TY - JOUR
T1 - Nuclear grade and necrosis predict prognosis in malignant epithelioid pleural mesothelioma
T2 - A multi-institutional study
AU - Rosen, Lauren E.
AU - Karrison, Theodore
AU - Ananthanarayanan, Vijayalakshmi
AU - Gallan, Alexander J.
AU - Adusumilli, Prasad S.
AU - Alchami, Fouad S.
AU - Attanoos, Richard
AU - Brcic, Luka
AU - Butnor, Kelly J.
AU - Galateau-Sallé, Françoise
AU - Hiroshima, Kenzo
AU - Kadota, Kyuichi
AU - Klampatsa, Astero
AU - Le Stang, Nolween
AU - Lindenmann, Joerg
AU - Litzky, Leslie A.
AU - Marchevsky, Alberto
AU - Medeiros, Filomena
AU - Montero, M. Angeles
AU - Moore, David A.
AU - Nabeshima, Kazuki
AU - Pavlisko, Elizabeth N.
AU - Roggli, Victor L.
AU - Sauter, Jennifer L.
AU - Sharma, Anupama
AU - Sheaff, Michael
AU - Travis, William D.
AU - Vigneswaran, Wickii T.
AU - Vrugt, Bart
AU - Walts, Ann E.
AU - Tjota, Melissa Y.
AU - Krausz, Thomas
AU - Husain, Aliya N.
N1 - Publisher Copyright:
© 2018 USCAP, Inc All rights reserved.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - A recently described nuclear grading system predicted survival in patients with epithelioid malignant pleural mesothelioma. The current study was undertaken to validate the grading system and to identify additional prognostic factors. We analyzed cases of epithelioid malignant pleural mesothelioma from 17 institutions across the globe from 1998 to 2014. Nuclear grade was computed combining nuclear atypia and mitotic count into a grade of I-III using the published system. Nuclear grade was assessed by one pathologist for three institutions, the remaining were scored independently. The presence or absence of necrosis and predominant growth pattern were also evaluated. Two additional scoring systems were evaluated, one combining nuclear grade and necrosis and the other mitotic count and necrosis. Median overall survival was the primary endpoint. A total of 776 cases were identified including 301 (39%) nuclear grade I tumors, 354 (45%) grade II tumors and 121 (16%) grade III tumors. The overall survival was 16 months, and correlated independently with age (P=0.006), sex (0.015), necrosis (0.030), mitotic count (0.001), nuclear atypia (0.009), nuclear grade (o0.0001), and mitosis and necrosis score (o0.0001). The addition of necrosis to nuclear grade further stratified overall survival, allowing classification of epithelioid malignant pleural mesothelioma into four distinct prognostic groups: nuclear grade I tumors without necrosis (29 months), nuclear grade I tumors with necrosis and grade II tumors without necrosis (16 months), nuclear grade II tumors with necrosis (10 months) and nuclear grade III tumors (8 months). The mitosis-necrosis score stratified patients by survival, but not as well as the combination of necrosis and nuclear grade. This study confirms that nuclear grade predicts survival in epithelioid malignant pleural mesothelioma, identifies necrosis as factor that further stratifies overall survival, and validates the grading system across multiple institutions and among both biopsy and resection specimens. An alternative scoring system, the mitosis-necrosis score is also proposed.
AB - A recently described nuclear grading system predicted survival in patients with epithelioid malignant pleural mesothelioma. The current study was undertaken to validate the grading system and to identify additional prognostic factors. We analyzed cases of epithelioid malignant pleural mesothelioma from 17 institutions across the globe from 1998 to 2014. Nuclear grade was computed combining nuclear atypia and mitotic count into a grade of I-III using the published system. Nuclear grade was assessed by one pathologist for three institutions, the remaining were scored independently. The presence or absence of necrosis and predominant growth pattern were also evaluated. Two additional scoring systems were evaluated, one combining nuclear grade and necrosis and the other mitotic count and necrosis. Median overall survival was the primary endpoint. A total of 776 cases were identified including 301 (39%) nuclear grade I tumors, 354 (45%) grade II tumors and 121 (16%) grade III tumors. The overall survival was 16 months, and correlated independently with age (P=0.006), sex (0.015), necrosis (0.030), mitotic count (0.001), nuclear atypia (0.009), nuclear grade (o0.0001), and mitosis and necrosis score (o0.0001). The addition of necrosis to nuclear grade further stratified overall survival, allowing classification of epithelioid malignant pleural mesothelioma into four distinct prognostic groups: nuclear grade I tumors without necrosis (29 months), nuclear grade I tumors with necrosis and grade II tumors without necrosis (16 months), nuclear grade II tumors with necrosis (10 months) and nuclear grade III tumors (8 months). The mitosis-necrosis score stratified patients by survival, but not as well as the combination of necrosis and nuclear grade. This study confirms that nuclear grade predicts survival in epithelioid malignant pleural mesothelioma, identifies necrosis as factor that further stratifies overall survival, and validates the grading system across multiple institutions and among both biopsy and resection specimens. An alternative scoring system, the mitosis-necrosis score is also proposed.
UR - https://www.scopus.com/pages/publications/85045563941
U2 - 10.1038/modpathol.2017.170
DO - 10.1038/modpathol.2017.170
M3 - Article
C2 - 29327706
AN - SCOPUS:85045563941
SN - 0893-3952
VL - 31
SP - 598
EP - 606
JO - Modern Pathology
JF - Modern Pathology
IS - 4
ER -