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

Research output: Contribution to journalArticle

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

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Neoplasm Staging
Mesothelioma
Myeloma Proteins
Databases
Kaplan-Meier Estimate
Malignant Mesothelioma

Keywords

  • Journal Article

Cite this

Rusch, V. W., Chansky, K., Kindler, H. L., Nowak, A. K., Pass, H. I., Rice, D. C., ... 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

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

In: Journal of Thoracic Oncology, Vol. 11, No. 12, 12.2016, p. 2112-2119.

Research output: Contribution to journalArticle

Rusch, VW, Chansky, K, Kindler, HL, Nowak, AK, Pass, HI, Rice, DC, Shemanski, L, Galateau-Sallé, F, McCaughan, BC, Nakano, T, Ruffini, E, van Meerbeeck, JP, 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, vol. 11, no. 12, pp. 2112-2119. https://doi.org/10.1016/j.jtho.2016.09.124
Rusch, Valerie W ; Chansky, Kari ; Kindler, Hedy L ; Nowak, Anna K. ; Pass, Harvey I ; Rice, David C ; Shemanski, Lynn ; Galateau-Sallé, Françoise ; McCaughan, Brian C ; Nakano, Takashi ; Ruffini, Enrico ; van Meerbeeck, Jan P ; Yoshimura, Masahiro ; IASLC Staging and Prognostic Factors Committee, advisory boards, and participating institutions. / 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. In: Journal of Thoracic Oncology. 2016 ; Vol. 11, No. 12. pp. 2112-2119.
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T1 - The IASLC Mesothelioma Staging Project

T2 - Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma

AU - Rusch, Valerie W

AU - Chansky, Kari

AU - Kindler, Hedy L

AU - Nowak, Anna K.

AU - Pass, Harvey I

AU - Rice, David C

AU - Shemanski, Lynn

AU - Galateau-Sallé, Françoise

AU - McCaughan, Brian C

AU - Nakano, Takashi

AU - Ruffini, Enrico

AU - van Meerbeeck, Jan P

AU - Yoshimura, Masahiro

AU - IASLC Staging and Prognostic Factors Committee, advisory boards, and participating institutions

N1 - Copyright © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

PY - 2016/12

Y1 - 2016/12

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1016/j.jtho.2016.09.124

DO - 10.1016/j.jtho.2016.09.124

M3 - Article

C2 - 27687962

VL - 11

SP - 2112

EP - 2119

JO - Journal of Thoracic Oncology

JF - Journal of Thoracic Oncology

SN - 1556-0864

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