How Mesothelioma is Measured Can be Improved | Loyola Medicine
Wednesday, February 3, 2016

Study by Leading Loyola Thoracic Surgeon Suggests Improvements in How Mesothelioma is Measured

MAYWOOD, Ill. – A new study suggests that significant improvements could be made in the scoring system physicians use to estimate the stage (severity) of mesothelioma, an aggressive and deadly cancer.

The current scoring system incorporates such factors as the size of the tumor and whether it has spread to other parts of the body. The study’s findings suggest that, in addition, tumor weight and volume “may be valuable components for staging malignant pleural mesothelioma.”

An improved scoring system could provide a more accurate prognosis and help guide treatment,   said lead author Wickii Vigneswaran, MD, MBA, who now is at Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine. Dr. Vigneswaran has performed nearly 200 mesothelioma surgeries, and he is among only a handful of surgeons nationwide who treat mesothelioma surgically.

The study is published in the European Journal of Cardio-Thoracic Surgery.

Mesothelioma occurs in the layer of tissue that covers internal organs. The most common type, malignant pleural mesothelioma, affects the tissue that surrounds the lungs (pleural).

Staging a malignancy is an important prognostic tool and plays a fundamental role in patient management. The current classification system, known as tumor/node/metastasis (TNM), considers the size and extent of the tumor, the amount of spread to nearby lymph nodes and whether there has been metastasis (spread of cancer to other parts of the body).

CT scans and MRIs used to determine TNM staging are more precise in measuring discrete tumors such as those in lung cancer. But TNM is less precise in staging mesothelioma, which is diffuse, varies in thickness and has a similar density to surrounding tissues. So Dr. Vigneswaran and colleagues examined whether measuring tumor volume also could predict diagnosis.

The study included 116 patients (95 males and 21 females). The median age was 68, with an age range of 43 to 88. As the volume (and therefore the weight) of the tumor increased, survival decreased. The median survival was 26.94 months in patients with tumor volumes between 0 and 300 millimeters; 19.45 months for tumor volumes between 301 and 600 ml.; 12.68 months for tumor volumes between 601 and 900 ml. and 11.7 months for tumor volumes greater than 901 ml. (By comparison 901 ml. equals about 30.4 oz.) While not surprising, the finding that larger tumor volumes were associated with shorter survivals had not been demonstrated previously.

The finding that tumor volume and weight are significant predictors of survival needs further validation in larger, multicenter studies, Dr. Vigneswaran and colleagues reported. Dr. Vigneswaran performed the study at the University of Chicago. He recently joined Loyola, where he is the division director of Thoracic Surgery and a professor in the Department of Thoracic and Cardiovascular Surgery at Loyola University Chicago Stritch School of Medicine.

The study is titled “Specimen weight and volume: important predictors of survival in malignant plural mesothelioma.” It was funded by Mesothelioma Heroes Foundation of Chicago.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.