Patients with stage I disease have a significantly better prognosis than those with more advanced stages. Because of the relative rarity of this disease, exact survival information based upon stage is limited.[1] A proposed staging system based upon thoracic surgery principles and clinical data is shown below.[2] It is a modification of the older system proposed by Butchart et al.[3] Other staging systems that have been employed, including the current international TNM staging system, are summarized by the International Mesothelioma Interest Group.[4]

• Stage I: Disease confined within the capsule of the parietal pleura (i.e., ipsilateral pleura, lung, pericardium, and diaphragm).
• Stage II: All of stage I with positive intrathoracic (N1 or N2) lymph nodes.
• Stage III: Local extension of disease into the following areas, e.g., chest wall or mediastinum, heart or through the diaphragm or peritoneum, with or without extrathoracic or contralateral (N3) lymph node involvement.
• Stage IV: Distant metastatic disease.

Localized malignant mesothelioma

See description of stage I above.

Advanced malignant mesothelioma

See descriptions of stages II, III, and IV above.

For the purposes of the discussion of treatment in this summary, the disease is categorized as either localized or advanced.

References

1. Chahinian AP, Pass HI: Malignant mesothelioma. In: Holland JC, Frei E, eds.: Cancer Medicine e.5. 5th ed. Hamilton, Ontario: B.C. Decker Inc, 2000, pp 1293-1312. 
   
   
2. Sugarbaker DJ, Strauss GM, Lynch TJ, et al.: Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol 11 (6): 1172-8, 1993.  [PUBMED Abstract]
   
   
3. Butchart EG, Ashcroft T, Barnsley WC, et al.: Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients. Thorax 31 (1): 15-24, 1976.  [PUBMED Abstract]
   
   
4. Rusch VW: A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest 108 (4): 1122-8, 1995.  [PUBMED Abstract]
   
   

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