Abstract：
Malignant mesothelioma (MM) is an aggressive cancer that primarily arises from the pleura (MPM) or peritoneum (MPeM), mostly due to asbestos exposure. This study reviewed the Dutch population-based incidence, treatment and survival since the national ban on asbestos in 1993.
Patients with MPM or MPeM diagnosed from 1993 to 2018 were selected from the Dutch cancer registry. Annual percentage change (APC) was calculated for (age-specific and sex-specific) revised European standardised incidence rates (RESR). Treatment pattern and Kaplan-Meier overall survival analyses were performed.
In total, 12 168 patients were included in the study. For male patients younger than 80 years, the MM incidence significantly decreased in the last decade (APC ranging between -9.4% and -1.8%, p<0.01). Among both male and female patients aged over 80 years, the incidence significantly increased during the entire study period (APC 3.3% and 4.6%, respectively, p<0.01). From 2003 onwards, the use of systemic chemotherapy increased especially for MPM (from 9.3% to 39.4%). Overall, 62.2% of patients received no antitumour treatment. The most common reasons for not undergoing antitumour treatment were patient preference (42%) and performance status (25.6%). The median overall survival improved from 7.3 (1993-2003) to 8.9 (2004-2011) and 9.3 months from 2012 to 2018 (p<0.001).
The peak of MM incidence was reached around 2010 in the Netherlands, and currently the incidence is declining in most age groups. The use of systemic chemotherapy increased from 2003, which likely resulted in improved overall survival over time. The majority of patients do not receive treatment though and prognosis is still poor.
Patients with MPM or MPeM diagnosed from 1993 to 2018 were selected from the Dutch cancer registry. Annual percentage change (APC) was calculated for (age-specific and sex-specific) revised European standardised incidence rates (RESR). Treatment pattern and Kaplan-Meier overall survival analyses were performed.
In total, 12 168 patients were included in the study. For male patients younger than 80 years, the MM incidence significantly decreased in the last decade (APC ranging between -9.4% and -1.8%, p<0.01). Among both male and female patients aged over 80 years, the incidence significantly increased during the entire study period (APC 3.3% and 4.6%, respectively, p<0.01). From 2003 onwards, the use of systemic chemotherapy increased especially for MPM (from 9.3% to 39.4%). Overall, 62.2% of patients received no antitumour treatment. The most common reasons for not undergoing antitumour treatment were patient preference (42%) and performance status (25.6%). The median overall survival improved from 7.3 (1993-2003) to 8.9 (2004-2011) and 9.3 months from 2012 to 2018 (p<0.001).
The peak of MM incidence was reached around 2010 in the Netherlands, and currently the incidence is declining in most age groups. The use of systemic chemotherapy increased from 2003, which likely resulted in improved overall survival over time. The majority of patients do not receive treatment though and prognosis is still poor.
摘要：
恶性间皮瘤（MM）是一种侵袭性癌症，主要来自胸膜（MPM）或腹膜（MPeM），主要是由于石棉暴露。这项研究回顾了荷兰人群的发病率，自1993年国家禁止石棉以来的治疗和生存。
从荷兰癌症登记处选择1993年至2018年诊断为MPM或MPeM的患者。计算（特定年龄和特定性别）修订后的欧洲标准化发病率（RESR）的年度变化百分比（APC）。进行治疗模式和Kaplan-Meier总生存分析。
总共，该研究包括12168名患者。对于80岁以下的男性患者，MM发病率在过去十年显著下降(APC范围在-9.4%和-1.8%之间，p<0.01)。在80岁以上的男性和女性患者中，在整个研究期间，发病率显著增加(APC3.3%和4.6%，分别,p<0.01)。从2003年起,全身化疗的使用增加,尤其是对于MPM(从9.3%增加到39.4%).总的来说,62.2%的患者未接受抗肿瘤治疗。未接受抗肿瘤治疗的最常见原因是患者偏好（42％）和表现状态（25.6％）。中位总生存期从7.3（1993-2003）提高到8.9（2004-2011），从2012年到2018年的9.3个月（p<0.001）。
在荷兰，MM发病率的高峰在2010年左右达到，目前，大多数年龄组的发病率正在下降。从2003年开始，全身化疗的使用有所增加，这可能导致总体生存率随着时间的推移而提高。大多数患者没有接受治疗，预后仍然很差。
从荷兰癌症登记处选择1993年至2018年诊断为MPM或MPeM的患者。计算（特定年龄和特定性别）修订后的欧洲标准化发病率（RESR）的年度变化百分比（APC）。进行治疗模式和Kaplan-Meier总生存分析。
总共，该研究包括12168名患者。对于80岁以下的男性患者，MM发病率在过去十年显著下降(APC范围在-9.4%和-1.8%之间，p<0.01)。在80岁以上的男性和女性患者中，在整个研究期间，发病率显著增加(APC3.3%和4.6%，分别,p<0.01)。从2003年起,全身化疗的使用增加,尤其是对于MPM(从9.3%增加到39.4%).总的来说,62.2%的患者未接受抗肿瘤治疗。未接受抗肿瘤治疗的最常见原因是患者偏好（42％）和表现状态（25.6％）。中位总生存期从7.3（1993-2003）提高到8.9（2004-2011），从2012年到2018年的9.3个月（p<0.001）。
在荷兰，MM发病率的高峰在2010年左右达到，目前，大多数年龄组的发病率正在下降。从2003年开始，全身化疗的使用有所增加，这可能导致总体生存率随着时间的推移而提高。大多数患者没有接受治疗，预后仍然很差。
