Pleomorphic epithelioid diffuse malignant pleural mesothelioma: A clinicopathological review and conceptual proposal to reclassify as biphasic or sarcomatoid mesothelioma Journal Article

  

Authors:	Kadota, K.; Suzuki, K.; Sima, C. S.; Rusch, V. W.; Adusumilli, P. S.; Travis, W. D.
Article Title:	Pleomorphic epithelioid diffuse malignant pleural mesothelioma: A clinicopathological review and conceptual proposal to reclassify as biphasic or sarcomatoid mesothelioma
Abstract:	Introduction: In patients with epithelioid diffuse malignant pleural mesothelioma (DMPM), clinical stage is the current primary prognostic factor. We sought to investigate whether histologic subtyping can prognostically stratify patients with epithelioid DMPM. METHODS:: Hematoxylin and eosin-stained slides of 232 patients with epithelioid DMPM (14 stage I, 54 stage II, 130 stage III, and 34 stage IV) from a single institution were reviewed. We classified the tumors into five subtypes, according to the predominant histological pattern: trabecular, tubulopapillary, micropapillary, solid, and pleomorphic (10% of tumor). Results: Median overall survival (OS) of all patients with epithelioid DMPM was 16.2 months. Patients with pleomorphic subtype (n = 34) had the worst median OS (8.1 months), followed by solid (n = 89, 13.7 months), micropapillary (n = 20, 15.8 months), tubulopapillary (n = 51, 17.9 months), and trabecular (n = 38, 24.9 months). The pleomorphic subtype was associated with lymphatic and vascular invasion (p < 0.001). The micropapillary subtype was associated with lymphatic invasion (p < 0.001). In univariate analyses, pleomorphic subtype was significantly associated with poor OS (p = 0.003). The pleomorphic subtype showed no significant difference on OS compared with biphasic and sarcomatoid DMPM. In a multivariate analysis, the pleomorphic subtype was an independent predictor of poor OS (p = 0.031). In patients who underwent R1 resection, pleomorphic subtype had the shortest median time to recurrence (13.7 months). Conclusion: Our finding that the pleomorphic subtype is a predictor of aggressive behavior in epithelioid DMPM with no survival difference from biphasic or sarcomatoid DMPM suggests that it may be best regarded as a sarcomatoid pattern rather than a subtype of epithelioid DMPM. Copyright © 2011 by the International Association for the Study of Lung Cancer.
Keywords:	survival; adult; cancer survival; human tissue; aged; cancer surgery; major clinical study; overall survival; histopathology; cancer recurrence; solid tumor; cancer staging; outcome assessment; lymph node metastasis; cancer palliative therapy; lung resection; thoracotomy; tumor biopsy; cancer invasion; survival time; malignant mesothelioma; pleura mesothelioma; eosin; hematoxylin; lung biopsy; pleurectomy; tumor classification; video assisted thoracoscopic surgery; predictive value; micropapillary; epithelioid mesothelioma; lymphatic invasion; pleomorphic; epithelioid diffuse malignant pleural mesothelioma; micropapillary tumor; pleomorphic tumor; pleurectomy decortication; tubulopapillary tumor
Journal Title:	Journal of Thoracic Oncology
Volume:	6
Issue:	5
ISSN:	1556-0864
Publisher:	Elsevier Inc.
Date Published:	2011-05-01
Start Page:	896
End Page:	904
Language:	English
DOI:	10.1097/JTO.0b013e318211127a
PROVIDER:	scopus
PUBMED:	21358344
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-79955481828&partnerID=40&md5=4c399dba7b56815b833c0b55d352593b
Notes:	--- - "Export Date: 23 June 2011" - "Source: Scopus"

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