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One of the major problems in these studies is the lack of adequate adjustment for potential confounders. Therefore, the aim of this study was to identify and quantify risk factors such as IMM and various tumor characteristics and their association with the subtype of MM and survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We examined IMM and other tumor markers in tumor tissues from 82 patients with MM. These markers were evaluated by histochemistry, immunohistochemistry, immunofluorescence, and morphometry. Logistic regression analysis, cluster analysis, and Cox regression analysis were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Hierarchical cluster analysis revealed two clusters of MM that were independent of clinicopathologic features. The high\u2010risk cluster included MM with high tumor cellularity, high type V collagen (Col V) fiber density, and low CD8<jats:sup>+<\/jats:sup> T lymphocyte density in the IMM. Our results showed that the risk of death was increased for patients with MM with high tumor cellularity (OR\u00a0=\u00a01.63, 95% CI\u00a0=\u00a01.29\u20102.89, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.02), overexpression of Col V (OR\u00a0=\u00a02.60, 95% CI\u00a0=\u00a00.98\u20106.84, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.04), and decreased CD8 T lymphocytes (OR\u00a0=\u00a01.001, 95% CI\u00a0=\u00a00.995\u20101.007, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.008). The hazard ratio for the high\u2010risk cluster was 2.19 (95% CI\u00a0=\u00a00.54\u20103.03, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) for mortality from MM at 40\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Morphometric analysis of Col V, CD8<jats:sup>+<\/jats:sup> T lymphocytes, and tumor cellularity can be used to identify patients with high risk of death from MM.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.3111","type":"journal-article","created":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T13:56:04Z","timestamp":1589205364000},"page":"4836-4849","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["An integrative histopathologic clustering model based on immuno\u2010matrix elements to predict the risk of death in malignant mesothelioma"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3798-8414","authenticated-orcid":false,"given":"Marcelo Luiz","family":"Balancin","sequence":"first","affiliation":[{"name":"Department of Pathology Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7559-4542","authenticated-orcid":false,"given":"Walcy Rosolia","family":"Teodoro","sequence":"additional","affiliation":[{"name":"Rheumatology Division Hospital das Clinicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Farhat","sequence":"additional","affiliation":[{"name":"Department of Pathology Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomas Jurandir","family":"de Miranda","sequence":"additional","affiliation":[{"name":"Rheumatology Division Hospital das Clinicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aline Kawassaki","family":"Assato","sequence":"additional","affiliation":[{"name":"Department of Pathology Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neila Aparecida","family":"de Souza Silva","sequence":"additional","affiliation":[{"name":"Department of Pathology Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Paula","family":"Velosa","sequence":"additional","affiliation":[{"name":"Rheumatology Division Hospital das Clinicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Falzoni","sequence":"additional","affiliation":[{"name":"Department of Pathology Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre Muxfeldt","family":"Ab'Saber","sequence":"additional","affiliation":[{"name":"Department of Pathology Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8948-4758","authenticated-orcid":false,"given":"Anja C.","family":"Roden","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9732-5853","authenticated-orcid":false,"given":"Vera Luiza","family":"Capelozzi","sequence":"additional","affiliation":[{"name":"Department of Pathology Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,5,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.19.8523"},{"key":"e_1_2_9_3_1","first-page":"52","article-title":"Pathologic diagnosis of malignant mesothelioma: chronological prospect and advent of recommendations and guidelines","volume":"51","author":"Ascoli V","year":"2015","journal-title":"Ann Ist Super Sanita"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2015.11.005"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(99)70469-1"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1993.11.6.1172"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)01038-3"},{"key":"e_1_2_9_8_1","unstructured":"National Lung Cancer Audit.National Lung Cancer Audit Report 2014. 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