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Updated: Dec 8, 2025
Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines
Published on: April 21, 2022
Does size matter? -a population-based analysis of malignant pleural mesothelioma
Jiaxi He1,2,3,4, Songhui Xu1, Hui Pan2,3,4
1Department of Pathology, University of Maryland Baltimore, School of Medicine, Baltimore, MD, USA.
Background:
The 8th edition staging system for malignant pleural mesothelioma (MPM) has been proposed. The size of tumor is not taken into consideration. We intend to elucidate the prognostic value of the size of MPM and evaluate the current staging system via the data of SEER database.
Methods:
All cases of primary MPM were identified and extracted from the SEER database during the period of 2004-2016. The endpoints were overall survival (OS) and cancer-specific survival (CSS) which were analyzed using Kaplan-Meier method. Log-rank test and Cox regression were utilized to identify the prognostic factors.
Results:
A total of 2,138 patients were included in the primary cohort. The 1-, 3- and 5-year survival rates of MPM were 39.4%, 11.8% and 3.8%. Older, male and advanced stage patients accounted for larger proportion of the cohort. Besides tumor extension, lymph node involvement and metastatic status, tumor size, pathological type and differentiation grade were significant prognostic factors. In the stratified analysis of tumor extension, size is a significant prognostic factor in T2 patients and indicates inferior survival outcomes. Surgery, chemotherapy and radiation can increase both OS and CSS in MPM patients. Triple combination treatments showed a superiority to other treatments.
Conclusions:
Tumor size matters in the prognosis of MPM especially in the early stage of MPM patients. The adjusted TNM staging system incorporating tumor size has better accuracy than the 8th edition IMIG system. However, some stages had not been fully identified. More cases of early stages are warranted for essential revision.
Insights
Tumor size is a significant prognostic factor for malignant pleural mesothelioma (MPM), particularly in early stages. Incorporating tumor size into staging systems improves accuracy over the current 8th edition IMIG system for predicting patient survival.
Area of Science:
- Oncology
- Thoracic Surgery
- Cancer Staging
Background:
- The 8th edition staging system for malignant pleural mesothelioma (MPM) does not consider tumor size.
- The prognostic value of tumor size in MPM requires further investigation.
Purpose of the Study:
- To determine the prognostic significance of tumor size in MPM.
- To evaluate the accuracy of the current MPM staging system using SEER database data.
Main Methods:
- Retrospective analysis of 2,138 primary MPM cases from the SEER database (2004-2016).
- Kaplan-Meier method for overall survival (OS) and cancer-specific survival (CSS) analysis.
- Log-rank test and Cox regression to identify prognostic factors.
Main Results:
- Tumor size, pathological type, and differentiation grade are significant prognostic factors in MPM.
- Tumor size is a significant prognostic factor in T2 patients, indicating poorer survival.
- Surgery, chemotherapy, and radiation improve OS and CSS; triple combination therapy is superior.
Conclusions:
- Tumor size is a critical prognostic factor for MPM, especially in early stages.
- An adjusted TNM staging system including tumor size demonstrates superior accuracy compared to the 8th edition IMIG system.
- Further revision of staging systems is needed, particularly for early-stage MPM cases.
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