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Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines
Published on: April 21, 2022
Comparative analysis of prognostic histopathologic parameters in subtypes of epithelioid pleural mesothelioma
Agnes Bilecz1, Paul Stockhammer2,3, Dirk Theegarten4
12nd Institute of Pathology, Semmelweis University, Budapest, Hungary.
Aims:
Malignant pleural mesothelioma (MPM) is a rare malignancy with a dismal prognosis. While the epithelioid type is associated with a more favourable outcome, additional factors are needed to further stratify prognosis and to identify patients who can benefit from multimodal treatment. As epithelioid MPM shows remarkable morphological variability, the prognostic role of the five defined morphologies, the impact of the nuclear grading system and the mitosis-necrosis score were investigated in this study.
Methods And Results:
Tumour specimens of 192 patients with epithelioid MPM from five European centres were histologically subtyped. Nuclear grading and mitosis-necrosis score were determined and correlated with clinicopathological parameters and overall survival (OS). Digital slides of 55 independent cases from The Cancer Genome Atlas (TCGA) database were evaluated for external validation. Histological subtypes were collapsed into three groups based on their overlapping survival curves. The tubulopapillary/microcystic group had a significantly longer OS than the solid/trabecular group (732 days versus 397 days, P = 0.0013). Pleomorphic tumours had the shortest OS (173 days). The solid/trabecular variants showed a significant association with high nuclear grade and mitosis-necrosis score. The mitosis-necrosis score was a robust and independent prognostic factor in our patient cohort. The prognostic significance of all three parameters was externally validated in the TCGA cohort. Patients with tubulopapillary or microcystic tumours showed a greater improvement in OS after receiving multimodal therapy than those with solid or trabecular tumours.
Conclusions:
Histological subtypes of epithelioid MPM have a prognostic impact, and might help to select patients for intensive multimodal treatment approaches.
Insights
Histological subtypes of epithelioid malignant pleural mesothelioma (MPM) impact prognosis. Tubulopapillary/microcystic types show better survival and benefit more from multimodal therapy than solid/trabecular types.
Area of Science:
- Oncology
- Pathology
Background:
- Malignant pleural mesothelioma (MPM) is a rare cancer with poor prognosis.
- Epithelioid MPM has variable morphology, necessitating better prognostic factors.
- Identifying patients for multimodal therapy requires refined prognostic stratification.
Purpose of the Study:
- Investigate the prognostic role of epithelioid MPM morphologies.
- Assess the impact of nuclear grading and mitosis-necrosis scoring.
- Determine if these factors can guide treatment selection.
Main Methods:
- Histological subtyping of 192 epithelioid MPM cases from five European centers.
- Correlation of subtypes, nuclear grade, and mitosis-necrosis score with survival.
- External validation using 55 cases from The Cancer Genome Atlas (TCGA).
Main Results:
- Tubulopapillary/microcystic MPM had significantly longer overall survival (OS) than solid/trabecular (732 vs. 397 days).
- Pleomorphic tumors showed the shortest OS (173 days).
- Mitosis-necrosis score was an independent prognostic factor, validated in TCGA data.
Conclusions:
- Epithelioid MPM histological subtypes significantly impact prognosis.
- These subtypes can help select patients for intensive multimodal treatment.
- Nuclear grade and mitosis-necrosis score are valuable prognostic indicators.
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