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:
The patient – their age, biology, and state of health
The cancer – has the mesothelioma spread or is it localized when it is diagnosed and what is the cell type
The treatment or treatments selected
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.
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»
Epithelioid Subtype Leads to Longer Survival Regardless of Treatment-Danish 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 … Continue reading Epithelioid Subtype Leads to Longer Survival Regardless of Treatment»
Autoimmune Disease and Mesothelioma: Will it Impact Survival?-A new lung cancer study suggests that having an autoimmune disease will not necessarily lead to shorter cancer survival. This could be good news for pleural mesothelioma patients suffering from autoimmune disorders. Pleural mesothelioma is a lung-related disease that has many characteristics in common with lung cancer. The new study comes from Northwestern University Feinberg School of Medicine in Chicago. It included 177 lung cancer patients who also had immune diseases. Doctors compared their survival with a control group of lung cancer patients. They determined that having an autoimmune disease did not negatively impact lung cancer survival. In fact, some of those patients lived longer than those with healthy immune systems. What is an Autoimmune Disease? An autoimmune disease is … Continue reading Autoimmune Disease and Mesothelioma: Will it Impact Survival?»
Predicting Mesothelioma Survival with Routine Clinical Tests-UK researchers say predicting mesothelioma survival does not have to be complicated. Their new study shows routine doctor’s office tests may be just as accurate as more complex metrics. The study appears in the new issue of the BMJ Open Respiratory Research journal. It involved 100 patients with malignant mesothelioma over a four-year period. The team compared treatment outcomes among these patients with their results on basic health tests. More often than not, these tests correctly predicted their prognosis. The researchers say simplifying the process of predicting mesothelioma survival could help doctors and patients make better treatment decisions. Prognostic Indicators in Asbestos Cancer Malignant pleural mesothelioma is an uncommon but lethal form of membrane cancer. Patients who get it usually … Continue reading Predicting Mesothelioma Survival with Routine Clinical Tests»
Breakthroughs in Mesothelioma in 2020-In spite of a global pandemic, there were some major breakthroughs in mesothelioma in 2020 that made the year a hopeful one for people fighting asbestos cancer. Malignant mesothelioma is the most serious illness caused by exposure to asbestos fibers. Mesothelioma is still not curable. But researchers have made major breakthroughs in mesothelioma diagnosis, prognosis, and treatment this year. Mesothelioma Treatment Advances Mesothelioma treatment saw the biggest breakthroughs in mesothelioma in 2020. The FDA approved the first systemic treatment for mesothelioma since 2004. That was the year that Alimta (pemetrexed) received approval. They approved a combination of the immunotherapy drugs Opdivo and Yervoy. Yervoy helps activate and proliferate T-cells. Opdivo helps existing T-cells discover the mesothelioma tumor. The patients who … Continue reading Breakthroughs in Mesothelioma in 2020»
High PD-L1 Levels Could Be Bad News for Mesothelioma Surgery Candidates-Yet another new study has found a link between PD-L1 levels and mesothelioma survival – this time in people slated to have surgery for malignant pleural mesothelioma. PD-L1 stands for programmed cell death ligand 1. It is a protein expressed by some cancer cells that helps them avoid immune system attack. Researchers at Baylor College of Medicine are the latest to show that higher PD-L1 levels may lead to a worse mesothelioma prognosis. Their study focused specifically on mesothelioma surgery candidates. The results were published recently in the Annals of Thoracic Surgery. PD-L1 Levels and Mesothelioma Prognosis Even healthy people express some amount of PD-L1. Its job is to suppress the part of the immune system that attacks foreign tissues. … Continue reading High PD-L1 Levels Could Be Bad News for Mesothelioma Surgery Candidates»
Age is a Factor in Mesothelioma Survival After Surgery-Age appears to be one of the biggest predictors of mesothelioma survival after surgery. This holds true no matter which kind of surgery a patient has. A new study from the University of Pennsylvania compared the outcomes of more than 2,000 mesothelioma surgery patients. They compared them by surgical type. They also compared their survival with that of people who did not have surgery. Mesothelioma survival after surgery was consistently longer for younger patients. The risk of death within a few months went up a little bit with each year of age. The news could help patients and doctors make better treatment decisions. Surgical Procedures for Mesothelioma Operating on mesothelioma patients is controversial. Mesothelioma tumors are irregularly shaped and difficult to … Continue reading Age is a Factor in Mesothelioma Survival After Surgery»
Mesothelioma Staging: Laparoscopy May Find Tumors PET-CT Misses-Cancer researchers at Baylor College of Medicine say diagnostic laparoscopy (DL) improves the accuracy of pleural mesothelioma staging prior to surgery. It is especially valuable for patients with cancer in both the chest and abdomen. Staging is a way for doctors to determine how widespread cancer is. Accurate staging is critical for the best surgical outcomes. For the right patients, mesothelioma surgery can be a life saver. Many mesothelioma patients undergo PET/CT as part of the staging process. But the Baylor study suggests that adding a tool called a laparoscope to the process may find tumors that PET-CT misses. What is Mesothelioma Staging? Malignant mesothelioma is a type of cancer that grows on internal membranes. It usually occurs on the … Continue reading Mesothelioma Staging: Laparoscopy May Find Tumors PET-CT Misses»
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