Catálogo de publicaciones - libros

Accurate staging of MPM allows us to stratify patients for treatment based on survival and to spare patients with advanced disease the morbidity of nonbeneficial surgical treatment. In MPM, patients with tumors of epithelioid histology and T1 or T2N0 stage have the best prognosis. This select group of patients appears to have a favorable survival with multimodality therapy that includes extrapleural pneumonectomy or pleurectomy/decortication and adjuvant radiation with or without chemotherapy. These findings justify the importance of applying staging systems at diagnosis. Currently CT and PET scanning provide the most accurate invasive staging and are routinely used at our institution; MRI does not appear to add significantly to CT and PET and should be used selectively; and VATS can provide some additional information about T status, transdiaphragmatic tumor invasion, and peritoneal metastases. Although the current AJCC/UICC staging system and the methods available for clinical staging represent advances made in the management of MPM during the past decade, they are imperfect. Further studies to improve the accuracy of staging in MPM are warranted.

Patients with good and poor prognosis can now be determined by well-validated prognostic factors based on the EORTC and CALGB scoring systems. These distinct, but closely related systems, have clarified much contradictory data accrued over the past two decades. The most important poor prognosis predictors are poor performance status, nonepithelial histology, male gender, low hemoglobin, high platelet count, high white blood cell count, and high LDH. In addition to prognostic information these systems have led to insights into the biology of mesothelioma, in particular, the possible role played by cytokine networks in the symptoms experienced by patients with mesothelioma. Prognostic factors may, at last, not simply enable us to predict a worse outcome for some patients compared to others, but help us understand mesothelioma and develop new treatments. Numerous molecular biologic markers of prognosis are under investigation. Overexpression of various cellular proteins has been demonstrated to correlate with the clinical outcome in the source patients. Understanding the importance of these markers in predicting prognosis will lead to better understanding of malignant mesothelioma and will help improve therapy.

Laparoscopy has a diagnostic role exclusively in peritoneal mesothelioma with ascites. While considering some encouraging therapeutic results that have been obtained with a combination of intraperitoneal chemotherapy and cytoreductive surgery, laparoscopy should always be performed with particular attention to the risk of neoplastic invasion of the parietal scars to avoid patients becoming untreatable by local-regional therapeutic strategies.