From the blog

Nomogram May More Accurately Predict Mesothelioma Survival

Published: April 8, 2019

Predicting pleural mesothelioma survival is a difficult task, as a number of factors are needed to make an accurate calculation. Currently, the TNM Staging system in place as one of the ways to predict life-expectancy and survival after a mesothelioma patient has had surgery. However, researchers from Peking University in China have recently discovered what may be a more accurate tool called a nomogram, in determining life expectancy than the TNM Staging system.

What is the TNM Staging System?

  • T – size of the main tumor, also known as the primary tumor. Classified from X (the main tumor cannot be measured) to 4, where the higher the number the larger the tumor
  • N – lymph nodes nearby. Classified from X (lymph nodes cannot be measured) to 4, where the higher the number, the more lymph nodes contain cancer
  • M- metastasis, or whether or not the cancer has spread. Classified from X (cannot be measured) and then 0-1, where M1 indicates that cancer has spread throughout the body.

In many cancer cases, the higher the TNM stage the poorer the prognosis. However, scientists and researchers found that with mesothelioma (after surgery), they were not able to significantly associate the TNM stage with survival.

A Visual Representation
Researchers and scientists from Peking University turned to what is known as a nomogram, which is a mathematical tool that will visually represent the characteristics of those suffering from mesothelioma. Their goal was to find a better plan for individualized treatment and give a more accurate prognosis by using these patient’s unique characteristics as plot points as a guide. Information was taken from The Surveillance, Epidemiology, and End Results (SEER) database from the National Cancer institute.

Researchers were able to investigate age, gender, cancer subtype and stage, and treatment given as survival factors. This data created the nomogram, which consisted of 312 mesothelioma patients. By using a calibration plot, researchers were able to compare probability and predict one-year and three-year survival rates with a relatively high accuracy. Results were then compared to other prior research and it was found that elderly men who had surgery for mesothelioma typically did not live as long, which has been the consensus in most cases.

Determining the stage of cancer after any treatment – not just surgery – is vital in uncovering not only what treatment methods could be used next, but also in establishing a more accurate prognosis.


Zhuo M. et al. “Survival analysis via nomogram of surgical patients with malignant pleural mesothelioma in the Surveillance, Epidemiology, and End Results database,” Thoracic Cancer (April 5, 2019). [Link]

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