A recent discovery at the University of Maryland could dramatically change how doctors handle the staging of malignant pleural mesothelioma. More accurate staging could lead to better mesothelioma treatment outcomes and longer survival.
More than three quarters of people diagnosed with mesothelioma have the pleural variety. Pleural mesothelioma is the deadliest form of asbestos cancer. Most patients do not live longer than 18 months, even with aggressive treatment.
Cancer staging is the process doctors use to determine how advanced the cancer is. Staging of mesothelioma is important because it directly impacts treatment decisions.
But staging of mesothelioma – just like diagnosis and treatment – can be difficult.
Lymph Nodes May Help in Staging of Mesothelioma
The discovery was made by University of Maryland School of Medicine researchers led by Dr. Joseph Friedberg. Dr. Friedberg is a world renowned mesothelioma expert and director of the Mesothelioma Thoracic Oncology Treatment and Research Center.
Dr. Friedberg and his colleagues found that a set of previously ignored lymph nodes in the chest may be critical to mesothelioma staging.
The posterior intercostal lymph nodes drain the spaces between the ribs. They are not usually considered in the staging of mesothelioma. Instead, doctors usually look at whether there are mesothelioma cells in the mediastinal lymph nodes. These nodes lie between the sternum and the spine.
But it turns out that the posterior intercostal lymph nodes may be even more important in mesothelioma staging. People with cancer in these lymph nodes were more than twice as likely to have recurrent mesothelioma or to die.
Lymph Node Involvement Doubles Risk of Death
The new study included 56 pleural mesothelioma patients who had lung-sparing surgery.
Along with diseased tissues, surgeons removed the posterior intercostal lymph nodes.
Forty-eight percent of the patients had mesothelioma cells in these lymph nodes. Seven percent of these patients did not have mesothelioma cells in any other lymph nodes. Without considering these lymph nodes, the staging of mesothelioma for these patients would have been inaccurate.
“Although larger studies are needed, we believe that these lymph nodes should routinely be removed during any surgery with therapeutic intent for malignant pleural mesothelioma, especially as they may be the only lymph nodes to harbor metastatic disease,” says Dr. Friedberg.
Mesothelioma patients with cancer cells in the posterior intercostal lymph nodes were two-and-a-half times more likely to have recurrence. Their risk of death was also 2.3-fold higher.
For now, there is no non-invasive way to check for mesothelioma cells in these lymph nodes. But Dr. Friedberg says that should be a goal for mesothelioma researchers.
Improved staging of mesothelioma could steer people away from surgery if the cancer has already spread. It could also help doctors and patients make better-informed decisions about their prognosis and treatment.
“University of Maryland Thoracic Surgeons Identify Lymph Nodes That May Help To Determine Prognosis for Patients with Pleural Mesothelioma”, January 30, 2019, University of maryland News Release, https://www.umms.org/umgccc/news/2018/thoracic-surgeons-identify-lymph-nodes-help-determine-prognosis