Robust data: the essential foundation of a revised staging system for pleural mesothelioma

Our plain-English summary of Robust data: the essential foundation of a revised staging system for pleural mesothelioma, by H.L. Kindler (Journal of Thoracic Oncology, 2012).

The study

• Author: H.L. Kindler
• Journal: Journal of Thoracic Oncology
• Published: 2012;7(11):1623-4
• Type of article: Editorial
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this editorial, the author commented on the initial retrospective analysis of the International Association for the Study of Lung Cancer (IASLC) mesothelioma database, published in the same journal issue. She noted that earlier staging systems for pleural mesothelioma were mostly built on small single-institution data sets that were not externally validated. The 1995 International Mesothelioma Interest Group/IASLC system, adopted by the UICC and the American Joint Commission on Cancer, was a consensus document based on several small retrospective surgical databases and was hard to apply reproducibly in clinically staged patients. The new analysis covered 3101 patients from 15 centers in four continents. The author highlighted several of its findings. Up to 80% of patients clinically thought to have stage I or II disease were upstaged at surgery. Outcomes for T1 and T2 disease did not differ significantly. Lymph node involvement was prognostic, but N1 versus N2 status was not. Median survival was 19 months for epithelial and 8 months for sarcomatoid histology. It was 20 versus 11 months for multimodality treatment versus surgery alone, and 18 versus 12 months for curative-intent versus palliative surgery. In stage I patients it was 40 months after extrapleural pneumonectomy versus 23 months after pleurectomy/decortication. She cautioned about selection bias in retrospective series and described the ongoing prospective staging project. She concluded that the analysis was a great beginning.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This is an editorial, not an original study. The author commented on a separate retrospective analysis, published in the same journal issue and led by Dr. Rusch, of the International Association for the Study of Lung Cancer mesothelioma database. That database held information on 3101 patients with pleural mesothelioma from 15 centers in four continents. The author argued that the current staging system was based on a limited number of patients and was hard to apply in patients staged without surgery. As the editorial reported, the analysis found that up to 80% of patients clinically thought to have stage I or II disease were upstaged at surgery. Outcomes for T1 and T2 disease did not differ statistically significantly. Whether lymph nodes were involved predicted outcome, but N1 versus N2 status did not. Survival was 19 months for epithelial and 8 months for sarcomatoid tumors. Patients given surgery plus chemotherapy or radiation lived 20 months, against 11 months for surgery alone. The author cautioned that this could reflect fitter patients getting more aggressive treatment. The editorial does not discuss asbestos. The author concluded the analysis was a beginning that suggests areas for revising the staging system.

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: Editorial commenting on a separate retrospective analysis of an international mesothelioma database; the author did no analysis of their own
• Who was studied: No patients were studied by the author. The editorial discusses the International Association for the Study of Lung Cancer mesothelioma database analysis covering 3101 patients with pleural mesothelioma from 15 centers in four continents.
• Main results:
  • Reported from the database analysis: up to 80% of patients clinically thought to have stage I or II disease were upstaged at surgery
  • Reported from the database analysis: no statistically significant differences in outcomes between T1 and T2 disease
  • Reported from the database analysis: whether lymph node metastases were present predicted outcome, but N1 versus N2 status did not
  • Reported from the database analysis: survival of 19 months for epithelial and 8 months for sarcomatoid patients
  • Reported from the database analysis: patients receiving surgery plus chemotherapy or radiation lived longer than those with surgery alone (20 versus 11 months, p less than 0.0001), with the caveat of selection bias
  • Reported from the database analysis: curative-intent surgery (EPP or P/D) was associated with longer survival than palliative surgery (18 versus 12 months, p less than 0.0001)
  • Reported from the database analysis: only stage I patients had a substantial survival benefit from extrapleural pneumonectomy (40 months, compared with 23 months for pleurectomy/decortication). The author called this a hypothesis-generating finding.
• The authors' conclusion: The author concluded that the database analysis confirms existing views about the current staging system and suggests key areas for modification. The author also suggested that histology should probably be added to the next staging system.
• Limitations the authors state:
  • The author noted selection bias inherent in a retrospective series: fitter patients undergo more aggressive treatment and so may seem to have better outcomes
  • The author noted that the retrospective project was limited by the data that could be collected

Topics

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

Medical terms in this study, explained in our Lexicon: Staging, Pleural Mesothelioma, Lung Cancer, IASLC, Mesothelioma, UICC, Median Survival, Sarcomatoid.

Related studies

• The revised staging system for malignant pleural mesothelioma based on surveillance, epidemiology, and end results database — S. Wang, K. Ma, et al. (2017)
• A proposed new international TNM staging system for malignant pleural mesothelioma from the International Mesothelioma Interest Group — V.W. Rusch (1996)
• Peritoneal mesothelioma proposal for a staging system — G. Sebbag, P.H. Sugarbaker (2001)
• Evaluation of the clinical TNM staging system for malignant pleural mesothelioma: an assessment in 88 patients — L. Tammilehto, L. Kivisaari, et al. (1995)
• Challenging a dogma; AJCC 8th staging system is not sufficient to predict outcomes of patients with malignant pleural mesothelioma — O. Abdel-Rahman (2017)
• 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 — V.W. Rusch, K. Chansky, et al. (2016)

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