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

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 »

Personalized Immunotherapy for Mesothelioma: New Research Sheds Lights - New research conducted by a team of German and Austrian scientists could help make personalized immunotherapy for mesothelioma possible.  Mesothelioma is an incurable cancer caused by exposure to asbestos. Immunotherapy is one of the most promising treatment approaches.  But immunotherapy drugs like Keytruda do not work for all patients. Scientists do not know exactly why this is. The new study suggests that understanding biomarkers could lead to better outcomes through personalized immunotherapy for mesothelioma.  How Does Immunotherapy Work? Immunotherapy is a broad term that means using the patient’s own immune system to fight their cancer. There are many different types of immunotherapy. Some involve stimulating an immune response. Others involve turning off the mechanism that lets mesothelioma cells hide from … Continue reading Personalized Immunotherapy for Mesothelioma: New Research Sheds Lights »

Genetics Affect Accuracy of SMRP Test for Mesothelioma - The SMRP test for mesothelioma is a tool doctors use to help diagnose asbestos cancer and plan treatment. But new research suggests that the test is not as useful as it could be due to genetic variability.  Slovenian doctors say a person’s genetics influence how much SMRP they produce.  Based on their research, they recommend combining the SMRP test for mesothelioma with genetic testing. Their findings suggest the combination method produces a more accurate and useful mesothelioma biomarker. What is the SMRP Test for Mesothelioma? SMRP stands for soluble mesothelin-related peptides. They are produced when proteins found in the mesothelial membranes start to break down. Malignant mesothelioma is one condition that can trigger this breakdown.  As a mesothelioma tumor grows … Continue reading Genetics Affect Accuracy of SMRP Test for Mesothelioma »

The Importance of Subtype in PET Scanning for Mesothelioma Prognosis - A new study of PET scanning for mesothelioma prognosis shows how much radioactive tracer a tumor absorbs can predict survival. This is especially true in people with the epithelioid mesothelioma subtype.  The study comes from the Sungkyunkwan University School of Medicine in Seoul, South Korea. Researchers studied the medical records of dozens of mesothelioma patients diagnosed between 2009 and 2018. They found that SUVmax, a key factor in PET scanning for mesothelioma, is directly related to mesothelioma survival.  How PET Scanning Works Mesothelioma diagnosis is challenging. Pleural mesothelioma grows quickly on the membrane around the lungs. It is one of the rarest and deadliest cancers. Positron emission tomography (PET) combined with computed tomography (CT) can help with diagnosis.  During a … Continue reading The Importance of Subtype in PET Scanning for Mesothelioma Prognosis »

Invasiveness of Peritoneal Mesothelioma: MRI Beats CT for Assessment - New research shows MRI beats CT when it comes to measuring the invasiveness of peritoneal mesothelioma. Scientists from several of the top US cancer centers ran the study. It included nearly 500 mesothelioma patients and appears in the journal Clinical Colorectal Cancer.  The study shows that the invasiveness of peritoneal mesothelioma is more visible on MRI than it is on CT. The news could make a difference in how doctors plan peritoneal mesothelioma treatment.  Peritoneal Cancer Index and Mesothelioma Peritoneal mesothelioma cancer grows on the peritoneal membrane lining the abdomen. Like all forms of mesothelioma, it usually comes from exposure to asbestos. Peritoneal mesothelioma accounts for about a fifth of all mesothelioma cases.  Doctors assess the invasiveness of peritoneal mesothelioma … Continue reading Invasiveness of Peritoneal Mesothelioma: MRI Beats CT for Assessment »

Mesothelioma Recurrence After PD Surgery - A new study finds that mesothelioma recurrence after PD surgery is common but most patients still live for more than a year afterwards. More than a third were still alive three years after recurrence. The study included 90 Japanese patients with malignant pleural mesothelioma.  Those who lived for at least a year without mesothelioma recurrence after PD surgery had the best chance of longer term survival. A good performance status and undergoing additional treatment were also key to better outcomes.  Understanding Pleurectomy with Decortication (PD) Surgery Pleural mesothelioma is a virulent cancer that occurs on the membrane around the lungs. There is no cure for mesothelioma. Even with the best treatment, the cancer usually comes back. The goal of most … Continue reading Mesothelioma Recurrence After PD Surgery »

It May Be Possible to Predict Recurrence of Mesothelioma with Help from AI - A newly-published report suggests that artificial intelligence (AI) might help pathologists predict recurrence of mesothelioma. The report focuses on technology developed by the RIKEN Center for Advanced Intelligence Project (AIP) in Japan. The Center claims the computer program taught itself to recognize key features in images of cancer.  Some of the features were ones that even pathologists did not know about. The findings suggest that AI and pathologists could predict recurrence of mesothelioma better than pathologists alone.  How AI Might Predict Recurrence of Mesothelioma  A computer program usually has to be “taught” to perform a certain task. But this limits how far the learning can go. Instead of “teaching” it about cancer, researchers let the RIKEN technology learn on its … Continue reading It May Be Possible to Predict Recurrence of Mesothelioma with Help from AI »

Antibiotic May Boost Response to Radiation Therapy for Mesothelioma - A common antibiotic may improve mesothelioma patients’ response to radiation therapy.  The concept is based on new research from the Perelman School of Medicine at the University of Pennsylvania.  Doctors there gave the antibiotic vancomycin to genetically modified mice. The mice had been modified to develop cancer. Mice that got the antibiotic had a better response to radiation therapy than untreated mice.  The effect applied not only to the treated tumor but also to tumors outside the treatment area. A heightened response to radiation therapy could be good news for patients with metastatic mesothelioma.  Understanding Cancer Response to Radiation Therapy Radiation therapy combats malignant mesothelioma by disrupting the DNA inside cancer cells. Mesothelioma tumors are irregularly-shaped which can make them … Continue reading Antibiotic May Boost Response to Radiation Therapy for Mesothelioma »

Is There a Risk for Depression Among Pleural Mesothelioma Patients? - Newly diagnosed pleural mesothelioma patients may be at higher risk for depression and that could be impacting their outcomes.   A new report finds that people diagnosed with advanced lung cancers are more likely to suffer from depression. Pleural mesothelioma is a form of lung cancer.  This risk for depression appears to have an impact on patients’ quality of life, their pain, and even the number of complications they experience.  Assessing the Risk for Depression in Cancer Patients Researchers at Ohio State University directed the study. It included 186 patients with Stage IV non-small-cell lung cancer. The patients had not yet started their cancer treatment.  Although pleural mesothelioma is not the same as non-small cell lung cancer, the two diseases share … Continue reading Is There a Risk for Depression Among Pleural Mesothelioma Patients? »