Prognosis

A mesothelioma diagnosis comes with many important questions. Perhaps the most crucial question is – what is the prognosis? In fact, the prognosis of mesothelioma varies depending on a number of variables. These variables include:

1. The patient – their age, biology, and state of health
2. The cancer – has the mesothelioma spread or is it localized when it is diagnosed and what is the cell type
3. The treatment or treatments selected
4. The expertise of the treatment team (doctors and other clinicians)

The Patient’s Health

A patient’s general state of health is an important prognostic factor in fighting any disease and mesothelioma is no exception. In addition, a patient’s biology or physiology also plays a role. For example, will chemotherapy work or can it be tolerated? Does the patient have a heart condition so that surgery is not an option? How will the patient’s biology interact with the treatment? The answers to these questions can all play a role in the prognosis.

The Cancer

The spread or lack of spread of the cancer is also an important factor. If mesothelioma is localized it can be easier to treat. In fact, surgery is usually only an option if the cancer has not metastasized. If it has spread then treatment options may be more limited. In addition, there are three cell types of mesothelioma – epithelioid, biphasic, and sacramatoid. The first, epithelioid, often has the best prognosis of the three.

The Treatment

The treatment or therapies selected is also important. Patients can select from conventional therapies (radiation, chemo, and surgery), clinical trials or integrative or alternative modalities. Not every therapy works in every patient. There is an important connection between a person’s physiology, cancer and the treatments selected. The interchange or intersection of these three factors often dictate what the treatment outcome and prognosis will be. Unfortunately, it is often difficult to predict because how a tumor or a treatment acts in a patient’s body is often not known until after the fact.

The Doctors’ Expertise

The last factor is the expertise of your doctors or licensed care givers. How these people do their jobs can be a key factor in prognosis. Are the surgeons experienced with mesothelioma? For example, what is their mortality rate for surgery? The smallest rate bodes better than the highest rate. Also, what options can these treaters suggest? Do they only offer chemo or can they offer a wide range of different modalities and treatment options. All these factors play a role in the prognosis of mesothelioma.

Below are some more details about the prognosis for mesothelioma.

Prognosis of Pleural Mesothelioma

The prognosis of pleural mesothelioma with standard treatment is typically not great.   Median overall survival is a little over a year.  However, there are a number of factors that affect prognosis.

A number of studies have been performed over the years to determine what treatments are optimum for mesothelioma and what factors lead to a better prognosis. Below, we report on several of these.

In a September 2016 Austrian study, a total of 210 patients with malignant pleural mesothelioma were followed.

• 167 (79.5%) were men and 43 (20.5%) were women
• The average age was 67 at the time of diagnosis
• Asbestos exposure was confirmed in 109 (69.4%) patients
• The majority of patients had epithelioid cell type (67.2%)
• Sarcomatoid comprised 16 (7.6%)
• Biphasic was found in 28 patients (13.3%)
• In 25 patients, the cell type was not specified

Data about survival was available for 185 patients. The study found:

• Median overall survival was 19.1 months.
• Pleural mesothelioma patients with early-stage disease (stages I, II) had an overall survival of 26.4 months.
• Pleural mesothelioma patients with late-stage disease (stages III, IV) had an overall survival of 13.0 months .
• Patients with epithelioid cell type had overall survival of 25.1 months.
• Patients with sarcomatoid or biphasic cell type had overall survival of 10.2 months.
• There was no survival difference between males and females.
• There was no survival difference between patients below or above the age of 65 years.
• Survival was significantly better in patients undergoing surgery. However, these patients were significantly younger, had earlier-stage disease, better performance status, and more often had epithelioid subtype.

The study concluded that factors that indicated a better prognosis included: higher Karnofsky score, earlier stage disease, epithelioid cell type, and surgery within multimodality treatment.

• Management of malignant pleural mesothelioma – part 3 : Data from the Austrian Mesothelioma Interest Group (AMIG) database. Klikovits T, et al., Wien Klin Wochenschr. 2016 Sep;128(17-18):627-34.

Prognosis of Peritoneal Mesothelioma

The prognosis of peritoneal mesothelioma has become much better with the advent of surgery and HIPEC.  The following studies illustrate the improvements in prognosis over the last several years.

Peritoneal Mesothelioma Prognosis with Chemotherapy

In a 2011 Greek Study, chemotherapy was used to treat peritoneal mesothelioma patients.  Six patients with peritoneal mesothelioma were treated with 6 cycles of pemetrexed (500 mg/m2) and cisplatin (75 mg/m2). Chemotherapy was administered on an outpatient basis every 3 weeks. The estimated median overall survival was 24 months.

• Systemic chemotherapy with pemetrexed and cisplatin for malignant peritoneal mesothelioma: a single institution experience. Lainakis G, et al., Tumori. 2011 Jan-Feb;97(1):25-9.

Peritoneal Mesothelioma Prognosis with HIPEC

An April 2014 United States Study examined 65 patients with pleural mesothelioma who underwent surgery and HIPEC (hyperthermic intraperitoneal chemoperfusion) between 2001 and 2010.

What is HIPEC for Mesothelioma?

HIPEC is where heated chemotherapy is used to bath the surgical cavity putting the chemo in direct contact where the tumor cells remain.  The study found that overall mesothelioma survival was 46.2 months.  The study also found that although survival was better, there were side effects associated with this treatment approach that included:

• Six percent of the patients died within 60 days.
• Of the 65 patients, 91 % were admitted to the intensive care unit (ICU) postoperatively, with median hospital length of 12 days.
• A total of 12 patients (18 %) underwent reoperation: four patients (33 %) for enteric leak, 1 patient (8 %) for an intra-abdominal abscess, and seven patients (58%) for other reasons.

Factors that contributed to a poor prognosis included:

• Older patient
• More widespread tumors
• More aggressive cell type
• Incomplete surgery
• Post-operative infection

The study concluded that better prognosis is associated with patients who have the epithelioid cell type, lower volume of tumor, and more effective surgery (most tumor removed).

• Malignant peritoneal mesothelioma: prognostic factors and oncologic outcome analysis. Magge D., et al., Ann Surg Oncol. 2014 Apr;21(4):1159-65.

Next: Treatment

Related Posts

New Test May Help Doctors Choose the Best Mesothelioma Surgery - A new predictive model may make it easier for cancer doctors to choose the best mesothelioma surgery for each pleural mesothelioma patient.  There are two major surgical approaches for pleural mesothelioma. One involves removal of a lung and the other does not.  Right now, the choice about which surgery to have is based on patient demographics, symptoms, and lab values. Which surgery is most common at the institution may also play a role. Many surgeons have strong opinions about which is the best mesothelioma surgery.   But Harvard researchers say the new predictive model they tested is a better way to stratify mesothelioma patients. Their study suggests that this approach may lead to better treatment outcomes and more accurate clinical trials.  … Continue reading New Test May Help Doctors Choose the Best Mesothelioma Surgery »

Peritoneal Mesothelioma Prognosis: Searching for New Factors - An international research study including patients from 11 countries may help reveal new and better ways to predict peritoneal mesothelioma prognosis.  Right now, doctors use three primary criteria to determine peritoneal mesothelioma prognosis. Those are how much cancer was in the abdomen at the time of surgery, how complete the surgery was, and the tumor grade.  But about 70 percent of people treated for peritoneal cancers like mesothelioma have recurrent disease. The goal of the new study is to find more prognostic factors. Knowing these factors could help doctors make better choices about which patients are most likely to benefit from cytoreductive surgery (CRS).  The CRS/HIPEC Procedure for Mesothelioma Peritoneal mesothelioma occurs on the lining of the abdomen. Peritoneal mesothelioma … Continue reading Peritoneal Mesothelioma Prognosis: Searching for New Factors »

Does Pleural Fluid Exposure Affect Mesothelioma Survival? - A recent study found no link between mesothelioma survival and exposure to pleural fluid. But that does not necessarily mean the link doesn’t exist.  Pleural fluid is also called pleural effusions or “water on the lungs”. It is extra fluid that builds up around the lungs. It is common in people with heart failure, kidney or liver disease, pleural mesothelioma and some other kinds of cancer.  Pleural effusions are usually treated as an uncomfortable mesothelioma symptom. Draining the fluid can help patients breathe easier.  But researchers at Oxford University wondered whether the pleural fluid itself could shorten mesothelioma survival. In this study, the answer appears to be no. But the researchers warn this may not be the final word on … Continue reading Does Pleural Fluid Exposure Affect Mesothelioma Survival? »

Treatment Advances Fail to Improve Mesothelioma Survival Trends - A new report shows mesothelioma survival trends have remained steady for decades, despite new drugs, new surgery techniques, and the introduction of pleural catheters.  The report comes from cancer researchers at Ottawa Hospital Cancer Centre in Canada. Canada has one of the world’s highest rates of malignant pleural mesothelioma. This is likely related to the country’s long history of asbestos production. To compile the new report, researchers compared mesothelioma outcomes in three different decades between 1991 and 2019. There were surprisingly few differences in mesothelioma survival trends in the three decades.  Mesothelioma’s Destructive History Pleural mesothelioma is a virulent cancer of the pleural membrane. This is the tissue or mesothelium that surrounds the lungs. It is thin but flexible and … Continue reading Treatment Advances Fail to Improve Mesothelioma Survival Trends »

Concerning CT Findings and Mesothelioma Prognosis - One of the nation’s top mesothelioma doctors says concerning CT findings may be one of the best ways to predict peritoneal mesothelioma outcomes.  Dr. Paul Sugarbaker is with MedStar Washington Hospital Center in Washington, DC. His newly published study compares 11 different concerning CT findings with outcomes in 100 mesothelioma patients.  Sugarbaker and his team found that the prognostic value of these 11 CT features is on a par with peritoneal cancer index (PCI) and cytoreduction (CC) score. It means that CT findings could become even more important for mesothelioma treatment planning.  CT Scans Reveal Information About Peritoneal Mesothelioma Peritoneal mesothelioma occurs on the lining around the abdomen. It is an aggressive and hard-to-treat cancer caused by exposure to asbestos. … Continue reading Concerning CT Findings and Mesothelioma Prognosis »

Prognostic Value of PET/CT in Pleural Mesothelioma Patients - New data highlights the prognostic value of PET/CT scans for patients with malignant pleural mesothelioma. Pleural mesothelioma is a rare malignancy with a poor prognosis. But some patients tend to do better than others. Scientists are always looking for better ways to predict which patients will respond best to which treatment. A new Turkish study focused on the prognostic value of scans that measure tumor volume and metabolic activity. They conclude that PET/CT is a valuable way to predict mesothelioma outcomes. Doctors can use the information to help plan for chemotherapy or surgical treatment.  How PET/CT Scans Work Doctors have been aware of malignant mesothelioma since the 1930s. That is when it first started appearing among asbestos workers. But there … Continue reading Prognostic Value of PET/CT in Pleural Mesothelioma Patients »

Age and Smoking Less Important Than Other Factors for Mesothelioma Outcomes - A newly published study suggests that a mesothelioma patient’s age and smoking history is less important to prognosis than certain biomarkers or what treatment they choose. The study comes from scientists at the National Institute of Respiratory Diseases in Mexico City.  They performed a retrospective analysis of 136 patients with pleural mesothelioma. The goal was to see which factors played the biggest role in outcomes. Age and smoking were among seven factors evaluated. It turns out they were not the most important ones.  Who Gets Pleural Mesothelioma? Malignant mesothelioma is the cancer most closely associated with asbestos exposure. Most people who get it have lived or worked around asbestos. Mesothelioma can take decades to develop. Most patients are over 65.  … Continue reading Age and Smoking Less Important Than Other Factors for Mesothelioma Outcomes »

Estrogen Signaling Genes May be Secret to Survival for Women with Mesothelioma - Scientists think they now have a better understanding of why most women with mesothelioma live longer than men.  Malignant mesothelioma is four times more common in men than in women. But many studies show that women with mesothelioma do better than men after treatment.  Researchers with The International Mesothelioma Program at Brigham and Women’s Hospital in Boston say the difference is in the genes. Their new study focused on the potentially protective role of estrogen signaling genes in female patients. The RERG Gene and Mesothelioma Survival In the latest study, researchers analyzed genetic data and survival in groups of mesothelioma patients. The groups included both men and women with mesothelioma. The goal was to determine what aspect of the women’s … Continue reading Estrogen Signaling Genes May be Secret to Survival for Women with Mesothelioma »

Radiotherapy Outcomes in Mesothelioma Linked to Metabolism - Italian researchers say metabolic markers may hold the key to predicting radiotherapy outcomes in people with mesothelioma. Metabolism is the process by which cells produce energy. Metabolism is necessary for cancer cells to live. Mesothelioma cells metabolize faster than healthy cells.  Radiotherapy affects cancer cell metabolism. A new study shows that compounds produced during metabolism may impact radiotherapy outcomes. It suggests that a patient’s metabolic profile – or metabolome – could help doctors choose good candidates for radiation. Radical Hemithoracic Radiotherapy and Mesothelioma  Pleural mesothelioma is a rare lung-related cancer caused by asbestos exposure. There is no cure for mesothelioma. Most mesothelioma patients have a combination of therapies. Radiation is one of the methods doctors use to help slow its … Continue reading Radiotherapy Outcomes in Mesothelioma Linked to Metabolism »

Standard Biomarkers for Pleural Mesothelioma “Not Useful” for Immunotherapy - Two of the most important biomarkers for pleural mesothelioma are not much help when it comes to tracking response to immunotherapy. Top mesothelioma researchers at the University of Pennsylvania drew that conclusion based on data from a cohort of 58 patients.  They focused on two primary biomarkers for pleural mesothelioma: SMRP and fibulin-3. Doctors use both of these markers to diagnose and plan treatment for mesothelioma.  The study confirms the correlation between these markers and mesothelioma tumor volume. But the Penn Medicine researchers say these biomarkers of pleural mesothelioma were “not useful” for measuring immunotherapy response. Understanding Biomarkers for Pleural Mesothelioma A biomarker is a substance produced by the body that indicates a biological process or condition. Most mesothelioma biomarkers … Continue reading Standard Biomarkers for Pleural Mesothelioma “Not Useful” for Immunotherapy »