Supplementary Prognostic Variables for Pleural Mesothelioma: A Report from the IASLC Staging Committee

• Published in: Journal of thoracic oncology Vol. 9; no. 6; pp. 856 - 864
• Main Authors: Pass, Harvey I., Giroux, Dorothy, Kennedy, Catherine, Ruffini, Enrico, Cangir, Ayten K., Rice, David, Asamura, Hisao, Waller, David, Edwards, John, Weder, Walter, Hoffmann, Hans, van Meerbeeck, Jan P., Rusch, Valerie W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2014; Copyright by the European Lung Cancer Conference and the International Association for the Study of Lung Cancer; Lippincott Williams & Wilkins
• Subjects: Age Factors; Aged; Chemotherapy, Adjuvant; Female; Hemoglobins - metabolism; Humans; Kaplan-Meier Estimate; Leukocyte Count; Male; Mesothelioma; Mesothelioma - pathology; Mesothelioma - surgery; Mesothelioma - therapy; Middle Aged; Neoplasm Staging; Original; Platelet Count; Pleural Neoplasms - pathology; Pleural Neoplasms - surgery; Pleural Neoplasms - therapy; Prognosis; Proportional Hazards Models; Radiotherapy, Adjuvant; Registry; Sex Factors; Staging; Surgery; Mesothelioma; Prognosis; Registry; Staging; Surgery
• ISSN: 1556-0864; 1556-1380
• DOI: 10.1097/JTO.0000000000000181

The staging system for malignant pleural mesothelioma is controversial. To revise this system, the International Association for the Study of Lung Cancer Staging Committee developed an international database. This report analyzes prognostic variables in a surgical population, which are supplementary to previously published CORE variables (stage, histology, sex, age, and type of procedure). Supplementary prognostic variables were studied in three scenarios: (1) all data available, that is, patient pathologically staged and other CORE variables available (2) only clinical staging available along with CORE variables, and (3) only age, sex, histology, and laboratory parameters are known. Survival was analyzed by Kaplan–Meier, prognostic factors by log rank and stepwise Cox regression modeling after elimination of nonsignificant variables. p value less than 0.05 was significant. A total of 2141 patients with best tumor, node, metastasis (TNM) stages (pathologic with/without clinical staging) had nonmissing age, sex, histology, and type of surgical procedure. Three prognostic models were defined. Scenario A (all parameters): best pathologic stage, histology, sex, age, type of surgery, adjuvant treatment, white blood cell count (WBC) (≥15.5 or not), and platelets (≥400 k or not) (n = 550). Scenario B (no surgical staging): clinical stage, histology, sex, age, type of surgery, adjuvant treatment, WBC, hemoglobin (<14.6 or not), and platelets (n = 627). Scenario C (limited data): histology, sex, age, WBC, hemoglobin, and platelets (n = 906). Refinement of these models could define not only the appropriate patient preoperatively for best outcomes after cytoreductive surgery but also stratify surgically treated patients after clinical and pathologic staging who do or do not receive adjuvant therapy.