title: Supplementary prognostic variables for pleural mesothelioma: a report from the IASLC staging committee.
abstract: BACKGROUND
  The staging system for malignant pleural mesothelioma is controversial. To revise this system, the International Association for the Study of Lung Cancer Staging Committee developed an international database. This report analyzes prognostic variables in a surgical population, which are supplementary to previously published CORE variables (stage, histology, sex, age, and type of procedure).
  
  
  METHODS
  Supplementary prognostic variables were studied in three scenarios: (1) all data available, that is, patient pathologically staged and other CORE variables available (2) only clinical staging available along with CORE variables, and (3) only age, sex, histology, and laboratory parameters are known. Survival was analyzed by Kaplan-Meier, prognostic factors by log rank and stepwise Cox regression modeling after elimination of nonsignificant variables. p value less than 0.05 was significant.
  
  
  RESULTS
  A total of 2141 patients with best tumor, node, metastasis (TNM) stages (pathologic with/without clinical staging) had nonmissing age, sex, histology, and type of surgical procedure. Three prognostic models were defined. Scenario A (all parameters): best pathologic stage, histology, sex, age, type of surgery, adjuvant treatment, white blood cell count (WBC) (≥15.5 or not), and platelets (≥400 k or not) (n = 550). Scenario B (no surgical staging): clinical stage, histology, sex, age, type of surgery, adjuvant treatment, WBC, hemoglobin (<14.6 or not), and platelets (n = 627). Scenario C (limited data): histology, sex, age, WBC, hemoglobin, and platelets (n = 906).
  
  
  CONCLUSIONS
  Refinement of these models could define not only the appropriate patient preoperatively for best outcomes after cytoreductive surgery but also stratify surgically treated patients after clinical and pathologic staging who do or do not receive adjuvant therapy.
authors.affiliation: *Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York; †Statistics Department, Cancer Research and Biostatistics, Seattle, Washington; ‡Department of Cardiothoracic Surgery, University of Sydney, Strathfield Private Hospital Campus, Sydney, Australia; §Department of Thoracic Surgery, University of Torino, Ospedale San Giovanni Battista, Torino, Italy; ‖Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey; ¶Department of Thoracic and Cardiovascular Surgery, M. D. Anderson Cancer Center, Houston, Texas; #Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan; **Department of Thoracic Surgery, Glenfield Hospital, Leicester, United Kingdom; ††Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom; ‡‡Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland; §§Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany; ‖‖Thoracic Oncology, University Hospital, Ghent, Belgium; and ¶¶Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Harvey I
authors.initials: HI
authors.lastname: Pass
authors.forename: Dorothy
authors.initials: D
authors.lastname: Giroux
authors.forename: Catherine
authors.initials: C
authors.lastname: Kennedy
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.forename: Ayten K
authors.initials: AK
authors.lastname: Cangir
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.forename: Hisao
authors.initials: H
authors.lastname: Asamura
authors.forename: David
authors.initials: D
authors.lastname: Waller
authors.forename: John
authors.initials: J
authors.lastname: Edwards
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.forename: Hans
authors.initials: H
authors.lastname: Hoffmann
authors.forename: Jan P
authors.initials: JP
authors.lastname: van Meerbeeck
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
mesh_terms: D000367:Age Factors; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D008654:Mesothelioma / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D008875:Middle Aged; D009367:Neoplasm Staging; D010976:Platelet Count; D010997:Pleural Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012737:Sex Factors
chemical_list: D006454:Hemoglobins