higher in the treated versus the BSC group ( < 0.02).
This retrospective study showed that epithelioid subtype is the only independent positive prognostic factor of survival in treated patients with MPM. For BSC patients, the epithelioid subtype, good PS, and female gender were positive prognostic factors, while age and comorbidities were not significant. This study with long-term follow-up of treated and BSC MPM patients can contribute to the clinical stratification of patients. Further validation is appropriate to verify these findings.
本研究旨在探讨接受抗肿瘤治疗与接受最佳支持治疗（BSC）的恶性胸膜间皮瘤（MPM）患者的生存与患者和疾病特征的关系。
对 1972 年至 2015 年期间在丹麦北日德兰地区诊断的连续 MPM 病例进行重新评估，并由两位病理学家使用现代免疫组织化学技术进行验证。利用丹麦登记处和医院记录收集患者、石棉暴露和疾病信息。
在 279 名患者中，有 184 名（66.0%）接受了抗肿瘤治疗。所有患者均接受了单独化疗或多模式治疗，其中 126 名（68.5%）患者接受了培美曲塞治疗。所有患者中有 92.5%的人有石棉暴露史。在治疗组中，平均年龄较低（66 岁对 74 岁， < 0.01），职业性石棉暴露率较高（74.5%对 54.7%， < 0.01），更好的表现评分（98.4%对 60%， < 0.01）和更低的分期（81 对 63.2%， < 0.01）。多变量分析显示，上皮样亚型是两组患者总生存期（OS）的唯一共同预后因素。在 BSC 患者中，良好的 PS 和女性性别与 OS 改善相关。中位总生存期（OS）为 17 个月对 4 个月（ < 0.01），并且独立于组织病理学亚型，治疗组与 BSC 组的中位和 2 年生存率均较高（ < 0.02）。
本回顾性研究表明，上皮样亚型是接受 MPM 治疗的患者生存的唯一独立正预后因素。对于 BSC 患者，上皮样亚型、良好的 PS 和女性性别是正预后因素，而年龄和合并症则不是显著因素。这项对接受治疗和 BSC 的 MPM 患者进行长期随访的研究有助于对患者进行临床分层。进一步的验证是合适的，以验证这些发现。
