Improvements in scoring the severity of mesothelioma could be achieved by considering both tumor weight and volume, suggested a recent study in the European Journal of Cardio-Thoracic Surgery.1 A better scoring system for mesothelioma could improve prognosis and treatment plans.
Mesothelioma tumors arise in tissue layers that cover internal organs. Malignant pleural mesothelioma, the most common type, occurs in the tissue around the lungs. Unlike other types of tumors, mesothelioma tumors have similar density to surrounding tissues, vary in thickness, and are dispersed.
The conventional classification strategy of tumor/node/metastasis (TNM) accounts for size and range of the tumor, whether the tumor has spread to lymph nodes, and whether the cancer has metastasized. CT scans and MRIs precisely determine TNM classification when tumors are discrete, but such approaches are imprecise for mesothelioma assessment.
This study used tumor weight and volume to determine if these were better predictors of mesothelioma outcomes. The study enrolled 116 people (95 men and 21 women) diagnosed with malignant pleural mesothelioma who underwent extended pleurectomy and decortication. Patient ages ranged from 43 to 88 years (median 68 years). All resected tumors were weighed and their volumes were measured.
Survival decreased as the volume and weight of the tumors increased. Mean tumor volume was 641 milliliters, and mean weight was 620.8 grams. Two-year survival was 44% from initial diagnosis, and it was 28% from extended pleurectomy and decortication. In the smallest tumor group (0-300 milliliter tumor volume), patient median survival was 26.94 months, and it was 11.7 months in the largest tumor group (greater than 901 milliliter tumor volume).
This study was led by Wickii Vigneswaran, MD, MBA, of Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine in Chicago, IL. The potentially predictive relationship between larger tumor volumes and shorter survivals had not been demonstrated previously.
Using tumor weight and volume in mesothelioma staging and treatment needs larger, multicenter studies for validation. This study was funded by the Mesothelioma Heroes Foundation of Chicago.
1. Kircheva DY, Husain AN, Watson S, et al. Specimen weight and volume: important predictors of survival in malignant pleural mesothelioma [published online ahead of print on January 21, 2016]. Eur J Cardiothorac Surg. doi: 10.1093/ejcts/ezv422.