Surgery to remove cancer tissue can lead to improved survival for epithelioid malignant pleural mesothelioma (MPM).
Patients with sarcomatoid or biphasic malignant pleural mesothelioma did not have the same results.
This is the finding of a study that looked at patient data from the National Cancer Database.
Worst Prognosis with Standard Therapies
There are three cell types for this type of cancer: epithelioid, sarcomatoid, and biphasic. About half of malignant mesotheliomas are epithelioid. This type tends to have better treatment outcomes.
About 10% of mesotheliomas are sarcomatoid. This type generally has the worst prognosis with standard therapies.
Mixed (biphasic) mesotheliomas have both epithelioid and sarcomatoid cells. They represent about 30% to 40% of the diagnoses.
Surgery Based on Cell Type
The recommended treatment for MPM depends on the cell type, or histology, of the cancer.
The National Comprehensive Cancer Network recommends that patients epithelioid mesothelioma receive surgery to remove cancerous tissue. Patients with sarcomatoid or biphasic mesothelioma should not have surgery. These patients should be treated with chemotherapy or radiation.
The authors of this study wanted to find out of these recommendations were supported by patient data found in the National Cancer Database. They looked at 2,285 patients who were diagnosed with MPM between 2004 and 2017.
The study found that surgery was associated with improved survival in the patients with epithelioid MPM. The median survival of the epithelioid group was almost 20 months.
Surgery was not associated with improved survival in patients with sarcomatoid or biphasic MPM. Sarcomatoid MPM patients had a median survival rate of eight months. The biphasic group had a median survival rate of 13.5 months.
Based on these results, the study authors say that doctors should identify the specific cell type of patients with MPM before starting treatment. This will prevent patients with sarcomatoid or biphasic MPM from having a risky surgery.
Mansur A, Potter A, Zurovec AJ, et al. An Investigation of Cancer-Directed Surgery for Different Histologic Subtypes of Malignant Pleural Mesothelioma [published online ahead of print, 2022 Dec 24]. Chest. 2022;S0012-3692(22)04340-9. doi:10.1016/j.chest.2022.12.019. https://pubmed.ncbi.nlm.nih.gov/36574925/