Initial analysis of the international association for the study of lung cancer mesothelioma database

Our plain-English summary of Initial analysis of the international association for the study of lung cancer mesothelioma database, by V.W. Rusch, D. Giroux, C. Kennedy, et al (Journal of Thoracic Oncology, 2012).

The study

• Authors: V.W. Rusch, D. Giroux, C. Kennedy, E. Ruffini, A.K. Cangir, D. Rice, H. Pass, H. Asamura, D. Waller, J. Edwards, W. Weder, H. Hoffmann, J.P. van Meerbeeck, IASLC Staging Committee
• Journal: Journal of Thoracic Oncology
• Published: 2012;7(11):1631-9
• Cited by: 290 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The current staging system for malignant pleural mesothelioma (MPM) is controversial. To plan revisions of this system, the International Association for the Study of Lung Cancer Staging Committee developed an international database. Initial analyses focus on patients managed surgically.

Methods: Participation was solicited from centers known to have MPM registries. Common data elements were analyzed by the International Association for the Study of Lung Cancer Staging Committee Statistical Center. Survival was analyzed by the Kaplan-Meier method, prognostic factors by log rank and Cox regression model. p Value less than 0.05 was significant.

Results: Data included 3101 patients (15 centers, 4 continents).

Demographics: median age 63 years, 79% men, 62.3% epithelioid tumor. Best tumor, node, metastasis (bTNM) stages were: I (11%), II, (21%), III (48%), and IV (20%). Curative-intent surgery was performed in 1494 patients (64.5%). Median survivals by clinical TNM and pathological TNM were similar: stage I, 21 months; stage II, 19 months; stage III, 16 months; and stage IV, 12 months. Median survival by histology: epithelioid 19 months, biphasic 13 months, and sarcomatoid 8 months. By multivariable analyses, significant differences in overall survival were seen for: T4 versus T3 and T3 versus T2 but not T2 versus T1; N0 versus N1 and N2 but not N1 versus N2; stages III and IV versus I but not II versus I; epithelioid histology versus other; age of female versus age of male; and palliative versus curative-intent surgery.

Conclusions: This is the largest international database examining outcomes in surgically managed MPM patients. Survival differences reported from smaller databases are confirmed but suggest the need to revise tumor and node staging.

In plain English

This retrospective study analyzed an international database built to plan revisions of malignant pleural mesothelioma staging. It included 3101 patients from 15 centers on four continents (1995 to 2009), focusing on surgically managed patients. Asbestos exposure was recorded as 'yes' for 1495 patients (48.2%) and was missing for 957 (30.9%). Median survival by stage was 21, 19, 16 and 12 months for stages I to IV, and by tumor type 19 months for epithelioid, 13 for biphasic and 8 for sarcomatoid tumors. In multivariable models, survival did not differ significantly between stages I and II, T1 and T2, or N1 and N2. Measured from pathological diagnosis, median survival was 18 months in the curative-intent surgery group and 12 months in the palliative surgery group. The authors concluded that the findings confirmed results from smaller databases and suggested a need to revise tumor and node staging. They added that the current system generally separated patients into groups with different outcomes, but more detailed data were needed. They cautioned that comparisons of treatments were only exploratory because the data were retrospective.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of a multicenter international database (IASLC/IMIG mesothelioma staging database)
• Who was studied: 3101 patients with malignant pleural mesothelioma from 15 centers in four continents (mostly North America and Europe), data from 1995 to 2009; analyses focused on patients who had surgery
• Exposure: The study examined tumor stage, histology, sex, age and type of surgery (curative-intent vs palliative) in relation to survival, not asbestos exposure. Asbestos exposure was recorded as yes in 1495 patients (48.2%), probable in 91 (2.9%), no in 558 (18.0%) and missing in 957 (30.9%).
• Main results:
  • Median survivals by clinical and pathological staging were similar: stage I, 21 months; stage II, 19 months; stage III, 16 months; stage IV, 12 months
  • Median survival by histology: epithelioid 19 months, biphasic 13 months, sarcomatoid 8 months
  • In multivariable analyses for patients having any surgery, survival differences between adjacent groups were statistically significant except stage I versus II (hazard ratio 1.16, p 0.1153), T1 versus T2 (hazard ratio 1.16, p 0.0907), and N1 versus N2 (hazard ratio 1.11, p 0.2771)
  • Men had worse survival than women in the multivariable model (hazard ratio 1.28, p 0.0002)
  • Median survival, measured from pathological diagnosis, was 18 months in the curative-intent surgery group versus 12 months in the palliative surgery group
  • Among stage I tumors, median survival was 40 months for those resected by extrapleural pneumonectomy (EPP) and 23 months for those managed by pleurectomy/decortication (P/D); no EPP vs P/D difference was found in higher-stage disease
  • Among curative-intent surgery patients, the 1162 who also received chemotherapy and/or radiation had median survival of 20 months versus 11 months for the 207 treated by surgery alone
  • In the 1056 patients with both clinical and pathological staging, upstaging at pathology occurred in up to 80% of clinical stage I or II patients and in 22.8% of clinical stage III tumors
• The authors' conclusion: The authors concluded that survival differences reported from smaller databases were confirmed and suggested a need to revise tumor and node staging; they also said the current system generally classifies patients into groups with distinctly different outcomes and that more detailed T and N information is needed to propose revisions
• Limitations the authors state:
  • Because the data were retrospective and heterogeneous and treatment was individually selected, effects of treatments on survival are only exploratory
  • Details of chemotherapy and radiation were not available
  • Surgically managed patients presumably had earlier-stage disease and better performance status than those managed nonsurgically
  • Few institutions provided the precise anatomical extent of tumor, and the number of involved lymph nodes was available for only 181 patients
  • Why stage I EPP patients survived longer could not be determined without knowing how treatment was selected

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Mesothelioma, Staging, Pleural Mesothelioma, Epithelioid, Metastasis, Median Survival, Histology.

Related studies

• The IASLC Mesothelioma Staging Project: Improving Staging of a Rare Disease Through International Participation — H. Pass, D. Giroux, et al. (2016)
• Supplementary prognostic variables for pleural mesothelioma: a report from the IASLC staging committee — H.I. Pass, D. Giroux, et al. (2014)
• Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group — D. Rice, V. Rusch, et al. (2011)
• Global trends in mortality from malignant mesothelioma: Analysis of WHO mortality database (1994-2013) — O. Abdel-Rahman (2018)
• Role of postoperative radiotherapy in the management of malignant pleural mesothelioma : A propensity score matching of the SEER database — O. Abdel-Rahman (2017)
• A proposed new international TNM staging system for malignant pleural mesothelioma from the International Mesothelioma Interest Group — V.W. Rusch (1996)

Browse more research in Journal of Thoracic Oncology, or return to medical research.