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

Pandemic-Related Mesothelioma Treatment Delays Could Impact Outcomes - Mesothelioma treatment delays that happened because of the COVID-19 pandemic will probably impact survival rates for some patients.  A new study of Canadian lung cancer patients found that more than half of them stopped or delayed treatment because of concerns about the virus this spring. Pleural mesothelioma is a lung-related cancer. Like lung cancer patients, mesothelioma patients face a higher risk of virus-related complications because they already have breathing problems.  But mesothelioma is also a fast-growing cancer. Most patients get several kinds of treatment at the same time. Mesothelioma treatment delays may give tumors a chance to grow unchecked.  A Catch-22 for Mesothelioma Patients Mesothelioma patients and others with lung diseases have had to make some difficult decisions because of … Continue reading Pandemic-Related Mesothelioma Treatment Delays Could Impact Outcomes »

Gene Targeting Slows Aggressive Form of Pleural Mesothelioma - Scientists in Vienna are developing a new treatment for a particularly aggressive form of pleural mesothelioma.  This form of mesothelioma occurs in people with a genetic mutation. The mutation produces signals that fuel tumor growth. These patients typically have an even worse prognosis than other mesothelioma patients.  But the Austrian team came up with a way to block activation of the mutated gene. If the gene does not send its signal, this aggressive form of pleural mesothelioma may grow more slowly.  Aggression Fueled by Telomerase Malignant mesothelioma is one of the most aggressive kinds of cancer. It starts on the membranes around organs and can quickly spread to other parts of the body. By the time most people notice symptoms, … Continue reading Gene Targeting Slows Aggressive Form of Pleural Mesothelioma »

The Peritoneal Cancer Index in Mesothelioma Prognosis - The peritoneal cancer index is a valuable prognostic tool and should be considered in mesothelioma treatment planning. That is the word from a group of Finnish cancer researchers. They analyzed twelve years of data on peritoneal mesothelioma in their country. Mesothelioma patients with a higher peritoneal cancer index had a worse prognosis than those with a lower PCI. The group says cancer doctors ought to be including the PCI in their decision-making for people with peritoneal mesothelioma. What is the Peritoneal Cancer Index? Peritoneal mesothelioma makes up about a fifth of all mesothelioma cases. It grows on the peritoneum, a membrane that surrounds the abdominal organs. As cancer spreads, tumors can show up in other areas inside the peritoneal cavity.  … Continue reading The Peritoneal Cancer Index in Mesothelioma Prognosis »

Breath Test for Mesothelioma Might Identify Subtypes - Researchers in the UK say a breath test for mesothelioma might be able to distinguish between mesothelioma subtypes. There are three major subtypes of mesothelioma. It is important to know which kind of person has. A patient’s subtype can impact their prognosis and even their mesothelioma treatment choice.  Right now, the only way to tell the mesothelioma subtypes apart is to look at the cells under the microscope. But scientists at Sheffield Hallam University have identified volatile organic compounds (VOCs) in the rarest and the most common mesothelioma subtypes.  These VOCs could be used to develop a mesothelioma breath test that could tell the subtypes apart.  The Advantages of Breath Testing Breath testing is a way of measuring VOCs in … Continue reading Breath Test for Mesothelioma Might Identify Subtypes »

The Best Biomarkers for Mesothelioma Diagnosis, Prognosis, & Monitoring - What are the best biomarkers for mesothelioma? The answer is still Soluble Mesothelin-Related Proteins (SMRPs). That is the conclusion of a major review of medical literature by some of the world’s top mesothelioma experts. Dr. Harvey Pass of New York University’s Langone Medical Center and Dr. Michele Carbone of the University of Hawaii are among the authors on the new report.  They analyzed 20 years of research on the best biomarkers for mesothelioma. Several were valuable for mesothelioma prognosis. But SMRPs once again came out the winner for mesothelioma prognosis, diagnosis, and treatment monitoring.  How Do Biomarkers Work? A biomarker is any substance produced by the body that can act as a biological signpost. Proteins usually make the best biomarkers … Continue reading The Best Biomarkers for Mesothelioma Diagnosis, Prognosis, & Monitoring »

Predicting Mesothelioma Outcomes with FDG-PET: A New Model - Swiss doctors have created a new tool for predicting mesothelioma outcomes with FDG-PET scans.  FDG-PET scanning is a nuclear imaging technique. It gives doctors a non-invasive way to track the growth of pleural mesothelioma tumors.  The Swiss team analyzed multiple PET scans and CT scans from mesothelioma patients. They used a computer to look for commonalities in the scans. Then they used the information to create a computer model for predicting mesothelioma outcomes with FDG-PET. The model may help doctors and patients make better decisions about mesothelioma treatment in the future.  Imaging Studies for Mesothelioma Prognosis Pleural mesothelioma tumors occur on the pleural lining around the lungs. In the early stages, mesothelioma causes few symptoms. As mesothelioma tumors grow, they … Continue reading Predicting Mesothelioma Outcomes with FDG-PET: A New Model »

Some Long-Term Mesothelioma Survivors May Have Few Symptoms - New research shows that some long-term mesothelioma survivors may have few or no symptoms of the disease for years.  The research appears in a recent issue of the journal Clinical Lung Cancer. A team of Finnish doctors wanted to identify the unique characteristics of long-term mesothelioma survivors. They discovered that some of these survivors seem to have an indolent form of asbestos cancer. This suggests that it is possible for a person to live for many years with pleural  mesothelioma and not even know they have it. Typical Mesothelioma Symptoms It is not unusual for mesothelioma patients to have no symptoms in the early stages, but long-term mesothelioma survivors are rare. Once the cancer takes hold, it usually grows quickly.  … Continue reading Some Long-Term Mesothelioma Survivors May Have Few Symptoms »

BAP1 Expression Not an Independent Factor in Mesothelioma Prognosis - A new report says the prognostic role of BAP1 expression in mesothelioma is not as cut-and-dried as some studies suggest. Italian researchers analyzed the cases of 698 patients with pleural mesothelioma. The group included 60 of their own patients and another 638 from other studies. Their analysis suggests that mesothelioma prognosis has more to do with subtype than with genetic BAP1 expression. They caution doctors not to put too much stock in a patient’s BAP1 status without also considering other factors. Genetic Alterations and Mesothelioma Survival Asbestos exposure is the primary cause of mesothelioma. But not everyone who is exposed to asbestos gets cancer. This may have to do with their genetic makeup. Certain genetic alterations may make a person … Continue reading BAP1 Expression Not an Independent Factor in Mesothelioma Prognosis »

Predicting the Risk of Death from Mesothelioma - New research suggests that the risk of death from mesothelioma does not always hinge on disease type or overall health. Researchers in Brazil and at Mayo Clinic have identified some subtle mesothelioma risk factors that only pathologists can see. These factors go beyond the characteristics of the mesothelioma cells themselves. The study shows the environment around the tumor, the number and type of immune system cells at the tumor site, and even how many cells are in the tumor can all impact the risk of death from mesothelioma.  Understanding the Risk Factors for Mesothelioma Asbestos exposure causes most cases of mesothelioma. But not everyone who encounters asbestos gets cancer. Genes and certain lifestyle factors may influence whether an exposed person … Continue reading Predicting the Risk of Death from Mesothelioma »

PD-L1 Expression and Mesothelioma Prognosis - The largest study yet on PD-L1 expression and mesothelioma prognosis shows that patients with more of this protein in their cells have poorer odds of survival. Programmed death ligand 1 (PD-L1) helps cancer cells evade immune system attack.  Other studies have suggested a link between PD-L1 expression and mesothelioma prognosis. But the new meta-analysis performed by two Chinese researchers appears to confirm it with an even bigger data set.  Understanding Mesothelioma Prognosis Malignant mesothelioma is an uncommon cancer that typically carries a poor prognosis. Many people diagnosed with mesothelioma lose their lives to the illness within a year.  But there are also many exceptions. Some mesothelioma survivors live for decades after a mesothelioma diagnosis. Australian Paul Kraus is an example. … Continue reading PD-L1 Expression and Mesothelioma Prognosis »