title: Do we need a revised staging system for malignant pleural mesothelioma? Analysis of the IASLC database.
abstract: BACKGROUND
  A number of staging systems have been proposed for malignant pleural mesothelioma (MPM) in the past, but few have utilized a TNM (tumor, node, metastasis) system. The International Association for the Study of Lung Cancer (IASLC) and the International Mesothelioma Interest Group (IMIG) previously developed a TNM-staging system which has been accepted by the International Union Against Cancer (UICC) and the American Joint Commission on Cancer (AJCC). The present study examines this staging system by analysing the updated IASLC database for patients with MPM.
  
  
  METHODS
  De-identified data from participating centres dated from 1995 to 2009 were submitted to the IASLC Statistical Center. Surgical procedures included those with a curative or palliative intent. Survival was measured from the date of pathologic diagnosis to the most recent contact or death. Endpoints included overall survival and analysis of potential prognostic factors.
  
  
  RESULTS
  Data was available for 3,101 patients from 15 centers, mostly from North America and Europe. After a median follow-up of 15 months, a number of clinicopathological and treatment-related prognostic factors were found to significantly influence overall survival. These included overall tumor stage based on the proposed TNM staging system, T category, N category, tumor histology, gender, age, and type of operation.
  
  
  CONCLUSIONS
  The IASLC database represents the largest, multicenter and international database on MPM to date. Analyses demonstrate that the proposed TNM staging system effectively distinguishes the T and N categories, but also highlight areas for potential revision in the future.
authors: Memorial Sloan-Kettering Cancer Center, New York, NY, USA;
authors: Valerie W
authors: VW
authors: Rusch
authors: Dorothy
authors: D
authors: Giroux
keywords: Pleural mesothelioma; decortication; extrapleural pneumonectomy; multi-institutional database; pleurectomy; staging; survival; trimodality therapy
references: J Thorac Cardiovasc Surg. 2006 May;131(5):981-7
references: 16678579
references: Clin Cancer Res. 2010 Apr 15;16(8):2409-17
references: 20371686
references: Lancet Oncol. 2011 Aug;12(8):763-72
references: 21723781
references: Chest. 1995 Oct;108(4):1122-8
references: 7555126
references: Eur J Cardiothorac Surg. 2010 Jun;37(6):1457-63
references: 20138534
references: Lung Cancer. 2007 Jul;57(1):89-95
references: 17403553
references: J Clin Oncol. 2004 Sep 1;22(17):3451-7
references: 15337794
references: Ann Thorac Surg. 2007 Nov;84(5):1685-92; discussion 1692-3
references: 17954086
references: J Thorac Cardiovasc Surg. 2009 Sep;138(3):619-24
references: 19698846
references: Ann Thorac Surg. 2008 Apr;85(4):1206-10
references: 18355497
references: Med Phys. 2011 Jan;38(1):238-44
references: 21361192
references: Eur J Cardiothorac Surg. 2008 Oct;34(4):886-91
references: 18656373
references: Eur Respir J. 2010 Mar;35(3):479-95
references: 19717482
references: J Thorac Oncol. 2007 Aug;2(8):706-14
references: 17762336
references: J Thorac Cardiovasc Surg. 2001 Oct;122(4):788-95
references: 11581615
references: J Clin Oncol. 2009 Mar 20;27(9):1413-8
references: 19224855
references: J Thorac Cardiovasc Surg. 2008 Mar;135(3):620-6, 626.e1-3
references: 18329481
references: J Thorac Cardiovasc Surg. 1996 Apr;111(4):815-25; discussion 825-6
references: 8614142
references: Eur J Cardiothorac Surg. 2011 Aug;40(2):298-303
references: 21310625
references: J Thorac Oncol. 2009 Aug;4(8):1010-6
references: 19546819
references: Ann Thorac Cardiovasc Surg. 2011;17(3):243-9
references: 21697784
references: Ann Thorac Surg. 2008 Jan;85(1):257-64; discussion 264
references: 18154820
references: Eur Respir J. 2010 Dec;36(6):1362-9
references: 20525721
references: J Clin Oncol. 2009 Jun 20;27(18):3007-13
references: 19364962
references: Eur J Cardiothorac Surg. 2010 Mar;37(3):552-6
references: 19717307
references: Interact Cardiovasc Thorac Surg. 2011 May;12(5):754-7
references: 21303872
references: J Thorac Cardiovasc Surg. 2008 Sep;136(3):605-10
references: 18805259
references: Cancer. 2010 Mar 15;116(6):1510-7
references: 20108310
references: Lancet Oncol. 2011 Nov;12(12):1093-4; author reply 1094-5
references: 22041539
references: J Clin Oncol. 2003 Jul 15;21(14):2636-44
references: 12860938
references: Lung Cancer. 2011 Jan;71(1):75-81
references: 19765853
references: Eur J Cardiothorac Surg. 2007 May;31(5):765-70; discussion 770-1
references: 17337201
references: J Thorac Oncol. 2007 Oct;2(10):957-65
references: 17909360
references: J Thorac Oncol. 2008 May;3(5):499-504
references: 18449002
references: Ann Oncol. 2007 Jul;18(7):1196-202
references: 17429100
references: J Thorac Cardiovasc Surg. 2007 Jan;133(1):111-6
references: 17198794
references: Ann Thorac Surg. 2008 May;85(5):1740-6
references: 18442576
references: J Thorac Oncol. 2012 Nov;7(11):1631-9
references: 23070243
references: J Thorac Oncol. 2010 Oct;5(10):1692-703
references: 20802345
references: J Thorac Oncol. 2010 Jun;5(6):879-84
references: 20421814
references: Eur Radiol. 2008 Aug;18(8):1635-43
references: 18369634
references: Eur Respir J. 2011 Jul;38(1):162-8
references: 21273389
references: Jpn J Clin Oncol. 2009 Mar;39(3):186-8
references: 19131427
references: Eur J Radiol. 2010 Apr;74(1):130-5
references: 19268516
references: Eur J Cardiothorac Surg. 2008 Jul;34(1):204-7
references: 18407510