Cancer Immunology, Immunotherapy

, Volume 60, Issue 12, pp 1721–1728

Chronic inflammation in tumor stroma is an independent predictor of prolonged survival in epithelioid malignant pleural mesothelioma patients

  • Kei Suzuki
  • Kyuichi Kadota
  • Camelia S. Sima
  • Michel Sadelain
  • Valerie W. Rusch
  • William D. Travis
  • Prasad S. Adusumilli
Original article


This study aims to determine whether a semi-quantitative assessment of inflammatory response in tumor and stroma on routine hematoxylin and eosin-stained (H&E) slides can predict survival in patients with epithelioid malignant pleural mesothelioma (MPM). H&E sections of 175 epithelioid MPM specimens from a single institution (1989–2009) were reviewed. Patients who received neoadjuvant chemotherapy were excluded from analysis. Each tumor was histologically assessed for acute and chronic inflammatory response both within the tumor and the stromal component. Inflammatory response was graded: low (none to mild infiltrate) or high (moderate to severe infiltrate). Log-rank test and Cox proportional hazards regression were used to investigate the association between the degree of inflammation (acute/tumor, acute/stroma, chronic/tumor, and chronic/stroma) and overall survival (OS). Patients with high chronic inflammatory response in stroma (n = 59) had improved survival compared to low (n = 116) (median OS = 19.4 vs. 15.0 months, P = 0.01). This prognostic stratification remained significant in stage III patients (median OS = 16.0 vs. 9.3 months, P = 0.03). In multivariate analysis, chronic inflammation in stroma was an independent predictor of survival (HR = 0.659, 95% CI 0.464–0.937, P = 0.02). While high degree of chronic inflammatory cell infiltration in the stromal component was associated with improved overall survival, degree of other inflammatory responses did not show significant correlation with OS. Our study for the first time investigates inflammatory response in tumor and stroma and not only suggests the prognostic value of inflammatory response in epithelioid MPM but also provides rationale for investigation of immunotherapy to benefit epithelioid MPM patients.


Epithelioid mesothelioma Tumor stroma Immune response Prognosis 

Supplementary material

262_2011_1073_MOESM1_ESM.pdf (79 kb)
Supplementary material 1 (PDF 78.8 kb)


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Kei Suzuki
    • 1
  • Kyuichi Kadota
    • 1
  • Camelia S. Sima
    • 2
  • Michel Sadelain
    • 3
  • Valerie W. Rusch
    • 1
  • William D. Travis
    • 4
  • Prasad S. Adusumilli
    • 5
  1. 1.Division of Thoracic Surgery, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology & BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Center for Cell EngineeringMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  5. 5.Division of Thoracic Surgery, Department of Surgery, Center for Cell EngineeringMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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