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Epithelioid Subtype Leads to Longer Survival Regardless of Treatment

epithelioid subtypeDanish researchers say people with the epithelioid subtype of pleural mesothelioma tend to live longer than those with other subtypes, even if they don’t receive treatment. 

The study is the latest to confirm what prior research suggests: that epithelial mesothelioma is more survivable than other subtypes. 

In the newest report, mesothelioma patients with the epithelioid subtype lived longer, even when they were not good candidates for curative treatment.

Mesothelioma Subtypes and Symptoms

Pleural mesothelioma is a fast-growing cancer on the membrane around the lungs. Exposure to asbestos is the primary cause of mesothelioma. 

There are three main mesothelioma subtypes. They are the epithelioid subtype, the sarcomatoid subtype, and the biphasic subtype. Epithelioid mesothelioma is the most common subtype. Sarcomatoid is the second most common. Biphasic is the rarest. It contains some of both types of cells. 

All three subtypes cause mesothelioma symptoms like coughing, chest pain, fatigue and weight loss. The only way to tell the three types of cells apart is to examine them under a microscope. 

Knowing which subtype a person has helps doctors decide which treatments to try. All types of mesothelioma cells can be resistant to standard cancer treatments. But people with the epithelioid subtype usually have the best results. 

Epithelioid Subtype Independently Linked to Survival

Danish researchers combed the country’s cancer registry for people diagnosed with mesothelioma between 1972 and 2015. Two pathologists reexamined each case. They used modern techniques to confirm the subtype was right. 

Hospital records and registries provided information on each patient’s disease, treatment, and asbestos exposure. 

“This retrospective study showed that epithelioid subtype is the only independent positive prognostic factor of survival in treated patients with MPM,” writes author Thomas Ringgaard Petersen. Dr. Petersen is a respiratory disease specialist at Aalborg University Hospital in Aalborg. 

There were 279 patients in the study. Sixty-six percent of them (184) got anti-tumor treatments. The rest received best supportive care (BSC). BSC helps to keep patients comfortable but does not aim to cure cancer. 

Treated patients were mostly younger than the BSC group (66 versus 74). They were also in better overall health. In most cases, their mesothelioma diagnosis also came at an earlier stage. 

But none of those factors were as important as having the epithelioid subtype. Epithelial mesothelioma patients lived longer whether or not they had any curative treatments. In the BSC patients, being a woman and having good performance status also contributed to survival. But age and other health conditions did not.

Dr. Petersen says the data will help doctors choose the right treatments for each patient. Pleural mesothelioma is rare but nearly always fatal. Survival often depends on picking the best treatment for the patient’s situation. 


Ringgaard Petersen, T, et al, “Clinical prognostic factors in pleural mesothelioma: best supportive care and anti-tumor treatments in a real-life setting, January 27, 2021, Acta Oncologica (Stockholm, Sweden), Online ahead of print, https://www.tandfonline.com/doi/full/10.1080/0284186X.2021.1876246

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