1. A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database.
- Author
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Yan, Tristan D., Deraco, Marcello, Elias, Dominique, Glehen, Olivier, Levine, Edward A., Moran, Brendan J., Morris, David L., Chua, Terence C., Piso, Pompiliu, and Sugarbaker, Paul H.
- Subjects
PERITONEUM tumors ,CANCER patients ,DRUG therapy ,TUMOR surgery ,CANCER treatment - Abstract
BACKGROUND: Currently, no tumor-node-metastasis (TNM) staging system exists for patients with diffuse malignant peritoneal mesothelioma (DMPM). The primary objective was to formulate a clinicopathological staging system through the identification of significant prognostic parameters. METHODS: Eight international institutions with prospectively collected data on patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy contributed to the registry. Two hundred ninety-four patients had complete clinicopathological data and formed the basis of this staging project. RESULTS: Peritoneal cancer index (PCI) was categorized into T
1 (PCI 1-10), T2 (PCI 11-20), T3 (PCI 21-30), and T4 (PCI 30-39). Twenty-two patients had positive lymph nodes (N1) and 12 patients had extra-abdominal metastases (M1). The survival for patients with T1 (PCI 1-10) N0 M0 was significantly superior to the other patients. This group of patients is therefore designated as Stage I. The survival of patients with T2 (PCI 11-20) and T3 (PCI 21-30), in absence of N1 or M1 disease, was similar. This group of patients was categorized as Stage II. The survival of patients with T4 (PCI 30-39), N1 , and/or M1 was similarly poor. This group of patients was therefore categorized as Stage III. Three prognostic factors were independently associated with survival in the multivariate analysis: histological subtype, completeness of cytoreduction, and the proposed TNM staging. The 5-year survival associated with Stage I, II, and III disease was 87%, 53%, and 29%, respectively. CONCLUSIONS: The proposed TNM staging system resulted in significant stratification of survival by stage when applied to the current multi-institutional registry data. [ABSTRACT FROM AUTHOR]- Published
- 2011
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