David Rice1, Kari Chansky2, Anna Nowak3, Harvey Pass4, Hedy Kindler5, Lynn Shemanski2, Isabelle Opitz6, Sergi Call7, Seiki Hasegawa8, Kemp Kernstine9, Cansel Atinkaya10, Federico Rea11, Philippe Nafteux12, Valerie W Rusch13. 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.
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 pN2tumors 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 pN2tumors (HR = 0.99, p = 0.99). Patients with both pN1 and pN2 nodal involvement had poorer survival than those with pN2tumors 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.