A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database
✍ Scribed by Tristan D. Yan; Marcello Deraco; Dominique Elias; Olivier Glehen; Edward A. Levine; Brendan J. Moran; David L. Morris; Terence C. Chua; Pompiliu Piso; Paul H. Sugarbaker; Peritoneal Surface Oncology Group
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 412 KB
- Volume
- 117
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
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), t(2) (pci 11-20), t(3) (pci 21-30), and t(4) (pci 30-39). twenty-two patients had positive lymph nodes (n(1) ) and 12 patients had extra-abdominal metastases (m(1) ). the survival for patients with t(1) (pci 1-10) n(0) m(0) was significantly superior to the other patients. this group of patients is therefore designated as stage i. the survival of patients with t(2) (pci 11-20) and t(3) (pci 21-30), in absence of n(1) or m(1) disease, was similar. this group of patients was categorized as stage ii. the survival of patients with t(4) (pci 30-39), n(1,) and/or m(1) 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.