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

Valerie W Rusch, Kari Chansky, Hedy L Kindler, Anna K. Nowak, Harvey I Pass, David C Rice, Lynn Shemanski, Françoise Galateau-Sallé, Brian C McCaughan, Takashi Nakano, Enrico Ruffini, Jan P van Meerbeeck, Masahiro Yoshimura, IASLC Staging and Prognostic Factors Committee, advisory boards, and participating institutions

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Abstract

INTRODUCTION: The M component and TNM stage groupings for malignant pleural mesothelioma (MPM) have been empirical. The International Association for the Study of Lung Cancer developed a multinational database to propose evidence-based revisions for the eighth edition of the TNM classification of MPM.

METHODS: Data from 29 centers were submitted either electronically or by transfer of existing institutional databases. The M component as it currently stands was validated by confirming sufficient discrimination (by Kaplan-Meier analysis) with respect to overall survival (OS) between the clinical M0 (cM0) and cM1 categories. Candidate stage groups were developed by using a recursive partitioning and amalgamation algorithm applied to all cM0 cases.

RESULTS: Of 3519 submitted cases, 2414 were analyzable and 84 were cM1 cases. Median OS for cM1 cases was 9.7 months versus 13.4 months (p = 0.0013) for the locally advanced (T4 or N3) cM0 cases, supporting inclusion of only cM1 in the stage IV group. Exploratory analyses suggest a possible difference in OS for single- versus multiple-site cM1 cases. A recursive partitioning and amalgamation-generated survival tree on the OS outcomes restricted to cM0 cases with the newly proposed (eighth edition) T and N components indicates that optimal stage groupings for the eighth edition will be as follows: stage IA (T1N0), stage IB (T2-3N0), stage II (T1-2N1), stage IIIA (T3N1), stage IIIB (T1-3N2 or any T4), and stage IV (any M1).

CONCLUSIONS: This first evidence-based revision of the TNM classification for MPM leads to substantial changes in the T and N components and the stage groupings.

Original languageEnglish
Pages (from-to)2112-2119
Number of pages8
JournalJournal of Thoracic Oncology
Volume11
Issue number12
DOIs
Publication statusPublished - Dec 2016
Externally publishedYes

Keywords

  • Journal Article

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    Rusch, V. W., Chansky, K., Kindler, H. L., Nowak, A. K., Pass, H. I., Rice, D. C., Shemanski, L., Galateau-Sallé, F., McCaughan, B. C., Nakano, T., Ruffini, E., van Meerbeeck, J. P., Yoshimura, M., & IASLC Staging and Prognostic Factors Committee, advisory boards, and participating institutions (2016). 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. Journal of Thoracic Oncology, 11(12), 2112-2119. https://doi.org/10.1016/j.jtho.2016.09.124