The IASLC Mesothelioma Staging Project: Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma.
The M component and TNM stage groupings for malignant pleural mesothelioma (MPM) have been empirical. The International Association for the Study of Lung Cancer developed a multinational database to propose evidence-based revisions for the eighth edition of the TNM classification of MPM.



Data from 29 centers were submitted either electronically or by transfer of existing institutional databases. The M component as it currently stands was validated by confirming sufficient discrimination (by Kaplan-Meier analysis) with respect to overall survival (OS) between the clinical M0 (cM0) and cM1 categories. Candidate stage groups were developed by using a recursive partitioning and amalgamation algorithm applied to all cM0 cases.



Of 3519 submitted cases, 2414 were analyzable and 84 were cM1 cases. Median OS for cM1 cases was 9.7 months versus 13.4 months (p = 0.0013) for the locally advanced (T4 or N3) cM0 cases, supporting inclusion of only cM1 in the stage IV group. Exploratory analyses suggest a possible difference in OS for single- versus multiple-site cM1 cases. A recursive partitioning and amalgamation-generated survival tree on the OS outcomes restricted to cM0 cases with the newly proposed (eighth edition) T and N components indicates that optimal stage groupings for the eighth edition will be as follows: stage IA (T1N0), stage IB (T2-3N0), stage II (T1-2N1), stage IIIA (T3N1), stage IIIB (T1-3N2 or any T4), and stage IV (any M1).



This first evidence-based revision of the TNM classification for MPM leads to substantial changes in the T and N components and the stage groupings.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: ruschv@mskcc.org.
Valerie W
VW
Rusch
Cancer Research And Biostatistics, Seattle, Washington.
Kari
K
Chansky
Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.
Hedy L
HL
Kindler
National Centre for Asbestos Related Diseases, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Anna K
AK
Nowak
Department of Cardiothoracic Surgery, New York University Medical Center, New York, New York.
Harvey I
HI
Pass
Department of Thoracic and Cardiovascular Surgery, M.D. Anderson Cancer Center, Houston, Texas.
David C
DC
Rice
Cancer Research And Biostatistics, Seattle, Washington.
Lynn
L
Shemanski
Department of Biopathology, Centre Leon Berard, Lyon, France.
Françoise
F
Galateau-Sallé
Sydney Cardiothoracic Surgeons, Royal Prince Alfred Medical Centre, Sydney, New South Wales, Australia.
Brian C
BC
McCaughan
Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Takashi
T
Nakano
Department of Surgical Sciences, City of Health and Science Hospital, University of Turin, Turin, Italy.
Enrico
E
Ruffini
Department of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium.
Jan P
JP
van Meerbeeck
Department of Thoracic Surgery, Hyogo Cancer Center, Akashi City, Hyogo, Japan.
Masahiro
M
Yoshimura
D006801:Humans; D008175:Lung Neoplasms / Q000145:classification* / Q000473:pathology; D008654:Mesothelioma / Q000145:classification* / Q000473:pathology; D000086002:Mesothelioma, Malignant; D009367:Neoplasm Staging / Q000145:classification*; D010997:Pleural Neoplasms / Q000145:classification* / Q000473:pathology
Mesothelioma; Staging; Staging system; TNM stage groupings