Pleural Mesothelioma (PM) remains a challenging malignancy associated with asbestos exposure and characterized by poor prognosis. This review aims to consolidate recent findings on the efficacy of perioperative therapies encompassing chemotherapy, surgery, and emerging immunotherapy strategies. Current management strategies debate the role of surgery in early-stage patients, particularly due to the limited success of solitary treatment modalities and significant rates of postoperative complications. Retrospective studies indicate that multimodal treatment, incorporating surgical resection with perioperative chemotherapy, can enhance overall survival (OS), especially in favorable prognostic subsets. However, significant randomized trials, notably the MARS and MARS 2 trials, revealed that the addition of aggressive surgical strategies like extrapleural pneumonectomy (EPP) did not confer survival benefits and was accompanied by heightened morbidity. In light of persistent challenges, integrating perioperative chemotherapy—primarily with platinum-based regimens—has shown improved disease control outcomes. Neoadjuvant chemotherapy permits real-time assessment of tumor responsiveness, providing valuable clinical insights for surgical candidacy. The role of immunotherapy, particularly immune checkpoint inhibitors (ICIs), is also under active exploration, with preliminary results suggesting promising activity and manageable safety profiles. In conclusion, while current protocols primarily recommend surgery for a select group of patients, ongoing investigations into neoadjuvant approaches, adjuvant therapies, and novel immunotherapeutic strategies are crucial for developing effective, personalized treatment paradigms for PM. Future efforts should prioritize clinical trials that integrate these therapies within a structured multidisciplinary approach to optimize patient outcomes.
胸膜间皮瘤（PM）是一种与石棉暴露相关的难治性恶性肿瘤，预后普遍较差。本综述旨在整合围手术期治疗的最新研究进展，涵盖化疗、手术及新兴免疫治疗策略。当前治疗策略对早期患者手术作用的争议较大，主要源于单一治疗模式效果有限且术后并发症发生率较高。回顾性研究表明，结合手术切除与围手术期化疗的多模式治疗可提高总生存期（OS），尤其在预后较好的亚组中效果显著。然而，多项重要随机试验（特别是MARS和MARS 2试验）显示，胸膜外全肺切除术等激进手术策略并未带来生存获益，反而增加了并发症风险。面对持续存在的治疗挑战，围手术期化疗（尤其是以铂类为基础的方案）的整合应用已显示出改善疾病控制的效果。新辅助化疗能够实时评估肿瘤反应性，为手术适应症选择提供重要临床依据。免疫治疗（特别是免疫检查点抑制剂）的作用也处于积极探索阶段，初步研究结果显示出良好的活性与可控的安全性。总之，虽然当前方案主要推荐对特定患者群体实施手术，但持续探索新辅助治疗、辅助治疗及新型免疫治疗策略对于建立有效的个体化PM治疗模式至关重要。未来应重点开展将这些疗法整合于结构化多学科框架内的临床试验，以优化患者治疗结局。
Perioperative Treatments in Pleural Mesothelioma: State of the Art and Future Directions
肿瘤(癌症)患者之家