Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Kanker Instituut, Rotterdam, The Netherlands.
Pulmonary Medicine, Erasmus MC Kanker Instituut, Rotterdam, The Netherlands.
Thorax. 2022 Dec;77(12):1260-1267. doi: 10.1136/thoraxjnl-2021-217709. Epub 2022 Feb 11.
Malignant mesothelioma (MM) is an aggressive cancer that primarily arises from the pleura (MPM) or peritoneum (MPeM), mostly due to asbestos exposure. This study reviewed the Dutch population-based incidence, treatment and survival since the national ban on asbestos in 1993.
Patients with MPM or MPeM diagnosed from 1993 to 2018 were selected from the Dutch cancer registry. Annual percentage change (APC) was calculated for (age-specific and sex-specific) revised European standardised incidence rates (RESR). Treatment pattern and Kaplan-Meier overall survival analyses were performed.
In total, 12 168 patients were included in the study. For male patients younger than 80 years, the MM incidence significantly decreased in the last decade (APC ranging between -9.4% and -1.8%, p<0.01). Among both male and female patients aged over 80 years, the incidence significantly increased during the entire study period (APC 3.3% and 4.6%, respectively, p<0.01). From 2003 onwards, the use of systemic chemotherapy increased especially for MPM (from 9.3% to 39.4%). Overall, 62.2% of patients received no antitumour treatment. The most common reasons for not undergoing antitumour treatment were patient preference (42%) and performance status (25.6%). The median overall survival improved from 7.3 (1993-2003) to 8.9 (2004-2011) and 9.3 months from 2012 to 2018 (p<0.001).
The peak of MM incidence was reached around 2010 in the Netherlands, and currently the incidence is declining in most age groups. The use of systemic chemotherapy increased from 2003, which likely resulted in improved overall survival over time. The majority of patients do not receive treatment though and prognosis is still poor.
恶性间皮瘤（MM）是一种侵袭性癌症，主要起源于胸膜（MPM）或腹膜（MPeM），主要由于暴露于石棉。本研究回顾了自 1993 年国家禁止使用石棉以来，荷兰基于人群的发病率、治疗和生存情况。
从荷兰癌症登记处选择了 1993 年至 2018 年间诊断为 MPM 或 MPeM 的患者。计算了（年龄特异性和性别特异性）修订后的欧洲标准化发病率（RESR）的年百分比变化（APC）。进行了治疗模式和 Kaplan-Meier 总体生存分析。
共有 12168 名患者纳入研究。对于年龄小于 80 岁的男性患者，MM 发病率在过去十年中显著下降（APC 范围在-9.4%至-1.8%之间，p<0.01）。在 80 岁以上的男性和女性患者中，整个研究期间发病率均显著增加（APC 分别为 3.3%和 4.6%，p<0.01）。自 2003 年以来，系统化疗的应用尤其增加了 MPM（从 9.3%增加到 39.4%）。总体而言，62.2%的患者未接受抗肿瘤治疗。不接受抗肿瘤治疗的最常见原因是患者偏好（42%）和表现状态（25.6%）。总生存中位数从 1993-2003 年的 7.3 个月改善到 2004-2011 年的 8.9 个月和 2012-2018 年的 9.3 个月（p<0.001）。
荷兰 MM 的发病率峰值出现在 2010 年左右，目前大多数年龄组的发病率正在下降。自 2003 年以来，系统化疗的应用增加，这可能导致总体生存时间的改善。然而，大多数患者没有接受治疗，预后仍然较差。
