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Cancer. 2011 May 1;117(9):1855-63. doi: 10.1002/cncr.25640. Epub 2010 Nov 18.

A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database*.

Author information

1
The Baird Institute for Applied Heart and Lung Surgical Research, NSW Australia. Tristan.Yan@hotmail.com

Abstract

BACKGROUND:

Currently, no tumor-node-metastasis (TNM) staging system exists for patients with diffuse malignant peritoneal mesothelioma (DMPM). The primary objective was to formulate a clinicopathological staging system through the identification of significant prognostic parameters.

METHODS:

Eight international institutions with prospectively collected data on patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy contributed to the registry. Two hundred ninety-four patients had complete clinicopathological data and formed the basis of this staging project.

RESULTS:

Peritoneal cancer index (PCI) was categorized into T(1) (PCI 1-10), T(2) (PCI 11-20), T(3) (PCI 21-30), and T(4) (PCI 30-39). Twenty-two patients had positive lymph nodes (N(1) ) and 12 patients had extra-abdominal metastases (M(1) ). The survival for patients with T(1) (PCI 1-10) N(0) M(0) was significantly superior to the other patients. This group of patients is therefore designated as Stage I. The survival of patients with T(2) (PCI 11-20) and T(3) (PCI 21-30), in absence of N(1) or M(1) disease, was similar. This group of patients was categorized as Stage II. The survival of patients with T(4) (PCI 30-39), N(1,) and/or M(1) was similarly poor. This group of patients was therefore categorized as Stage III. Three prognostic factors were independently associated with survival in the multivariate analysis: histological subtype, completeness of cytoreduction, and the proposed TNM staging. The 5-year survival associated with Stage I, II, and III disease was 87%, 53%, and 29%, respectively.

CONCLUSIONS:

The proposed TNM staging system resulted in significant stratification of survival by stage when applied to the current multi-institutional registry data.

PMID:
21509762
DOI:
10.1002/cncr.25640
[Indexed for MEDLINE]
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