Histopathologic features predict survival in diffuse pleural malignant mesothelioma on pleural biopsies
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Malignant pleural mesothelioma is a rare tumor with a poor prognosis. The only universally recognized pathological prognostic factor is histopathological subtype with a shorter survival in non-epithelioid subtypes. Recently, a grading of epithelioid mesothelioma on surgical resection has been proposed. The aim of our work is to assess the prognostic role of several histopathological factors on a retrospective cohort of 116 patients diagnosed as a pleural mesothelioma for more than 95% of patients on pleural biopsy. Our work shows that mitotic count <3/10 HPF (p < 0.0001), the lack of necrosis (p = 0.0379), mild nuclear atypia (p = 0.0054), the lack of atypical mitoses (p = 0.0265), a nucleoli size <3 μm (p = 0.0139), and a nucleoli absent or visible at 200× or higher magnification (p = 0.0170) are significantly associated with a better median overall survival in epithelioid mesothelioma. The presence of atypical mitoses was found to be related to a worse median survival in non-epithelioid mesothelioma. Mitotic count, necrosis, nuclear atypia, and nucleoli size are not associated with overall survival in non-epithelioid mesothelioma. Our work highlights that histopathological prognostic factors can be assessed on pleural biopsies and can predict reliably median overall survival. This is of interest in order to define subgroups of patients who could benefit of different therapies and select patients who could benefit of surgical excision.
KeywordsMesothelioma, malignant Neoplasm grading Mitosis Survival analysis
Compliance with ethical standards
Authorization to use human biological samples for research was obtained (no. AC-2013-1835). Institutional ethical approval was obtained in compliance with the Declaration of Helsinki.
Conflict of interest
The authors declare that they have no conflict of interest.
No funding was received.
- 3.Jassem J, Ramlau R, Santoro A, Schuette W, Chemaissani A, Hong S, Blatter J, Adachi S, Hanauske A, Manegold C (2008) Phase III trial of pemetrexed plus best supportive care compared with best supportive care in previously treated patients with advanced malignant pleural mesothelioma. J Clin Oncol 26:1698–1704CrossRefPubMedGoogle Scholar
- 4.Stahel RA, Riesterer O, Xyrafas A et al (2015) Neoadjuvant chemotherapy and extrapleural pneumonectomy of malignant pleural mesothelioma with or without hemithoracic radiotherapy (SAKK 17/04): a randomised, international, multicentre phase 2 trial. Lancet Oncol 16:1651–1658CrossRefPubMedGoogle Scholar
- 6.Travis WD (ed) (2015) WHO classification of tumours of the lung, pleura, thymus and heart, 4th edn. International Agency for Research on Cancer, LyonGoogle Scholar
- 11.Moch H (2016) WHO classification of tumours of the urinary system and male genital organs. IARC Press, LyonGoogle Scholar
- 16.Duregon E, Molinaro L, Volante M, Ventura L, Righi L, Bolla S, Terzolo M, Sapino A, Papotti MG (2014) Comparative diagnostic and prognostic performances of the hematoxylin-eosin and phospho-histone H3 mitotic count and Ki-67 index in adrenocortical carcinoma. Mod Pathol 27:1246–1254CrossRefPubMedGoogle Scholar
- 20.Valente K, Blackham AU, Levine E, Russell G, Votanopoulos KI, Stewart JH, Shen P, Geisinger KR, Sirintrapun SJ (2016) A histomorphologic grading system that predicts overall survival in diffuse malignant peritoneal mesothelioma with epithelioid subtype. Am J Surg Pathol 40:1243–1248CrossRefPubMedPubMedCentralGoogle Scholar