Behandling og overlevelse af nordjyske patienter med malignt pleuralt mesotheliom i perioden 2002-2013, en retrospektiv analyse

Treatment and survival of patients with malignant pleural mesothelioma in North Jutland in the period 2002-2013, a retrospective analysis

Nielsen, Ida

5. semester (speciale)

Medicin, Kandidat

2015

2015-12-20

22

Malignt pleuralt mesotheliom (MPM) er en sjælden, asbestrelateret kræft i lungernes beklædning (pleura) med dårlig prognose. Nordjylland har haft stor asbestindustri, og regionen har derfor flere patienter med MPM end forventet. Formålet med denne retrospektive undersøgelse var at beskrive behandling og overlevelse hos nordjyske patienter diagnosticeret med MPM over en 12-årig periode. Vi gennemgik data fra 2002-2013 og foretog en supplerende journalgennemgang, fordi de eksisterende oplysninger var ufuldstændige. Vi beskrev kliniske og patologiske forhold som alder, sygdomsstadie, performance status (funktionsniveau i hverdagen), histologisk subtype (celletypning) og andre sygdomme (komorbiditet). Overlevelse ved forskellige behandlinger blev sammenlignet med tosidede t-tests (p<0,05 blev anset som signifikant). I alt blev 192 patienter inkluderet. Der var signifikante forskelle i median overlevelse mellem ingen/symptomlindrende behandling (3 måneder), alle typer kemoterapi (13,5 måneder) og alle typer kirurgi (21 måneder) (p≤0,001). Pemetrexed-baseret kemoterapi var forbundet med længere median overlevelse end andre kemoterapiregimer (16 vs. 11 måneder, p=0,034). Radikal kirurgi (med sigte på at fjerne al synlig tumor) uden intensiv stråleterapi var forbundet med længere median overlevelse end irradikal kirurgi (51,5 vs. 20 måneder, p=0,047) og viste en tendens til bedre overlevelse end trimodal behandling (kombination af kirurgi, kemoterapi og stråleterapi) (51,5 vs. 20 måneder, p=0,083). Pleurektomi/dekortikation (P/D) havde numerisk længere overlevelse end ekstrapleural pneumonektomi (EPP) (38 vs. 19 måneder), men forskellen var ikke statistisk signifikant (p=0,127); med flere patienter kunne den muligvis være blevet signifikant. Konklusion: Inden for rammerne af et retrospektivt studie levede patienter, der fik kirurgi kombineret med kemoterapi, længere end patienter med kemoterapi alene, og begge grupper levede længere end patienter uden tumormodificerende behandling. Pemetrexed-baseret kemoterapi var forbundet med bedre overlevelse end andre kemoterapier. Radikal kirurgi uden intensiv stråling var forbundet med bedre overlevelse end irradikal kirurgi og viste en tendens til bedre overlevelse end trimodal behandling. Små gruppestørrelser og tegn på selektionsbias betyder, at der ikke kan drages faste konklusioner om optimal behandling af MPM.

Malignant pleural mesothelioma (MPM) is a rare asbestos-related cancer of the lining of the lungs (pleura) with a poor outlook. North Jutland has had substantial asbestos industry, leading to an overrepresentation of MPM cases in the region. This retrospective study aimed to describe treatment and survival among North Jutland patients diagnosed with MPM over a 12-year period. We reviewed data from 2002–2013 and conducted an additional chart review because existing information was incomplete. We summarized clinical and pathological factors such as age, disease stage, performance status (ability to carry out daily activities), histological subtype (cell type under the microscope), and comorbidities. Survival with different treatments was compared using two-sided t-tests (p<0.05 considered significant). A total of 192 patients were included. Median survival differed significantly between no/tumor-non-modifying (symptom-relieving) care (3 months), any chemotherapy (13.5 months), and any surgery (21 months) (p≤0.001). Pemetrexed-based chemotherapy was associated with longer median survival than other chemotherapy regimens (16 vs 11 months, p=0.034). Radical surgery (aiming to remove all visible tumor) without intensive radiotherapy was associated with longer median survival than non-radical surgery (51.5 vs 20 months, p=0.047) and showed a trend toward better survival compared with trimodal treatment (combining surgery, chemotherapy, and radiotherapy) (51.5 vs 20 months, p=0.083). Pleurectomy/decortication (P/D) had numerically longer survival than extrapleural pneumonectomy (EPP) (38 vs 19 months), but the difference was not statistically significant (p=0.127); with more patients, it might have reached significance. Conclusion: Within the limits of a retrospective study, patients who received surgery combined with chemotherapy lived longer than those who received chemotherapy alone, and both groups lived longer than patients without tumor-modifying treatment. Pemetrexed-based chemotherapy was associated with better survival than other chemotherapy. Radical surgery without intensive radiotherapy was associated with better survival than non-radical surgery and showed a tendency to outperform trimodal treatment. Small group sizes and signs of selection bias mean that no firm conclusions can be drawn about the optimal treatment of MPM.

[Dette resumé er genereret ved hjælp af AI]

malignt pleuralt mesotheliom ; behandling ; overlevelse ; asbest ; Nordjylland

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