Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100, Pavia, Italy.
Department of Intensive Medicine, Unit of Radiology, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy.
BMC Cancer. 2021 Jul 1;21(1):762. doi: 10.1186/s12885-021-08532-x.
Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy that most commonly affects the pleural layers. MPM has a strong association with asbestos, mainly caused by exposure to its biopersistent fibers in at least 80% of cases. Individuals with a chronic exposure to asbestos might develop disease with a 20-40-year latency with few or no symptoms. Such has been the case in the Italian regions of Piedmont and Lombardy, where industrial production of materials laden with asbestos, mainly cements, has been responsible for the onset of a large epidemic. Since 2018, a multidisciplinary team at San Matteo hospital in Pavia has been collecting data on over 100 patients with MPM. The main goal of this project is to define and describe an integrated profile for each MPM case at diagnosis by using data mining and partition analysis.
Here we bring together exhaustive epidemiologic, histologic and radiologic data of 88 MPM patients that came to our observation and draw correlations with predictive and prognostic significance.
The median overall survival (OS) was 15.6 months. Most patients presented with pleural effusion, irrespective of disease stage. Quite unexpectedly, no statistically significant association was demonstrated between OS and TNM disease stage at diagnosis. Although average OS is similar in male and female patients, partition analysis of data underlined a significant differential hierarchy of predictor categories based on patient gender. In females with no smoking history, full chemotherapeutic regimens are associated with better outcomes. Moreover, concerning second line treatments, vinorelbine emerged as the most advantageous choice for female patients, whereas in the male subgroup no statistically significant difference resulted between gemcitabine and vinorelbine.
A multidisciplinary approach to MPM is mandatory to define better therapeutic approaches, personalize the management and improve patient outcomes.
恶性胸膜间皮瘤（MPM）是一种罕见且侵袭性的恶性肿瘤，最常累及胸膜层。MPM 与石棉有很强的关联性，主要是由于在至少 80%的病例中暴露于其生物持久性纤维。个体如果长期接触石棉，可能会在 20-40 年内发病，且症状很少或没有。意大利皮埃蒙特和伦巴第地区就是如此，这些地区的工业生产的富含石棉的材料，主要是水泥，导致了大规模的流行。自 2018 年以来，帕维亚圣马泰奥医院的一个多学科团队一直在收集超过 100 名 MPM 患者的数据。该项目的主要目标是通过数据挖掘和分区分析，为每个 MPM 病例在诊断时定义和描述一个综合的特征。
我们在这里汇集了 88 名 MPM 患者的详尽流行病学、组织学和影像学数据，并从中得出与预测和预后意义相关的结论。
中位总生存期（OS）为 15.6 个月。大多数患者出现胸腔积液，无论疾病分期如何。令人意外的是，在诊断时，OS 与 TNM 疾病分期之间没有显示出统计学上的显著相关性。尽管男性和女性患者的平均 OS 相似，但数据的分区分析强调了基于患者性别预测因素类别的显著差异层次。在没有吸烟史的女性中，完整的化疗方案与更好的结局相关。此外，关于二线治疗，长春瑞滨对于女性患者是更有利的选择，而在男性亚组中，吉西他滨和长春瑞滨之间没有统计学上的显著差异。
对 MPM 采取多学科方法是必须的，以确定更好的治疗方法，实现个体化管理，并改善患者的结局。
