Related Experiment Video
Updated: Jan 19, 2026
Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines
Published on: April 21, 2022
Development of a Novel Prognostic Risk Classification System for Malignant Pleural Mesothelioma
Hiroshi Doi1, Kozo Kuribayashi2, Kazuhiro Kitajima3
1Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
Introduction:
This study aimed to assess prognostic factors to better understand malignant pleural mesothelioma (MPM) and to develop a new classification protocol beyond the standard tumor node metastasis (TNM) staging system.
Materials And Methods:
We retrospectively reviewed the data of 188 patients with MPM who had not undergone surgical resection. For each patient, we calculated the maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis (TLG) on pretreatment 18F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography. Using the Cox proportional hazards model, we evaluated the relationships among potential MPM predictors, including age, gender, performance status, histologic type, stage, possible serum markers, and volume-based positron emission tomography parameters, as well as overall survival.
Results:
The median survival was 461 days, and the 1- and 2-year overall survival rates were 60.70% and 31.10%, respectively. Univariate and multivariate analyses revealed that the significant independent predictors of poor survival outcomes were the non-epithelioid histologic type, elevated serum lactate dehydrogenase levels, a neutrophil-to-lymphocyte ratio of ≥ 5.0, and a TLG of ≥ 525 g. We then used these results to develop a prognostic risk classification system. From the resulting survival curve, we found a significant difference among the 3 risk groups of independent variables. Moreover, there were significant differences between all pairs of 2 separated risk groups.
Conclusions:
Pathologic subtypes, serum lactate dehydrogenase, neutrophil-to-lymphocyte ratio, and TLG in 18F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography were independent and significant prognostic factors of MPM. Using this model, we created a new risk classification system that supplants the standard TNM staging protocol.
Insights
This study identified key prognostic factors for malignant pleural mesothelioma (MPM), including histology, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, and total lesion glycolysis (TLG). These factors form a new risk classification system for MPM patients.
Area of Science:
- Oncology
- Radiology
- Pathology
Background:
- Malignant pleural mesothelioma (MPM) is an aggressive cancer with limited prognostic tools.
- The standard tumor node metastasis (TNM) staging system may not fully capture prognostic variability in MPM.
- Identifying novel prognostic factors is crucial for improving patient stratification and treatment planning.
Purpose of the Study:
- To identify independent prognostic factors for overall survival in patients with malignant pleural mesothelioma (MPM).
- To develop a new risk classification system for MPM based on identified prognostic factors.
- To evaluate the utility of this new system in comparison to the standard TNM staging.
Main Methods:
- Retrospective review of 188 MPM patients who did not undergo surgical resection.
- Calculation of maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis (TLG) using 18F-FDG-PET/CT.
- Cox proportional hazards model analysis to assess predictors of overall survival, including clinical, serological, and imaging parameters.
Main Results:
- Non-epithelioid histology, elevated serum lactate dehydrogenase, neutrophil-to-lymphocyte ratio ≥ 5.0, and TLG ≥ 525 g were significant independent predictors of poor survival.
- A new prognostic risk classification system was developed, demonstrating significant differences in survival among three risk groups.
- The developed classification system showed significant differences between all pairs of risk groups.
Conclusions:
- Pathologic subtypes, serum lactate dehydrogenase, neutrophil-to-lymphocyte ratio, and TLG are significant independent prognostic factors for MPM.
- A novel risk classification system based on these factors can be used to stratify MPM patients.
- This new system offers a potential alternative or supplement to the standard TNM staging protocol for MPM.
