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Supplementary prognostic variables for pleural mesothelioma: a report from the IASLC staging committee
Harvey I Pass1, Dorothy Giroux, Catherine Kennedy
1*Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York; †Statistics Department, Cancer Research and Biostatistics, Seattle, Washington; ‡Department of Cardiothoracic Surgery, University of Sydney, Strathfield Private Hospital Campus, Sydney, Australia; §Department of Thoracic Surgery, University of Torino, Ospedale San Giovanni Battista, Torino, Italy; ‖Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey; ¶Department of Thoracic and Cardiovascular Surgery, M. D. Anderson Cancer Center, Houston, Texas; #Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan; **Department of Thoracic Surgery, Glenfield Hospital, Leicester, United Kingdom; ††Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom; ‡‡Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland; §§Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany; ‖‖Thoracic Oncology, University Hospital, Ghent, Belgium; and ¶¶Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Introduction:
The staging system for malignant pleural mesothelioma is controversial. To revise this system, the International Association for the Study of Lung Cancer Staging Committee developed an international database. This report analyzes prognostic variables in a surgical population, which are supplementary to previously published CORE variables (stage, histology, sex, age, and type of procedure).
Methods:
Supplementary prognostic variables were studied in three scenarios: (1) all data available, that is, patient pathologically staged and other CORE variables available (2) only clinical staging available along with CORE variables, and (3) only age, sex, histology, and laboratory parameters are known. Survival was analyzed by Kaplan-Meier, prognostic factors by log rank and stepwise Cox regression modeling after elimination of nonsignificant variables. p value less than 0.05 was significant.
Results:
A total of 2141 patients with best tumor, node, metastasis (TNM) stages (pathologic with/without clinical staging) had nonmissing age, sex, histology, and type of surgical procedure. Three prognostic models were defined. Scenario A (all parameters): best pathologic stage, histology, sex, age, type of surgery, adjuvant treatment, white blood cell count (WBC) (≥15.5 or not), and platelets (≥400 k or not) (n = 550). Scenario B (no surgical staging): clinical stage, histology, sex, age, type of surgery, adjuvant treatment, WBC, hemoglobin (<14.6 or not), and platelets (n = 627). Scenario C (limited data): histology, sex, age, WBC, hemoglobin, and platelets (n = 906).
Conclusion:
Refinement of these models could define not only the appropriate patient preoperatively for best outcomes after cytoreductive surgery but also stratify surgically treated patients after clinical and pathologic staging who do or do not receive adjuvant therapy.
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01:28Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations: