title: Morphological aspects as prognostic factors in malignant mesothelioma: a study of 58 cases.
abstract: OBJECTIVE
  Various markers have shown promise as diagnostic markers and prognostic predictors in malignant mesothelioma (MM).
  
  
  METHODS
  Through morphometric and immunological studies of markers in stromal components (calretinin, CEA, Leu-M1 and thrombomodulin) and nuclear components (p53 and Ki-67), we evaluated post-diagnosis survival in 58 patients with MM.
  
  
  RESULTS
  The histologic pattern of the MM was typical in 50 cases and atypical in 8. Through immunohistochemistry, we confirmed 40 cases of mesothelioma and 11 cases of adenocarcinoma, although we were unable to classify 7 of the 8 cases presenting atypical histologic patterns. Cox multivariate analysis revealed that the risk factor for death was higher (476.2) among patients of advanced age, presenting the biphasic subtype and testing positive for components expressed at the nuclear level.
  
  
  CONCLUSIONS
  The most useful immunohistochemical markers were was calretinin (for mesothelioma) and CEA (for adenocarcinoma). Immunohistochemical quantification of thrombomodulin facilitated the diagnosis of mesothelioma in patients testing positive for both calretinin and CEA. The most useful prognostic information was that provided by the routine histopathological analysis of the tumor type. It is of note that the combination of a mean age of 55 years and 30.5% immunohistochemical markers in nuclear components created a natural dividing point between patients in which survival was shorter than expected and those in which it was longer than expected. Therefore, histopathological analysis offers a powerful weapon with great potential to inform decisions regarding the use of adjuvant chemotherapy after surgical excision of a mesothelioma.
authors.affiliation: Department of Pathology School of Medicine, University of São Paulo, SP, Brazil.
authors.forename: Alexandre Bottrel
authors.initials: AB
authors.lastname: Motta
authors.forename: Germânia
authors.initials: G
authors.lastname: Pinheiro
authors.forename: Leila
authors.initials: L
authors.lastname: Antonângelo
authors.forename: Edwin Roger
authors.initials: ER
authors.lastname: Parra
authors.forename: Maria Margarida
authors.initials: MM
authors.lastname: Monteiro
authors.forename: José Carlos das Neves
authors.initials: JC
authors.lastname: Pereira
authors.forename: Tereza
authors.initials: T
authors.lastname: Takagaki
authors.forename: Mario
authors.initials: M
authors.lastname: Terra Filho
authors.forename: Sandro
authors.initials: S
authors.lastname: Martins
authors.forename: Vera Luiza
authors.initials: VL
authors.lastname: Capelozzi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D000951:Antigens, Neoplasm / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis*; D064032:Calbindin 2; D002272:Carcinoembryonic Antigen / Q000032:analysis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D016256:Lewis X Antigen; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D064030:S100 Calcium Binding Protein G / Q000032:analysis; D016019:Survival Analysis; D018180:Thrombomodulin / Q000032:analysis; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C576764:CALB2 protein, human; D064032:Calbindin 2; D002272:Carcinoembryonic Antigen; D019394:Ki-67 Antigen; C407642:Leu-M1 antigen; D016256:Lewis X Antigen; D064030:S100 Calcium Binding Protein G; D018180:Thrombomodulin; D016159:Tumor Suppressor Protein p53