Morphological aspects as prognostic factors in malignant mesothelioma: a study of 58 cases.
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.
Motta
Alexandre Bottrel
AB
Department of Pathology School of Medicine, University of São Paulo, SP, Brazil.
Pinheiro
Germânia
G
Antonângelo
Leila
L
Parra
Edwin Roger
ER
Monteiro
Maria Margarida
MM
Pereira
José Carlos das Neves
JC
Takagaki
Tereza
T
Terra Filho
Mario
M
Martins
Sandro
S
Capelozzi
Vera Luiza
VL
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
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