ORIGINAL RESEARCH article
Front. Oncol.
Sec. Thoracic Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1557097
External Validation of Pathologic T Adjustments in the Ninth Edition of Pleural Mesothelioma Tumor-Node-Metastasis Classification
Provisionally accepted
- Peking University People's Hospital, Beijing, China
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In the ninth (9 th ) edition of pleural mesothelioma (PM) pathological (p) T staging, patients with fissural invasion are upgraded from T1 to T2. This study aimed to externally validate this staging modification.Methods Resected pT1/2 PM patients were selected. Kaplan-Meier method was applied to assess survival differences, and propensity score matching was utilized to balance baseline characteristics. Univariable and multivariable Cox analyses were conducted to determine prognostic factors. Multiple model parameters were used to evaluate the performances of the ninth and eighth edition pT staging in distinguishing T1 and T2 patients.Results A total of 818 eligible patients were included, among whom 325 initially classified as T1 were reclassified as T2 due to fissural invasion, resulting in 57 patients remaining with pT1 disease. Survival analyses demonstrated that both before and after matching, the 9th edition T staging effectively differentiated between T1 and T2 patients, whereas the 8th edition did not perform as satisfactorily in distinguishing between the groups. Cox regression analyses further confirmed that the 9th edition T staging was a strong prognostic factor, whereas the 8th edition T staging was not prognostic. Lastly, model parameter results indicated that the 9th edition T staging performed better in distinguishing between T1 and T2 patients compared to the 8th edition.Our study provided validation and endorsement for the revisions implemented in the 9th edition pT staging, specifically the reclassification of patients with fissural invasion from pT1 to pT2. This research contributed to the precise staging of PM patients.
Keywords: Pleural mesothelioma, TNM classification, T category, fissural invasion, IASLC
Received: 08 Jan 2025; Accepted: 13 Aug 2025.
Copyright: © 2025 Liu, Cai, Li and Weng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wenhan Weng, Peking University People's Hospital, Beijing, China
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