Clinical characteristics and diagnostic analysis of 120 cases with malignant pleural mesothelioma / 肿瘤

ABSTRACT

Objective: To investigate the clinical characteristics of patients with pleural mesothelioma, including the history, symptoms, lymph node metastasis and the rule of distant metastasis, to analyze the survival of patients with different stages, pathological types and treatment methods, so as to provide ideas for the diagnosis and treatment of this disease. Methods: The clinical data of 120 patients with pleural mesothelioma admitted to Tangdu Hospital of Air Force Medical University from April 2009 to September 2016 were analyzed, and the staging was conducted according the eighth TNM staging standard. For the different clinical stages, pathological types and treatment methods, the median survival of patients in each group was calculated and analyzed by Kaplan-Meier method. Results: Among the 120 patients, 3 cases (2.5%) had a history of occupational exposure. There were 56 cases (46.7%) of l eft pl eural mesothel i oma, 63 cases (52.5%) of ri ght pleural mesothelioma, and 1 case of bilateral concurrent lesion. The total misdiagnosis rate of the patients was 30% (36/120), among which 32 cases (26.7%) were misdiagnosed as tuberculosis. In terms of symptoms, 55 cases (45.8%) suffered from chest pain, 107 cases (89.2%) suffered from pleural effusion, and 49 cases (40.8%) suffered from both symptoms. Fi fty-three cases (44. 2%) were di agnosed by pl eural puncture, 41 cases (34.2%) by thoracoscopy, and 26 cases (21.6%) by exploratory thoracotomy. There were 43 cases (35.8%) of lymph node metastasis (N1 and N2). There were 54 sites of lymph node metastasis, including 42 cases (77.8%) of metastasis in mediastinal lymph node areas and 12 cases (22.2%) of metastasis in other areas. Seventy-eight patients were followed up successfully. The overall median survival was 15.0 months, and the 1-year, 2-year, 3-year, and 5-year survival rates were 67.9%, 27.7%, 16.0%, and 4.2%, respectively. The median survival of patients in stage /Ⅱ was 17.0 months, which was longer than that of patients in stage III/ (13.0 months) (P < 0.05). The median survival time of patients with epithelial type of pleural mesothelioma was 17.0 months, which was better than those of patients with mixed type and sarcoma type of pleural mesothelioma (both P < 0.05). The median survival time of patients in the combination group of surgery and chemotherapy was 30.0 months, which was better than those of patients in surgery, chemotherapy alone and supportive treatment groups (all P < 0.05). Conclusion: The misdiagnosis rate of pleural mesothelioma is high, most of patients are misdiagnosed as tuberculosis. The incidence of malignant pleural effusion is high, and the pattern of lymph node metastasis is different from lung cancer. Therefore, for the diagnosis and treatment of pleural mesothelioma, these clinical features should be paid great attention to minimize misdiagnosis and improve the treatment efficiency. However, the prognosis of patients with early clinical stage and epithelial type of pleural mesothelioma is relatively better. Relatively long survival can be achieved by a combination of surgery and chemotherapy.