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1. The IASLC Mesothelioma Staging Project: Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma

Author

Valerie W. Rusch, Kari Chansky, Hedy L. Kindler, Anna K. Nowak, Harvey I. Pass, David C. Rice, Lynn Shemanski, Françoise Galateau-Sallé, Brian C. McCaughan, Takashi Nakano, Enrico Ruffini, Jan P. van Meerbeeck, Masahiro Yoshimura, Peter Goldstraw, Ramón Rami-Porta, Hisao Asamura, David Ball, David Beer, Ricardo Beyruti, Vanessa Bolejack, John Crowley, Frank C. Detterbeck, Wilfried Ernst Erich Eberhardt, John Edwards, Dorothy Giroux, Fergus Gleeson, Patti Groome, James Huang, Catherine Kennedy, Jhingook Kim, Young Tae Kim, Laura Kingsbury, Haruhiko Kondo, Mark Krasnik, Kaoru Kubota, Toni Lerut, Gustavo Lyons, Mirella Marino, Edith M. Marom, Alan Mitchell, Andrew G. Nicholson, Anna Nowak, Michael Peake, Thomas W. Rice, Kenneth Rosenzweig, Nagahiro Saijo, Paul Van Schil, Jean-Paul Sculier, Kelly Stratton, Kenji Suzuki, Yuji Tachimori, Charles F. Thomas, William D. Travis, Ming S. Tsao, Andrew Turrisi, Johan Vansteenkiste, Hirokazu Watanabe, Yi-Long Wu, Paul Baas, Jeremy Erasmus, Seiki Hasegawa, Kouki Inai, Kemp Kernstine, Hedy Kindler, Lee Krug, Kristiaan Nackaerts, Harvey Pass, David Rice, Conrad Falkson, Pier Luigi Filosso, Giuseppe Giaccone, Kazuya Kondo, Marco Lucchi, Meinoshin Okumura, Eugene Blackstone, H. Asamura, H. Batirel, A. Bille, U. Pastorino, S. Call, A. Cangir, S. Cedres, J. Friedberg, F. Galateau-Sallé, S. Hasagawa, K. Kernstine, H. Kindler, B. McCaughan, T. Nakano, A. Nowak, C. Atinkaya Ozturk, H. Pass, M. de Perrot, F. Rea, D. Rice, R. Rintoul, E. Ruffini, V. Rusch, L. Spaggiari, D. Galetta, K. Syrigos, C. Thomas, J.P. van Meerbeeck, P. Nafteux, J. Vansteenkiste, W. Weder, I. Optiz, M. Yoshimura, Nackaerts, Kristiaan, and IASLC Staging Prognostic Factors

Subjects
Oncology, Pulmonary and Respiratory Medicine, Mesothelioma, medicine.medical_specialty, Staging, Lung Neoplasms, Pleural Neoplasms, education, Locally advanced, Medizin, Recursive partitioning, Stage ii, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Stage (cooking), Lung cancer, neoplasms, Survival tree, Neoplasm Staging, business.industry, Mesothelioma, Malignant, respiratory system, medicine.disease, Staging system, Surgery, respiratory tract diseases, 030228 respiratory system, TNM stage groupings, 030220 oncology & carcinogenesis, Human medicine, Stage iv, business
Abstract

Introduction: The M component and TNM stage groupings for malignant pleural mesothelioma (MPM) have been empirical. The International Association for the Study of Lung Cancer developed a multinational database to propose evidence-based revisions for the eighth edition of the TNM classification of MPM. Methods: Data from 29 centers were submitted either electronically or by transfer of existing institutional databases. The M component as it currently stands was validated by confirming sufficient discrimination (by Kaplan-Meier analysis) with respect to overall survival (OS) between the clinical MO (cM0) and cM1 categories. Candidate stage groups were developed by using a recursive partitioning and amalgamation algorithm applied to all cM0 cases. Results: Of 3519 submitted cases, 2414 were analyzable and 84 were cM1 cases. Median OS for cM1 cases was 9.7 months versus 13.4 months (p = 0.0013) for the locally advanced (T4 or N3) cM0 cases, supporting inclusion of only cM1 in the stage IV group. Exploratory analyses suggest a possible difference in OS for single- versus multiple-site cM1 cases. A recursive partitioning and amalgamation generated survival tree on the OS outcomes restricted to cM0 cases with the newly proposed (eighth edition) T and N components indicates that optimal stage groupings for the eighth edition will be as follows: stage IA (T1N0), stage IB (T2-3N0), stage II (T1-2N1), stage IIIA (T3N1), stage IIIB (T1-3N2 or any T4), and stage IV (any M1). Conclusions: This first evidence-based revision of the TNM classification for MPM leads to substantial changes in the T and N components and the stage groupings. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Published
2016

2. The IASLC Mesothelioma Staging Project : Proposals for Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma

Author

Anna K. Nowak, Kari Chansky, David C. Rice, Harvey I. Pass, Hedy L. Kindler, Lynn Shemanski, Andrea Billé, Robert C. Rintoul, Hasan F. Batirel, Charles F. Thomas, Joseph Friedberg, Susana Cedres, Marc de Perrot, Valerie W. Rusch, Peter Goldstraw, Ramón Rami-Porta, Hisao Asamura, David Ball, David Beer, Ricardo Beyruti, Vanessa Bolejack, John Crowley, Frank Detterbeck, Wilfried Ernst Erich Eberhardt, John Edwards, Françoise Galateau-Sallé, Dorothy Giroux, Fergus Gleeson, Patti Groome, James Huang, Catherine Kennedy, Jhingook Kim, Young Tae Kim, Laura Kingsbury, Haruhiko Kondo, Mark Krasnik, Kaoru Kubota, Antoon Lerut, Gustavo Lyons, Mirella Marino, Edith M. Marom, Jan van Meerbeeck, Alan Mitchell, Takashi Nakano, Andrew G. Nicholson, Anna Nowak, Michael Peake, Thomas Rice, Kenneth Rosenzweig, Enrico Ruffini, Valerie Rusch, Nagahiro Saijo, Paul Van Schil, Jean-Paul Sculier, Kelly Stratton, Kenji Suzuki, Yuji Tachimori, William Travis, Ming S. Tsao, Andrew Turrisi, Johan Vansteenkiste, Hirokazu Watanabe, Yi-Long Wu, Paul Baas, Jeremy Erasmus, Seiki Hasegawa, Kouki Inai, Kemp Kernstine, Hedy Kindler, Lee Krug, Kristiaan Nackaerts, Harvey Pass, David Rice, Conrad Falkson, Pier Luigi Filosso, Giuseppe Giaccone, Kazuya Kondo, Marco Lucchi, Meinoshin Okumura, Eugene Blackstone, H. Asamura, H. Batirel, A. Bille, U. Pastorino, S. Call, A. Cangir, S. Cedres, J. Friedberg, F. Galateau-Salle, S. Hasagawa, K. Kernstine, H. Kindler, B. McCaughan, T. Nakano, A. Nowak, C. Atinkaya Ozturk, H. Pass, M. de Perrot, F. Rea, D. Rice, R. Rintoul, E. Ruffini, V. Rusch, L Spaggiari, D Galetta, K. Syrigos, C. Thomas, J. van Meerbeeck, P. Nafteux, J. Vansteenkiste, W. Weder, I. Optiz, M. Yoshimura, University of Zurich, Nowak, Anna K, Nowak, Anna K., Chansky, Kari, Rice, David C., Pass, Harvey I., Kindler, Hedy L., Shemanski, Lynn, Bille, Andrea, Rintoul, Robert C., Batirel, Hasan F., Thomas, Charles F., Friedberg, Joseph, Cedres, Susana, de Perrot, Marc, Rusch, Valerie W., and Nackaerts, Kristiaan

Subjects
Mesothelioma, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Staging, Lung Neoplasms, PREDICTION, 10255 Clinic for Thoracic Surgery, Pleural Neoplasms, Settore MED/21 - Chirurgia Toracica, education, Medizin, 610 Medicine & health, THERAPY, PARAMETERS, 03 medical and health sciences, 0302 clinical medicine, Prospective, T component, Humans, Mesothelioma, Malignant, Neoplasm Staging, Medicine, Lung cancer, TUMOR THICKNESS, Staging system, Pleural mesothelioma, business.industry, General surgery, CT SCANS, ASSOCIATION, respiratory system, medicine.disease, F-18-FDG PET/CT, respiratory tract diseases, 030228 respiratory system, Oncology, 2740 Pulmonary and Respiratory Medicine, 030220 oncology & carcinogenesis, VOLUME, SURVIVAL, 2730 Oncology, business, MALIGNANT MESOTHELIOMA
Abstract

Introduction: The current T component for malignant pleural mesothelioma (MPM) has been predominantly informed by surgical data sets and consensus. The International Association for the Study of Lung Cancer undertook revision of the seventh edition of the staging system for MPM with the goal of developing recommendations for the eighth edition. Methods: Data elements including detailed T descriptors were developed by consensus. Tumor thickness at three pleural levels was also recorded. An electronic data capture system was established to facilitate data submission. Results: A total of 3519 cases were submitted to the database. Of those eligible for T-component analysis, 509 cases had only clinical staging, 836 cases had only surgical staging, and 642 cases had both available. Survival was examined for T categories according to the current seventh edition staging system. There was clear separation between all clinically staged categories except T1a versus T1b (hazard ratio = 0.99, p = 0.95) and T3 versus T4 (hazard ratio = 1.22, p = 0.09), although the numbers of T4 cases were small. Pathological staging failed to demonstrate a survival difference between adjacent categories with the exception of T3 versus T4. Performance improved with collapse of T1a and T1b into a single T1 category; no current descriptors were shifted or eliminated. Tumor thickness and nodular or rindlike morphology were significantly associated with survival. Conclusions: A recommendation to collapse both clinical and pathological T1a and T1b into a T1 classification will be made for the eighth edition staging system. Simple measurement of pleural thickness has prognostic significance and should be examined further with a view to incorporation into future staging. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Published
2016

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