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Published on: October 2, 2015
The revised staging system for malignant pleural mesothelioma based on surveillance, epidemiology, and end results
Shuai Wang1, Ke Ma1, Qun Wang1
1Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180#, Fenglin Road, Xuhui District, Shanghai, 200032, China.
Background:
Several staging systems for MPM have been introduced. However, none of them provide perfect survival stratification among heterogeneous patients. The aim of this population-based cohort study was to propose adjustments to current staging system for malignant pleural mesothelioma (MPM).
Methods:
We retrieved MPM data from Surveillance, Epidemiology, and End Results database (1973-2014). Kaplan-Meier method was derived to examine the prognostic effects of tumor, lymph node, metastasis and histology features. Proportional hazards models guided adjustments to stage groupings. The accuracy of staging systems at predicting survival was evaluated by concordance index and bootstrap resampling.
Results:
A total of 1110 MPM cases were extracted from SEER. T stage failed to demonstrate survival difference between adjacent categories with the exception of T3 versus T4 (P < 0.001). Patients in M0 had better prognosis than those in M1 (P < 0.001). Exploratory analyses suggested important survival difference for single-versus multiple-site M1 cases (P < 0.001), but not for different metastatic sites (P = 0.286). Histology subtype was a significant prognostic indicator (P < 0.001). Regrouping of TNM and histology combinations resulted in the best concordance index (0.683), compared with UICC 2010 (0.578) and IASLC 2016 (0.585) staging systems. The revised staging system also improved patients distribution (IA:33.8%, IB:17.0%, II: 20.7%, IIIA:10.6%, IIIB: 6.8%, IV:11.1%). Log-rank analyses and calibration plots both demonstrated the new stage achieved optimal survival prediction and discrimination.
Conclusion:
The revised staging system improved patients distribution and survival stratification for MPM.
Insights
A revised staging system for malignant pleural mesothelioma (MPM) improves patient distribution and survival prediction. This new system offers better stratification for heterogeneous MPM patient populations compared to existing methods.
Area of Science:
- Oncology
- Thoracic Surgery
- Epidemiology
Background:
- Existing staging systems for malignant pleural mesothelioma (MPM) lack optimal survival stratification for heterogeneous patient groups.
- There is a need for improved prognostic accuracy in MPM patient management.
Purpose of the Study:
- To propose adjustments to current staging systems for malignant pleural mesothelioma (MPM).
- To enhance survival stratification and patient distribution for MPM.
Main Methods:
- Utilized population-based cohort data from the Surveillance, Epidemiology, and End Results (SEER) database (1973-2014).
- Employed Kaplan-Meier analysis and proportional hazards models to assess prognostic factors (tumor, lymph node, metastasis, histology).
- Evaluated staging system accuracy using concordance index and bootstrap resampling.
Main Results:
- The revised TNM and histology combination staging system achieved a higher concordance index (0.683) than UICC 2010 (0.578) and IASLC 2016 (0.585).
- Histology subtype and metastasis status (M0 vs. M1, single vs. multiple M1 sites) were significant prognostic indicators.
- The new system improved patient distribution across stages and demonstrated optimal survival prediction and discrimination.
Conclusions:
- The revised staging system significantly enhances patient distribution and survival stratification for malignant pleural mesothelioma.
- This adjusted system offers improved prognostic accuracy for heterogeneous MPM patient populations.
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