ArticleModern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc2018
Nuclear grade and necrosis predict prognosis in malignant epithelioid pleural mesothelioma: a multi-institutional study.
Article in Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers.
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Who cites it
49 citing papers in PubMed, 95 citations in OpenAlex.
- What's new in neoplastic pulmonary pathology 2026: updates on grading, staging and molecular testing.Journal of pathology and translational medicine · 2026Article
- Prognostic Factors in Patients with Peritoneal Mesothelioma Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Systematic Review and Meta-Analysis.Annals of surgical oncology · 2026Article
- Ki67 proliferation index augments two-tier tumour grade in prediction of survival and progression-free survival in epithelioid pleural mesothelioma.ERJ open research · 2026Article
- Factors affecting prognosis in patients diagnosed with epithelioid pleural mesothelioma who underwent surgery.Turk gogus kalp damar cerrahisi dergisi · 2026Article
- Review
- Tumor necrosis facilitates perihilar cholangiocarcinoma metastasis by ANGPTL6-augmented vessel permeability and tumor dissemination.JHEP reports : innovation in hepatology · 2025Article
- Pleural mesothelioma.Nature reviews. Disease primers · 2025Review
- Correlation of Histologic Features with Gene Alterations in Pleural Mesothelioma.Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc · 2025Article
- Article
- An Evaluation Into the Robustness of Grading of Pleural Mesothelioma Outside of Specialist Centres.APMIS : acta pathologica, microbiologica, et immunologica Scandinavica · 2025Article
- Radical hemithorax radiotherapy induces an increase in circulating PD-1Frontiers in immunology · 2025Article
- Individualized Cell-Free DNA Monitoring With Chromosomal Junctions for Mesothelioma.JTO clinical and research reports · 2024Article
- Diagnosis of Pleural Mesothelioma: Is Everything Solved at the Present Time?Current oncology (Toronto, Ont.) · 2024Review
- Diffuse Pleural Mesotheliomas with Genomic Near-Haploidization: A Newly Recognized Subset with Distinct Clinical, Histologic, and Molecular Features.Clinical cancer research : an official journal of the American Association for Cancer Research · 2024Article
- Article
- BAP1 Loss, Nuclear Grading, and Nonepithelioid Features in the Diagnosis of Mesothelioma in Italy: Nevermore without the Pathology Report.Journal of personalized medicine · 2024Review
- The prognostic role of single cell invasion and nuclear diameter in early oral tongue squamous cell carcinoma.BMC cancer · 2024Article
- Organoids derived from patients provide a new opportunity for research and individualized treatment of malignant peritoneal mesothelioma.Molecular cancer · 2024Article
- Reliability of assessing morphologic features with prognostic significance in cytology specimens of epithelioid diffuse pleural mesothelioma and implications for cytopathology reporting.Cancer cytopathology · 2023Article
- New Insights in Pleural Mesothelioma Classification Update: Diagnostic Traps and Prognostic Implications.Diagnostics (Basel, Switzerland) · 2022Review
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Authors and funding
33 authors at 20 institutions in 6 countries.
Funding
Abstract
A recently described nuclear grading system predicted survival in patients with epithelioid malignant pleural mesothelioma. The current study was undertaken to validate the grading system and to identify additional prognostic factors. We analyzed cases of epithelioid malignant pleural mesothelioma from 17 institutions across the globe from 1998 to 2014. Nuclear grade was computed combining nuclear atypia and mitotic count into a grade of I-III using the published system. Nuclear grade was assessed by one pathologist for three institutions, the remaining were scored independently. The presence or absence of necrosis and predominant growth pattern were also evaluated. Two additional scoring systems were evaluated, one combining nuclear grade and necrosis and the other mitotic count and necrosis. Median overall survival was the primary endpoint. A total of 776 cases were identified including 301 (39%) nuclear grade I tumors, 354 (45%) grade II tumors and 121 (16%) grade III tumors. The overall survival was 16 months, and correlated independently with age (P=0.006), sex (0.015), necrosis (0.030), mitotic count (0.001), nuclear atypia (0.009), nuclear grade (<0.0001), and mitosis and necrosis score (<0.0001). The addition of necrosis to nuclear grade further stratified overall survival, allowing classification of epithelioid malignant pleural mesothelioma into four distinct prognostic groups: nuclear grade I tumors without necrosis (29 months), nuclear grade I tumors with necrosis and grade II tumors without necrosis (16 months), nuclear grade II tumors with necrosis (10 months) and nuclear grade III tumors (8 months). The mitosis-necrosis score stratified patients by survival, but not as well as the combination of necrosis and nuclear grade. This study confirms that nuclear grade predicts survival in epithelioid malignant pleural mesothelioma, identifies necrosis as factor that further stratifies overall survival, and validates the grading system across multiple institutions and among both biopsy and resection specimens. An alternative scoring system, the mitosis-necrosis score is also proposed.
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