2nd Institute of Pathology, Semmelweis University, Budapest, Hungary.
Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany.
Histopathology. 2020 Jul;77(1):55-66. doi: 10.1111/his.14105. Epub 2020 May 25.
Malignant pleural mesothelioma (MPM) is a rare malignancy with a dismal prognosis. While the epithelioid type is associated with a more favourable outcome, additional factors are needed to further stratify prognosis and to identify patients who can benefit from multimodal treatment. As epithelioid MPM shows remarkable morphological variability, the prognostic role of the five defined morphologies, the impact of the nuclear grading system and the mitosis-necrosis score were investigated in this study.
Tumour specimens of 192 patients with epithelioid MPM from five European centres were histologically subtyped. Nuclear grading and mitosis-necrosis score were determined and correlated with clinicopathological parameters and overall survival (OS). Digital slides of 55 independent cases from The Cancer Genome Atlas (TCGA) database were evaluated for external validation. Histological subtypes were collapsed into three groups based on their overlapping survival curves. The tubulopapillary/microcystic group had a significantly longer OS than the solid/trabecular group (732 days versus 397 days, P = 0.0013). Pleomorphic tumours had the shortest OS (173 days). The solid/trabecular variants showed a significant association with high nuclear grade and mitosis-necrosis score. The mitosis-necrosis score was a robust and independent prognostic factor in our patient cohort. The prognostic significance of all three parameters was externally validated in the TCGA cohort. Patients with tubulopapillary or microcystic tumours showed a greater improvement in OS after receiving multimodal therapy than those with solid or trabecular tumours.
Histological subtypes of epithelioid MPM have a prognostic impact, and might help to select patients for intensive multimodal treatment approaches.
恶性胸膜间皮瘤（MPM）是一种罕见的恶性肿瘤，预后较差。虽然上皮样型与更好的预后相关，但还需要其他因素来进一步分层预后，并确定可以从多模式治疗中获益的患者。由于上皮样 MPM 表现出显著的形态学变异性，因此本研究调查了五种定义形态的预后作用、核分级系统的影响以及有丝分裂-坏死评分。
从五个欧洲中心的 192 名上皮样 MPM 患者的肿瘤标本中进行了组织学亚型分类。确定了核分级和有丝分裂-坏死评分，并将其与临床病理参数和总生存期（OS）相关联。对来自癌症基因组图谱（TCGA）数据库的 55 个独立病例的数字幻灯片进行了外部验证。根据其重叠的生存曲线，将组织学亚型分为三组。管状乳头状/微囊型的 OS 明显长于实体/小梁型（732 天对 397 天，P=0.0013）。多形性肿瘤的 OS 最短（173 天）。实体/小梁变体与高核分级和有丝分裂-坏死评分显著相关。有丝分裂-坏死评分是我们患者队列中一个稳健的独立预后因素。在 TCGA 队列中验证了所有三个参数的预后意义。接受多模式治疗后，管状乳头状或微囊型肿瘤患者的 OS 改善程度大于实体或小梁型肿瘤患者。
上皮样 MPM 的组织学亚型具有预后影响，并可能有助于选择接受强化多模式治疗方法的患者。
