Boutin C, Rey F, Gouvernet J, Viallat J R, Astoul P, Ledoray V
Department of Pneumology, University of Aix-Marseille Medical School, France.
Cancer. 1993 Jul 15;72(2):394-404. doi: 10.1002/1097-0142(19930715)72:2<394::aid-cncr2820720214>3.0.co;2-5.
Thoracoscopy appears to be essential in identifying tumors at the beginning of pleural disease.
Between 1973 and 1990, diagnostic thoracoscopy was carried out in a prospective series of 188 patients with malignant pleural mesothelioma (MPM). Biopsy samples were obtained in all cases, and diagnosis was confirmed by the French panel of mesothelioma specialists. In all patients we noted the degree of involvement of the parietal, diaphragmatic, or visceral pleura, and classified patients according to the Butchart system: Stage I (66 patients), II (110 patients), III (4 patients), and IV (8 patients). To assess prognostic factors, a multivariate analysis of clinical and endoscopic findings was performed according to the Cox model.
The most favorable factors were absence of weight loss at the time of diagnosis, absence of involvement of the visceral pleura, Butchart Stage I, and epithelial histopathologic type. When Stage I patients were subdivided into two groups according to whether or not they displayed involvement of the visceral pleura, a significant difference in survival was noted (32.7 months versus 7 months, respectively; P < 0.001).
Based on these findings, we propose to divide Butchart or Mattson Stage I into two subgroups, i.e., Stage IA in which only the parietal or diaphragmatic pleura is involved and Stage IB in which the visceral pleura is invaded. In the International Union Against Cancer (UICC) classification, T1 should be used for tumors restricted to the parietal or diaphragmatic pleura and T2 for tumors with additional involvement of the visceral pleura.
胸腔镜检查对于在胸膜疾病早期识别肿瘤似乎至关重要。
在1973年至1990年期间，对188例恶性胸膜间皮瘤（MPM）患者进行了前瞻性系列诊断性胸腔镜检查。所有病例均获取活检样本，并由法国间皮瘤专家小组确诊。在所有患者中，我们记录了壁层、膈或脏层胸膜的受累程度，并根据Butchart系统对患者进行分类：I期（66例患者）、II期（110例患者）、III期（4例患者）和IV期（8例患者）。为评估预后因素，根据Cox模型对临床和内镜检查结果进行多变量分析。
最有利的因素是诊断时无体重减轻、无脏层胸膜受累、Butchart I期以及上皮组织病理学类型。当将I期患者根据是否存在脏层胸膜受累分为两组时，观察到生存存在显著差异（分别为32.7个月和7个月；P < 0.001）。
基于这些发现，我们建议将Butchart或Mattson I期分为两个亚组，即仅壁层或膈胸膜受累的IA期和脏层胸膜受侵的IB期。在国际抗癌联盟（UICC）分类中，T1应用于局限于壁层或膈胸膜的肿瘤，T2应用于伴有脏层胸膜额外受累的肿瘤。
