title: Malignant Pleural Mesothelioma : Rationale for a New TNM Classification.
abstract: BACKGROUND
  Malignant pleural mesothelioma (MPM) is a rare but aggressive thoracic malignancy with a poor prognosis. In this regard, a well-defined staging system is of utmost importance in order to correctly diagnose and assign an appropriate treatment to the patient.
  
  
  METHODS
  The current TNM-staging system (7th edition) enables to either clinically or pathologically stage the severity of the disease according to extension of the tumor (T), number of nodes (N) and presence of metastases (M). Patients with stage I-III are considered for surgery, while palliative treatment is indicated for stage IV patients according to the current classification.
  
  
  RESULTS
  Despite its widespread use, the validity of this staging system is questioned due to the low prevalence, histological variety and retrospective nature of the previous study design. In addition, the role of specific treatment modalities including surgery, has yet to be determined, especially for treatment of early-stage disease. In this regard, the International Association for the Study of Lung Cancer (IASLC) initiated the multi-centre, prospective "Mesothelioma Staging Project" in order to address limitations of the 7th edition and to optimize the staging system in accordance to current needs.
  
  
  CONCLUSIONS
  An improved staging system will contribute to the design of prospective multi-institutional clinical trials investigating novel treatment strategies for mesothelioma. In this way comparison of outcome between different medical centres also becomes feasible.
authors.affiliation: Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium.
authors.forename: C
authors.initials: C
authors.lastname: De Laet
authors.forename: A
authors.initials: A
authors.lastname: Domen
authors.forename: K J
authors.initials: KJ
authors.lastname: Cheung
authors.forename: E
authors.initials: E
authors.lastname: Meulemans
authors.forename: P
authors.initials: P
authors.lastname: Lauwers
authors.forename: J M
authors.initials: JM
authors.lastname: Hendriks
authors.forename: P E
authors.initials: PE
authors.lastname: Van Schil
mesh_terms: D003131:Combined Modality Therapy; D008175:Lung Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D008654:Mesothelioma / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D000086002:Mesothelioma, Malignant; D009367:Neoplasm Staging / Q000379:methods*; D010997:Pleural Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies