| Surgical assessment of malignant pleural mesothelioma: have we reached a critical stage? | |
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MedLine Citation:
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PMID: 20138534 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The International Mesothelioma Interest Group (IMIG) classification is the most widely used staging system but is based on post-resectional parameters. We aimed to test the association between clinical and pathological staging and to identify possible discrepancies. METHODS: We identified 164 consecutive patients (144 males and 20 females, with mean age 58 years) who underwent radical surgery (114 extrapleural pneumonectomy; 50 radical pleurectomy/decortication) for malignant pleural mesothelioma (MPM). The patients were clinically staged with CT + or - MRI (CT, computed tomography; MRI, magnetic resonance imaging). RESULTS: Clinical T (cT) stage proved to be the same as pathological T (pT) stage in 44%; understaged in 46% and overstaged in 10%. Clinical N (cN) stage proved to be the same as pathological N (pN) stage in 56%; understaged in 31% and overstaged in 13%. Disease-free interval (DFI) was associated with cT stage (median DFI 29 months, SE 13, 95% CI 3-54 months for cT1; median 5, SE 3, 95% CI 3-6 months for cT4, p=0.02) but not clinical N stage (median DFI 12 months, SE 1, 95% CI 9-15 months for cN0; median DFI 11 months, SE 0.3, 95% CI 10-12 months for cN2, p=0.5) and was associated with both pT (median DFI 31 months, SE 17, 95% CI 0-64 months for pT1; median DFI 8 months, SE1, 95% CI 6-11 months for pT4, p=0.03) and pN stage (median DFI 14 months, SE 3, 95% CI 9-20 months for pN0; median DFI 10 months, SE 1, 95% CI 8-13 months for pN2, p=0.02). Overall survival was associated with cT stage (median survival 25 months, SE 3, 95% CI 20-30 months for cT1; median survival 11 months, SE 3, 95% CI 10-11 months for cT4, p=0.01) but not cN stage (median survival 15 months, SE 2, 95% CI 11-19 months for cN0; median survival 15 months, SE 2, 95% CI 12-19 months for cN2, p=0.49) and pN stage (median survival 22 months, SE 3, 95% CI 19-27 months for pN0; median survival 14 months, SE 1, 95% CI 12-17 months for pN2, p=0.01) but not pT stage (median survival 27 months, SE 4, 95% CI 19-35 months for pT1; median survival 12 months, SE 2, 95% CI 9-15 months for pT4, p=0.06). Pathological IMIG stage was associated with DFI and overall survival; however, preoperative IMIG stage was less useful. CONCLUSIONS: There are deficiencies in the current staging system for MPM and discrepancies between clinical and pathological systems. Future improvements are needed in clinical descriptors of nodal status and pathological descriptors of T stage. Subsequent IMIG stage grouping also needs revision. |
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Authors:
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Apostolos Nakas; Edward Black; James Entwisle; Salli Muller; David A Waller |
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Publication Detail:
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Type: Journal Article Date: 2010-02-06 |
Journal Detail:
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Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Volume: 37 ISSN: 1873-734X ISO Abbreviation: Eur J Cardiothorac Surg Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-31 Completed Date: 2011-04-06 Revised Date: 2011-06-02 |
Medline Journal Info:
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Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: Germany |
Other Details:
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Languages: eng Pagination: 1457-63 Citation Subset: IM |
Copyright Information:
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Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
Affiliation:
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Department of Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. apostolos.nakas@uhl-tr.nhs.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Epidemiologic Methods Female Humans Magnetic Resonance Imaging Male Mesothelioma / pathology*, surgery Middle Aged Neoplasm Staging Pleural Neoplasms / pathology*, surgery Pneumonectomy / methods Prognosis Recurrence Tomography, X-Ray Computed Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Eur J Cardiothorac Surg. 2011 May;39(5):800; author reply 800-1
[PMID:
20870418
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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