Chest
Special Report: ArticlesA Proposed New International TNM Staging System for Malignant Pleural Mesothelioma
Section snippets
Materials and Methods
The IMIG members listed in Appendix I who have been primary authors of large retrospective series or principal investigators in clinical trials in MPM presented their data with respect to the influence of T and N status and of other potential prognostic factors on overall survival. These data were used to create a TNM-based system that potentially can be applied to the radiographic, surgical, and pathologic staging of MPM. The precise TNM descriptors were developed by consensus during the
Results
The proposed new International Staging System for MPM is shown in Table 6. It includes precise TNM descriptors that are grouped into a stage I through IV classification. Though potentially applicable to radiographic staging by CT scan, these TNM descriptors are primarily based on surgical and pathologic findings.
T1 is divided into la and 1b. T1a describes a very early tumor that involves only the ipsilateral parietal pleura with or without tumor on the diaphragmatic or mediastinal pleura. The
Discussion
Until 30 years ago, MPM was thought to be a rare and idiopathic tumor. The link between asbestos exposure and the subsequent development of MPM was first established in 1960 by Wagner et al.12 Because of the histologic similarities between the epithelial form of MPM and adenocarcinoma, accurate pathologic diagnosis of MPM was initially challenging. It only became routine with the advent of electron microscopy and the increasing use of immunohis-tochemistry.13,14 The importance of CT scanning
ACKNOWLEDGMENT
The authors wish to acknowledge Melody Owens for her expert assistance in the preparation of this manuscript.
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Prepared by Valerie W. Rusch, MD, Attending Surgeon, Thoracic Service, Department of Surgery, and Member, Memorial Sloan-Kettering Cancer Center, New York.
This work was funded in part by educational grants from the International Association for the Study of Lung Cancer and the Oncology Division of the Bristol-Myers Corporation.
revision accepted June 7
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Members of the International Mesothelioma Interest Groups are listed in the Appendices at the end of this article.