The IASLC Mesothelioma Staging Project: Proposals for Revisions of the N Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma.
Nodal categories for malignant pleural mesothelioma are derived from the lung cancer staging system and have not been adequately validated. The International Association for the Study of Lung Cancer developed a multinational database to generate evidence-based recommendations to inform the eighth edition of the TNM classification of malignant pleural mesothelioma.



Data from 29 centers were entered prospectively (n = 1566) or by transfer of retrospective data (n = 1953). Survival according to the seventh edition N categories was evaluated using Kaplan-Meier survival curves and Cox proportional hazards regression analysis. Survival was measured from the date of diagnosis.



There were 2432 analyzable cases: 1603 had clinical (c) staging, 1614 had pathologic (p) staging, and 785 had both. For clinically staged tumors there was no separation in Kaplan-Meier curves between cN0, cN1 or cN2 (cN1 versus cN0 hazard ratio [HR] = 1.06, p = 0.77 and cN2 versus cN1 HR = 1.04, p = 0.85). For pathologically staged tumors, patients with pN1 or pN2 tumors had worse survival than those with pN0 tumors (HR = 1.51, p < 0.0001) but no survival difference was noted between those with pN1 and pN2 tumors (HR = 0.99, p = 0.99). Patients with both pN1 and pN2 nodal involvement had poorer survival than those with pN2 tumors only (HR = 1.60, p = 0.007) or pN0 tumors (HR = 1.62, p < 0.0001).



A recommendation to collapse both clinical and pN1 and pN2 categories into a single N category comprising ipsilateral, intrathoracic nodal metastases (N1) will be made for the eighth edition staging system. Nodes previously categorized as N3 will be reclassified as N2.
M. D. Anderson Cancer Center, Houston, Texas. Electronic address: drice@mdanderson.org.
David
D
Rice
Cancer Research And Biostatistics, Seattle, Washington.
Kari
K
Chansky
University of Western Australia, Perth, Australia.
Anna
A
Nowak
New York University School of Medicine, New York, New York.
Harvey
H
Pass
University of Chicago, Chicago, Illinois.
Hedy
H
Kindler
Cancer Research And Biostatistics, Seattle, Washington.
Lynn
L
Shemanski
University of Zurich, Zurich, Switzerland.
Isabelle
I
Opitz
Hospital Universitari Mutua Terrassa, Terrassa, Spain.
Sergi
S
Call
Hyogo College of Medicine, Hyogo, Japan.
Seiki
S
Hasegawa
University of Texas Southwestern Medical Center, Dallas, Texas.
Kemp
K
Kernstine
Sureyyapasa Training and Research Hospital, Istanbul, Turkey.
Cansel
C
Atinkaya
University of Padua, Padua, Italy.
Federico
F
Rea
Katholieke Universiteit Leuven-University Hospital Leuven, Leuven, Belgium.
Philippe
P
Nafteux
Memorial Sloan-Kettering Cancer Center, New York, New York.
Valerie W
VW
Rusch
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
Cancer staging; Database; Mesothelioma; Nodal metastases