Khosla Divya, Singh Pawan Kumar, Chhabria Bharath A, Kataria Vaishali, Singh Navneet, Kapoor Rakesh
Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India.
World J Exp Med. 2024 Sep 20;14(3):91739. doi: 10.5493/wjem.v14.i3.91739.
Pleural mesothelioma is a very aggressive malignancy that arises from the pleural mesothelial cell lining and is linked strongly to prior asbestos exposure. The ban on asbestos has helped to lower the incidence, but in developing countries like India, it is expected to rise. It has an extended latency period usually progressing over decades and presents with nonspecific symptoms. It has a median survival ranging between 10-22 months. The diagnosis of malignant pleural mesothelioma is challenging and is done using computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT, with the last two predicting the resectability of the tumor better than CT alone. A pleural biopsy along with an array of immunohistochemical markers, such as p16, BRCA1 associated protein 1, and claudin-4, are required for a definitive diagnosis. Several genetic alterations have prognostic significance as well. The current histological subtype identification is indispensable for decision making because of the new therapeutic avenues being explored. The combination of nivolumab and ipilimumab-based immunotherapy outperformed platinum and pemetrexed-based chemotherapy in terms of survival benefit and improved quality of life especially for non-epithelioid subtypes. However, the latter continues to be a robust treatment option for patients with the epithelioid subtype. Surgery is recommended for resectable cases with radiotherapy being indicated in neoadjuvant, adjuvant, and palliative settings along with systemic treatment. This review article provides an overview of epidemiology, etiology, clinical manifestations, diagnostic approaches (including immunohistochemical and genetic markers), staging, and multidisciplinary approaches to current treatment for malignant pleural mesothelioma using surgery, chemotherapy, immunotherapy, and radiotherapy. It also sheds light on some recent studies (EMPHACIS, CALGB30901, Checkmate-743, ) that have led to significant developments in recent years with clinically meaningful results.
胸膜间皮瘤是一种极具侵袭性的恶性肿瘤，起源于胸膜间皮细胞层，与既往石棉暴露密切相关。石棉禁令有助于降低发病率，但在印度等发展中国家，发病率预计仍会上升。它有较长的潜伏期，通常会在数十年间发展，并表现出非特异性症状。其平均生存期在10至22个月之间。恶性胸膜间皮瘤的诊断具有挑战性，需使用计算机断层扫描（CT）、磁共振成像或正电子发射断层扫描-CT进行诊断，后两者比单独使用CT更能准确预测肿瘤的可切除性。明确诊断需要进行胸膜活检，并结合一系列免疫组化标志物，如p16、BRCA1相关蛋白1和紧密连接蛋白-4。多种基因改变也具有预后意义。由于正在探索新的治疗途径，目前的组织学亚型鉴定对于决策至关重要。基于纳武单抗和伊匹单抗的免疫疗法在生存获益和改善生活质量方面优于基于铂类和培美曲塞的化疗，尤其是对于非上皮样亚型。然而，对于上皮样亚型患者，后者仍是一种有效的治疗选择。对于可切除的病例建议进行手术，在新辅助、辅助和姑息治疗中可联合全身治疗进行放疗。这篇综述文章概述了恶性胸膜间皮瘤的流行病学、病因、临床表现、诊断方法（包括免疫组化和基因标志物）、分期以及采用手术、化疗、免疫疗法和放疗的多学科综合治疗方法。文章还介绍了一些近年来取得重大进展并产生了具有临床意义结果的近期研究（EMPHACIS、CALGB30901、Checkmate-743）。
