Pathologic grading of malignant pleural mesothelioma

ǂan ǂevidence-based proposal

Giuseppe Pelosi (Avtor), Mauro Papotti (Avtor), Luisella Righi (Avtor), Giulio Rossi (Avtor), Stefano Ferrero (Avtor), Silvano Bosari (Avtor), Izidor Kern (Avtor)

Povzetek

Introduction: A pathologic grading system (PGS) for malignant pleural mesothelioma (MPM) is warranted to better identify different risk categories of patients, plan therapeutic options, and activate clinical trials. Methods: A series of 940 patients with MPM (328 in a training set and 612 in a validation set) that was diagnosed between October 1980 and June 2015 at the participant institutions was retrospectively assembled. A PGS was constructed by attributing to each histologic parameter, independent at multivariate analysis with excellent reproducibility (κ > 0.75), different scores based on the increase in corresponding hazard ratios. The relevant PGS score thus ranged from 0 to 8 points for individual patients with MPM. Conclusions: The PGS was constructed by taking into consideration the histological subtyping of MPM (epithelioid/biphasic = 0 points; sarcomatoid = 2 points), necrosis (absent = 0 points versus present = 1 point), mitotic count per 1 mm2 (cutoffs as follows: 1-2 = 0 points, 3-5 = 1 point, 6-9 = 2 points, or ≥10 = 4 points), and Ki-67 labeling index based on 2000 cells (<30% = 0 points versus ≥30 = 1 point), all of which are independent factors in both patient sets after adjustment for stage and age at diagnosis. No heterogeneity was seen across the validation centers (p = 0.19). Epithelioid/biphasic MPM patterning and biopsy versus resection did not affect survival, whereas the PGS outperformed mitotic count and Ki-67 LI in both the training (area under the curve receiver operating characteristic = 0.76) and validation sets (area under the curve receiver operating characteristic = 0.73) (p < 0.01). Patient survival progressively deteriorated from a score of 0 (median times of 26.3 and 26.9 months) to a score 1 to 3 (median times of 12.8 and 14.4 months) and a score of 4 to 8 (median times of 3.7 and 7.7 months) in both sets of patients, with the hazard ratio for a 1-point increase in score being 1.46 (95% confidence interval: 1.36-1.56) in the training set and 1.28 (95% confidence interval: 1.22-1.34) in the validation set (after adjustment for age and [when available] tumor stage). The PGS was effective even in subgroup analysis (epithelioid, biphasic, and sarcomatoid tumors). Discussion: A simple and reproducible multiparametric PGS effectively predicted survival in patients with MPM.

Ključne besede

grading;

Podatki

Jezik:	Angleški jezik
Leto izida:	2018
Tipologija:	1.01 - Izvirni znanstveni članek
Založnik:	Elsevier
UDK:	616.2
COBISS:	2048400497
ISSN:	1556-1380
Št. ogledov:	710
Št. prenosov:	260
Ocena:	0 (0 glasov)
Metapodatki:

Ostali podatki

Sekundarne ključne besede:	ocenjevanje;Carcinoma;Mesothelioma;Pleura;Survival;Karcinom;Mezoteliom;Plevra;Preživetje;
Komentar vira:	Soavtorji: Mauro Papotti, Luisella Righi, Giulio Rossi, Stefano Ferrero, Silvano Bosari, Fiorella Calabrese, Izidor Kern, Patrick Maisonneuve, Angelica Sonzogni, Adriana Albini, Sergio Harari, Fausto Barbieri, Enrica Capelletto, Anna Maria Catino, Domenica Cavone, Angela De Palma, Nicola Fusco, Francesca Lunardi, Eugenio Maiorano, Andrea Marzullo, Silvia Novello, Nikolaos Papanikolaou, Giulia Pasello, Antonio Pennella, Federica Pezzuto, Alessandra Punzi, Elena Prisciandaro, Federico Rea, Lorenzo Rosso, Anna Scattone, Gabriella Serio; Nasl. z nasl. zaslona; Opis vira z dne 29. 10. 2018;
Strani:	str. 1750-1761
Letnik:	ǂVol. ǂ13
Zvezek:	ǂno. ǂ11
Čas izdaje:	Nov. 2018
DOI:	10.1016/j.jtho.2018.07.002
ID:	12174555