Related Experiment Video
Updated: Jun 16, 2026
Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines
Published on: April 21, 2022
Proposed adjustments to pathologic staging of epithelial malignant pleural mesothelioma based on analysis of 354
William G Richards1, John J Godleski, Beow Y Yeap
1Division of Thoracic Surgery, Brigham and Women's Hospital, Thoracic Surgery, 75 Francis Street, Boston, MA 02115, USA. wrichards@partners.org
Background:
Several pathologic staging systems for malignant pleural mesothelioma (MPM) have been published, but none of them provide optimal survival stratification or stage distribution among patients treated with surgery. Interpretation of prior studies that correlate pathologic factors with outcome has been confounded by the inclusion of patients undergoing differing surgical procedures and with varied tumor histology.
Methods:
We examined pathologic characteristics, previously included in published studies, and explored correlations with outcome among patients with epithelioid MPM who underwent extrapleural pneumonectomy (EPP) at Brigham and Women's Hospital (BWH). Comparisons of survival among patients with and without each tumor or lymph node feature guided adjustments to the American Joint Commission on Cancer (AJCC)/International Union Against Cancer (UICC) classification criteria. Proportional hazards modeling of TN combinations guided adjustments to stage groupings.
Results:
Three hundred fifty-four patients were resectable by EPP and had complete pathologic data. Overall median survival was 18 months from surgery. By AJCC/UICC criteria, 233 (66%) patients were stage III, whereas by BWH criteria, 194 (55%) patients were stage III. T classification criteria were adjusted based on prevalence and relation to survival. N status correlated significantly with survival. Regrouping of TN combinations based on relative hazard and Kaplan-Meier survival analysis resulted in improved stage distribution (stage I-IV: 8%, 43%, 33%, 16%, respectively) and survival stratification (51, 26, 15, 8 months, respectively).
Conclusions:
Proposed adjustments to TNM staging criteria improved outcome stratification of patients with epithelial tumor histology who received surgical therapy by EPP and complete pathologic assessment. Determining relevance to other treatment or staging modalities will require verification in additional cohorts.
Insights
This study refined staging for malignant pleural mesothelioma (MPM) surgery by adjusting TNM criteria. The new system improves survival prediction and stage distribution for patients undergoing extrapleural pneumonectomy (EPP).
Area of Science:
- Oncology
- Thoracic Surgery
- Pathology
Background:
- Existing staging systems for malignant pleural mesothelioma (MPM) lack optimal survival stratification and stage distribution for surgically treated patients.
- Prior studies are limited by heterogeneous patient cohorts undergoing different surgical procedures and varying tumor histology.
Purpose of the Study:
- To refine pathologic staging criteria for epithelioid MPM.
- To improve survival stratification and stage distribution for patients undergoing extrapleural pneumonectomy (EPP).
Main Methods:
- Examined pathologic characteristics of 354 patients with epithelioid MPM who underwent EPP.
- Correlated tumor and lymph node features with patient outcomes.
- Adjusted American Joint Commission on Cancer (AJCC)/International Union Against Cancer (UICC) criteria using proportional hazards modeling and Kaplan-Meier analysis.
Main Results:
- The proposed TNM staging adjustments resulted in improved stage distribution (Stage I-IV: 8%, 43%, 33%, 16%) and survival stratification (51, 26, 15, 8 months).
- N status significantly correlated with survival.
- The revised criteria provided better outcome stratification compared to existing AJCC/UICC criteria.
Conclusions:
- Adjustments to TNM staging criteria enhance outcome stratification for patients with epithelioid MPM undergoing EPP and complete pathologic assessment.
- Further validation in additional cohorts is needed to determine relevance for other treatment and staging modalities.
