Abstract
Objective. We examined the clinical features, diagnosis, treatment, prognosis and prognostic factors of diffuse malignant pleural mesothelioma. Subjects. Fifty-one patients from the institutions of our study group with a pathological diagnosis of diffuse malignant pleural mesothelioma were enrolled. Results. Out of the 51 patients, 47 cases were male and four cases were female with an average age of 60 years old. A past history of exposure to asbestos was identified in 19 patients (37%). Forty-five patients (88%) presented symptoms such as chest pain, shortness of breath, and cough. Thoracoscopic pleural biopsy was the most effective method for diagnosis. It required 60 days (median) from the first visit to establish the diagnosis of malignant pleural mesothelioma. Cytodiagnosis and hyaluronic acid values of pleural effusion were not useful for the diagnosis in half of the cases. Operation was performed in 28 cases (pleuropneumonectomy for 26 cases and other operations for two cases). Chemotherapy and/or radiotherapy were performed in 13 cases, while supportive care alone was carried out in 10 cases. The 1-year, 2-year, and 3-year survival rates of the overall patients were 50.6%, 25.0% and 12.7%, respectively, while the median survival was 12.3 months. Statistically, significant differences of survival were seen according to age, clinical stage and surgery with univariate analysis, but only for clinical stage with multivariate analysis. Some cases undergoing intrathoracic perfusion chemohyperthermia as a postoperative adjuvant therapy showed better survival. Conclusion. For definitive diagnosis, thoracoscopic pleural biopsy should be done promptly in cases with pleural effusion of unknown origin. Establishment of the appropriate indications for surgery, the development of postoperative adjuvant therapy and the development of effective chemotherapy are required for the improvement of survival in diffuse malignant pleural mesothelioma.
