A team of French scientists believe they have found a way to predict survival and help plan a treatment course for people with the epithelioid form of malignant pleural mesothelioma.
Until now, mesothelioma histological subtype has been the only way to reliably predict mesothelioma prognosis based on pathology (cellular characteristics that can be seen under a microscope).
But mesothelioma researchers at the University Hospital of Saint Etienne have identified several subtle differences between epithelioid mesothelioma cells from different patients that may have an impact on their treatment outcomes.
Histopathology and Mesothelioma Prognosis
Histopathology is the study of changes in tissue caused by disease. In the case of pleural mesothelioma, exposure to asbestos can cause the healthy cells in a person’s mesothelial membrane (the membrane that surrounds the lungs) to undergo malignant changes.
During the diagnostic process, some of these cells must be removed via surgical biopsy and examined under a microscope. By looking at the shape, size, nucleus and other characteristics of these cells, a pathologist can not only confirm a diagnosis of mesothelioma, but can also tell what histological subtype a person has.
Epithelioid mesothelioma, which carries the best prognosis and the most options for treatment, is the most common subtype of mesothelioma. It features cells that lack uniformity and may form small tubes or clusters.
Differences Between Epithelioid Mesothelioma Cells
In the new French study, researchers assessed the relationship between histopathological factors and prognosis in 116 patients diagnosed with pleural mesothelioma.
They identified six factors in epithelioid mesothelioma cells, including the look and size of structures inside the nucleus and the way in which the cells divide, that appear to make a significant difference in mesothelioma prognosis.
Only one of those factors – atypical mitosis (cell division) – was found to be related to survival in people with non-epithelioid mesothelioma subtypes.
“Our work highlights that histopathological prognostic factors can be assessed on pleural biopsies and can predict reliably median overall survival,” writes Cyril Habougit, a researcher in the department of pathology at University Hospital of Saint Etienne.
Dr. Habougit says the information could help doctors select the best candidates for mesothelioma surgery and could identify subgroups of mesothelioma patients who might benefit from different therapies.
The article appears in the international medical journal Virchows Archiv.
Habougit, C, et al, “Histopathologic features predict survival in diffuse pleural malignant mesothelioma on pleural biopsies”, March 27, 2017, Virchows Archiv, Epub ahead of print