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. 2016 Dec;11(12):2112-2119.
doi: 10.1016/j.jtho.2016.09.124. Epub 2016 Sep 28.

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

Valerie W Rusch  1 , Kari Chansky  2 , Hedy L Kindler  3 , Anna K Nowak  4 , Harvey I Pass  5 , David C Rice  6 , Lynn Shemanski  2 , Françoise Galateau-Sallé  7 , Brian C McCaughan  8 , Takashi Nakano  9 , Enrico Ruffini  10 , Jan P van Meerbeeck  11 , Masahiro Yoshimura  12 ; IASLC Staging and Prognostic Factors Committee, advisory boards, and participating institutions
Collaborators, Affiliations
Free article

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

Valerie W Rusch et al. J Thorac Oncol. 2016 Dec.
Free article

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 M0 (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.

Keywords: Mesothelioma; Staging; Staging system; TNM stage groupings.

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