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Regionale Versorgung des malignen Pleuramesothelioms

Ergebnisse aus dem Tumorzentrum Regensburg

Regional treatment of malignant pleural mesothelioma

Results from the tumor centre Regensburg

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Zusammenfassung

Hintergrund

Das maligne Pleuramesotheliom (MPM) ist ein häufig asbestassoziierter hochmaligner Tumor der Pleura parietalis mit einem Inzidenzhöhepunkt in den nächsten Jahren. Die chirurgischen Therapiemöglichkeiten sind aufgrund des meist fortgeschrittenen Tumorstadiums begrenzt.

Patienten und Methoden

Retrospektiv wurden alle Patienten mit MPM, welche dem Tumorzentrum Regensburg im Zeitraum Januar 1998 bis August 2011gemeldet wurden, analysiert.

Ergebnisse

Insgesamt wurden 118 Patienten (85 % männlich, mittleres Alter: 67 Jahre) mit zytologisch bzw. histologisch gesichertem MPM erfasst. Die Inzidenz des MPM im Tumorzentrum Regensburg lag bei ca. 0,8 pro 100.000 Einwohner, wobei deutliche regionale Unterschiede aufgrund arbeitsbedingter Asbestexposition bestanden. Bei 65 % der Patienten konnte eine frühere Asbestexposition anamnestisch nachgewiesen werden. Ein komplettes Staging wurde bei 81 Patienten (67 %) durchgeführt: Stadium I 9 %, Stadium II 22 %, Stadium III 23 % und Stadium IV 46 %. Bei 87 (74 %) Patienten wurde mindestens ein operativer Eingriff durchgeführt: diagnostische Thorakoskopie mit Biopsie (n = 37; 43 %), Tumordebulking bzw. Talkumpleurodese (n = 33; 38 %) und die potenziell kurative Resektion (n = 17; 19 %). Nach einem mittleren Follow-up von 20 Monaten lag die mediane Überlebenszeit bei 14 Monaten (1-JÜR[-Jahres-Überlebensrate] 62 %; 3-JÜR 15 %). Patienten nach kurativer Resektion hatten mit 18 Monaten ein signifikant besseres medianes Überleben.

Schlussfolgerung

Das MPM ist durch Schwerpunkte der industriellen Asbestexposition regional deutlich unterschiedlich verteilt. Das Screening und die Diagnostik sollten sich auf Standorte erhöhter Inzidenz konzentrieren, um durch eine frühzeitige Erkennung multimodale Therapiekonzepte zu ermöglichen.

Abstract

Introduction

Malignant pleural mesothelioma (MPM) is an aggressive, malignant tumor of the pleural surface and is strongly associated with asbestos exposure. Incidence of MPM will reach its peak over the coming years. Most patients present with advanced tumor stages and therefore surgical options are limited.

Patients and methods

Retrospective analysis of all patients with MPM reported to the tumor centre Regensburg between January 1998 and August 2011.

Results

A total of 118 patients (85 % male) with cytologically or histologically confirmed MPM were reported. The mean age at diagnosis was 67 years (range 45–84 years) and 65 % of patients had a history of asbestos exposure. The incidence of MPM at the tumor centre Regensburg was 0.8/100,000 inhabitants with obvious regional differences depending on asbestos exposure. Staging was completed in 81 patients (67 %): stage I 9 %, stage II 22 %, stage III 23 % and stage IV 46 %. Of the patients 87 (74 %) underwent at least one surgical procedure: diagnostic thoracoscopy with biopsy (n = 37, 43 %), debulking surgery or talcum pleurodesis (n = 33, 38 %) and potentially curative resection (n = 17, 19 %). After a mean follow-up of 20 months the overall median survival was 14 months (1 year survival rate 62 %, 3 year survival rate 15 %). Patients had a significantly better median survival of 18 months after curative resection.

Conclusions

The distribution of MPM varies according to regional and industrial asbestos exposure. Screening and diagnostics should concentrate on locations with higher incidence of MPM to facilitate surgical therapy in a multimodal treatment regime.

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Authors and Affiliations

  1. Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland

    M. Ried, U. Speth, T. Potzger, R. Neu & H.-S. Hofmann

  2. Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland

    C. Diez

  3. Tumorzentrum Regensburg e. V., Josef-Engert Str. 9, 93053, Regensburg, Deutschland

    M. Klinkhammer-Schalke

  4. Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, Regensburg, Deutschland

    H.-S. Hofmann

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  1. M. Ried
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  2. U. Speth
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  3. T. Potzger
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  4. R. Neu
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  5. C. Diez
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  6. M. Klinkhammer-Schalke
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  7. H.-S. Hofmann
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Corresponding author

Correspondence to M. Ried.

Additional information

Diese Arbeit wurde als Vortrag bei der 21. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie im September 2012 in Karlsruhe vorgestellt.

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Ried, M., Speth, U., Potzger, T. et al. Regionale Versorgung des malignen Pleuramesothelioms. Chirurg 84, 987–993 (2013). https://doi.org/10.1007/s00104-013-2518-8

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