New Tool Could Replace TNM for Predicting Pleural Mesothelioma Survival

pleural mesothelioma survivalA new visual tool could offer a better way to predict pleural mesothelioma survival after surgery than the current TNM staging system.

That is the message from cancer researchers at China’s Peking University.

The group conducted a study using a large US government database of information on pleural mesothelioma survival and treatment.

They used the data to create a visual representation of pleural mesothelioma survival called a nomogram. Testing of the nomogram showed it was more accurate at predicting survival in patients who have mesothelioma surgery than the tool doctors normally use.

Pleural Mesothelioma Survival and TNM

The most popular method for “staging” cancer is called the TNM staging system. TNM stands for tumor node metastasis.

With TNM, the further a cancer has spread in the body, the higher the stage number. Some studies have linked higher TNM stage with poor pleural mesothelioma survival.

But the Chinese team says TNM does not go far enough. Their extensive study of the factors that impact pleural mesothelioma survival after surgery found “no significant association” between TNM stage and survival.

Instead, the researchers say their new nomogram can predict pleural mesothelioma survival in surgery patients with far greater accuracy.

The nomogram enables doctors to visually evaluate individual patient survival. The hope is that the new tool will make it easier to plan more effective mesothelioma treatments.

Focusing in on Pleural Mesothelioma Survival

The Chinese researchers created their tool using one of the most comprehensive databases of cancer in the world.

The SEER (Surveillance, Epidemiology, and End REsults) database is a program of the National Cancer Institute. It provides epidemiologic information on cancers like malignant mesothelioma to researchers around the world.

Using SEER, the Chinese team identified the top factors in pleural mesothelioma survival after surgery. These included things like age, gender, subtype, stage, chemotherapy, and type of mesothelioma surgery.

They used the data to create the nomogram. Then they validated the nomogram in a separate group of 312 mesothelioma surgery patients.

“A calibration plot for the nomogram for predicting one‐year and three‐year survival indicated that the nomogram has high predictive accuracy in the validation cohort,” writes lead researcher Minglei Zhuo.

What Factors Impact Pleural Mesothelioma Survival?

The results of the Chinese analysis of pleural mesothelioma survival were in line with prior research.

In general, people who are older, men, and those with a non-epithelial mesothelioma subtype do not live as long after pleural mesothelioma surgery.

But the goal of the nomogram is to allow for much more individualized treatment planning. Doctors can plot each mesothelioma patient’s unique characteristics on the nomogram to come up with a far more accurate predictor of their own mesothelioma prognosis

“These results improve our understanding of resected malignant pleural mesothelioma lesions and provide a reliable tool for predicting patient overall survival,” concludes Dr. Zhuo.

The research team plans to create a separate nomogram for predicting pleural mesothelioma survival in people who do not have surgery.


Zhuo, M, et al, “Survival analysis via nomogram of surgical patients with malignant pleural mesothelioma in the Surveillance, Epidemiology, and End Results database”, April 5, 2019, Thoracic Cancer, Epub ahead of print,

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