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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

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