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J Thorac Oncol. 2016 Dec;11(12):2100-2111. doi: 10.1016/j.jtho.2016.09.121. Epub 2016 Sep 26.

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

Author information

1
M. D. Anderson Cancer Center, Houston, Texas. Electronic address: drice@mdanderson.org.
2
Cancer Research And Biostatistics, Seattle, Washington.
3
University of Western Australia, Perth, Australia.
4
New York University School of Medicine, New York, New York.
5
University of Chicago, Chicago, Illinois.
6
University of Zurich, Zurich, Switzerland.
7
Hospital Universitari Mutua Terrassa, Terrassa, Spain.
8
Hyogo College of Medicine, Hyogo, Japan.
9
University of Texas Southwestern Medical Center, Dallas, Texas.
10
Sureyyapasa Training and Research Hospital, Istanbul, Turkey.
11
University of Padua, Padua, Italy.
12
Katholieke Universiteit Leuven-University Hospital Leuven, Leuven, Belgium.
13
Memorial Sloan-Kettering Cancer Center, New York, New York.

Abstract

INTRODUCTION:

Nodal categories for malignant pleural mesothelioma are derived from the lung cancer staging system and have not been adequately validated. The International Association for the Study of Lung Cancer developed a multinational database to generate evidence-based recommendations to inform the eighth edition of the TNM classification of malignant pleural mesothelioma.

METHODS:

Data from 29 centers were entered prospectively (n = 1566) or by transfer of retrospective data (n = 1953). Survival according to the seventh edition N categories was evaluated using Kaplan-Meier survival curves and Cox proportional hazards regression analysis. Survival was measured from the date of diagnosis.

RESULTS:

There were 2432 analyzable cases: 1603 had clinical (c) staging, 1614 had pathologic (p) staging, and 785 had both. For clinically staged tumors there was no separation in Kaplan-Meier curves between cN0, cN1 or cN2 (cN1 versus cN0 hazard ratio [HR] = 1.06, p = 0.77 and cN2 versus cN1 HR = 1.04, p = 0.85). For pathologically staged tumors, patients with pN1 or pN2 tumors had worse survival than those with pN0 tumors (HR = 1.51, p < 0.0001) but no survival difference was noted between those with pN1 and pN2 tumors (HR = 0.99, p = 0.99). Patients with both pN1 and pN2 nodal involvement had poorer survival than those with pN2 tumors only (HR = 1.60, p = 0.007) or pN0 tumors (HR = 1.62, p < 0.0001).

CONCLUSIONS:

A recommendation to collapse both clinical and pN1 and pN2 categories into a single N category comprising ipsilateral, intrathoracic nodal metastases (N1) will be made for the eighth edition staging system. Nodes previously categorized as N3 will be reclassified as N2.

KEYWORDS:

Cancer staging; Database; Mesothelioma; Nodal metastases

PMID:
27687964
DOI:
10.1016/j.jtho.2016.09.121
[Indexed for MEDLINE]
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