The IASLC Mesothelioma Staging Project: Improving Staging of a Rare Disease Through International Participation

Our plain-English summary of The IASLC Mesothelioma Staging Project: Improving Staging of a Rare Disease Through International Participation, by H. Pass, D. Giroux, C. Kennedy, et al (Journal of Thoracic Oncology, 2016).

The study

• Authors: H. Pass, D. Giroux, C. Kennedy, E. Ruffini, A.K. Cangir, D. Rice, H. Asamura, D. Waller, J. Edwards, W. Weder, H. Hoffmann, J.P. van Meerbeeck, A. Nowak, V.W. Rusch, IASLC Staging and Prognostic Factors Committee, Advisory Boards and Participating Institutions
• Journal: Journal of Thoracic Oncology
• Published: 2016;11(12):2082-2088
• Type of article: Review
• Cited by: 60 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

For nearly 40 years, there was no generally accepted staging system for malignant pleural mesothelioma. In 1994, members of the International Mesothelioma Interest Group, in collaboration with the International Association for the Study of Lung Cancer, proposed a TNM staging system based on analyses of outcomes in retrospective surgical series and small clinical trials. Subsequently accepted by the American Joint Commission on Cancer and the Union for International Cancer Control for the sixth editions of their staging manuals, this system has since been the international staging standard. However, it has significant limitations, particularly with respect to clinical staging and to the categories for lymph node staging. Here we provide an overview of the development of the International Association for the Study of Lung Cancer malignant pleural mesothelioma staging database, which was designed to address these limitations through the development of a large international data set. Analyses of this database, described in papers linked to this overview, are being used to inform revisions in the eighth editions of the American Joint Commission on Cancer and Union for International Cancer Control staging systems.

Copyright © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

In plain English

In this overview, which did not present a new analysis, the authors described how the International Association for the Study of Lung Cancer (IASLC) built an international database to revise staging of malignant pleural mesothelioma. They summarized earlier reports from the first database, published in 2012, which held data on 3,101 patients from 15 centers on 4 continents. In those reports, final pathologic staging raised the stage in up to 80% of patients judged clinically to have stage I or II disease, but in only 22.8% of clinical stage III tumors. Median survival was 18 months after surgery with curative intent versus 12 months after surgery with palliative intent. Epithelioid tumors had the best outcome and sarcomatoid tumors the worst. The authors said survival data largely supported the existing staging system but identified several areas for improvement. As of June 1, 2014, a second database had received 3,519 cases from 29 centers, of which 2,460 were eligible. Its analyses appear in linked papers. The authors noted that the database was dominated by surgical cases, although most patients are treated medically. Asbestos exposure history was recorded, but this overview reported no result for it.

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: Overview (narrative review) of the development of the IASLC malignant pleural mesothelioma staging database. It summarizes earlier analyses of the first database and describes the second database.
• Who was studied: First database: 3,101 patients with malignant pleural mesothelioma from 15 centers on 4 continents, diagnosed 1995 to 2009. Second database: 3,519 cases submitted from 29 centers on 4 continents as of June 1, 2014, of which 2,460 were eligible for analysis. Most cases in the second database were diagnosed between 2000 and 2013.
• Exposure: This is not an exposure study. History of asbestos exposure was one of the supplementary clinical variables in the first database, but the overview reports no result for it.
• Main results:
  • The first database, published in 2012, held data on 3,101 patients from 15 centers on 4 continents.
  • In the first database, final pathologic staging raised the stage in up to 80% of patients judged clinically to have stage I or II disease. It did so in only 22.8% of clinical stage III tumors and in none with stage IV disease.
  • In the first database, median survival was 18 months for patients whose surgery was done with curative intent and 12 months for those whose surgery was done with palliative intent (p less than 0.0001).
  • In the first database, epithelioid histology was associated with the best outcome and sarcomatoid histology with the worst.
  • In the first database, patients with stage I tumors resected by extrapleural pneumonectomy (EPP) with curative intent had a median survival of 40 months. Those managed by pleurectomy/decortication (P/D) had a median survival of 23 months. No survival difference between EPP and P/D was found in patients with higher-stage disease.
  • In the first database, multivariable analyses did not show a significant survival difference between stages I and II.
• The authors' conclusion: The authors concluded that survival data from the first database largely supported continued use of the original International Mesothelioma Interest Group (IMIG) staging system, while identifying areas for improvement. They stated that the linked analyses of the second database serve as the primary source supporting changes to the 8th editions of the AJCC and UICC staging systems.
• Limitations the authors state:
  • The database is dominated by surgical cases, although most patients with this disease are treated medically.
  • The database lacks data from non-surgical staging tools such as PET, EBUS and EUS.
  • The earlier analysis of supplementary prognostic variables was limited by missing data on key clinical factors, including weight loss and pain.

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: IASLC, Mesothelioma Staging, Staging, Pleural Mesothelioma, Mesothelioma, Lung Cancer, TNM Staging, Clinical Trial.

Related studies

• Supplementary prognostic variables for pleural mesothelioma: a report from the IASLC staging committee — H.I. Pass, D. Giroux, et al. (2014)
• 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)
• The IASLC Mesothelioma Staging Project: Proposals for Revisions of the N Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma — D. Rice, K. Chansky, et al. (2016)
• Initial analysis of the international association for the study of lung cancer mesothelioma database — V.W. Rusch, D. Giroux, et al. (2012)
• 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)
• Malignant peritoneal mesothelioma in a 16-year-old girl: presentation of a rare disease — I.B. Brecht, A. Agaimy, et al. (2012)

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