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摘要:
恶性胸腔积液（MPE）常见于恶性肿瘤晚期患者，生存期短，预后较差。近年来，对于MPE的发病机制及在肿瘤进展中的作用也逐渐有了深入的认识，为恶性肿瘤的治疗打开新的思路。胸腔积液细胞学检查和胸膜活检仍是目前诊断MPE的金标准。虽然MPE的治疗手段众多，但仍以姑息治疗为主，旨在缓解严重的呼吸困难等症状以及延长生存期。随着分子靶向治疗和免疫治疗的发展，出现了新的MPE诊断程序和治疗方法。近期有研究发现MPE对全身肿瘤起促进作用，对MPE进行早期治疗干预可能会对抑制肿瘤进展和改善预后有积极的影响，同时未来应加强对MPE形成的生物标志物分析，为选择合适的积液控制策略提供治疗思路。
Abstract:Malignant pleural effusion (MPE) is one of the most common complications of advanced malignant diseases. The patients with MPE have a short survival time and poor prognosis. Clinical therapeutic measures have greatly improved with the deepened exploration of the mechanisms of MPE. Diagnosis hinges on cytology, which is typically based on pleural fluid aspiration or pleural biopsy. Although numerous interventions exist, local palliative treatment is favored for the treatment of MPE. Such treatment aims to alleviate symptoms, such as aggravated dyspnea, and prolong survival time. As molecular targeted therapies and immunotherapies have developed, new diagnostic procedures and treatments have become available for patients with MPE. The recent discovery of the progrowth property of pleural fluid which may be an active promoter of cancer progression suggests that early intervention for the management of MPE may have a positive effect on inhibiting cancer progression and improving prognosis. In coming years, considerable effort should be directed at sophisticated biomarker analysis to select appropriate treatment strategies for the management of MPE.
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Key words:
- Malignant pleural effusion /
- Pleural biopsy /
- Thoracentesis /
- Biomarker
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Competing interests: The authors declare that they have no competing interests.利益冲突声明：所有作者均声明不存在利益冲突。作者贡献：刘 晔：统计与分析数据，撰写论文王立峰：审阅及指导文章写作
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表 1 贝伐珠单抗在治疗NSCLC相关MPE中的研究
Table 1 Studies on bevacizumab in the treatment of NSCLC-related MPE
Reference Research design (phase) n Methods Effect Jiang, et al[35] Retrospective 43 Bevacizumab + Cisplatin (ip);
Cisplatin (ip)PFS: 5.4 months;
4.0 monthsOS: 10.5 months;
10.3 monthsSong, et al[36] Retrospective 45 Bevacizumab + Pemetrexed (ip);
Bevacizumab + Cisplatin (ip)mPFS: 5.4 months;
4.0 months
mOS: 10.5 months;
10.3 monthsDu, et al[37] Prospective 70 Cisplatin (ip);
Cisplatin + Bevacizumab (ip)mPFS: 4.5 months;
5.3 monthsUsui, et al[39] Prospective(Ⅱ) 28 Bevacizumab + Carboplatin (iv) mPFS: 8.2 months mOS: 18.6 months Tamiya, et al[40] Prospective(Ⅱ) 23 Bevacizumab + Carboplatin + Paclitaxel (iv) mPFS: 7.1 months mOS: 11.7 months Notes: MPE: malignant pleural effusion; PES: progression-free survival; OS: overall survival; mPFS: median progression-free survival; mOS: median overall survival; iv: intravenous; ip: intraperitoneal. 
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