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Surgery May Impact Mesothelioma Survival More Than Stage

2214038_patient5A study conducted in Belgium appears to support the idea that whether or not a malignant pleural mesothelioma patient undergoes surgery may be a better predictor of survival than the stage of their cancer.

The study including 101 patients diagnosed with or treated for pleural mesothelioma between 2001 and 2015 at Antwerp University Hospital.

The goal of the study was to determine how closely the experience with mesothelioma at this single institution matched that of other institutions as documented in the medical literature.

Overall Mesothelioma Survival

In most respects, the mesothelioma survival data from the Antwerp study was similar to past mesothelioma studies. The analysis found that most (80%) mesothelioma patients at their hospital were men and that their median age was 66. More than 80 percent had the epithelioid type of mesothelioma, which is also consistent with rates around the world.

Overall, the pleural mesothelioma patients in the study had a median survival of 18.3 months. At one year, 68 percent of patients were still living. By year two, 37 percent were still alive. Only 7 percent of the mesothelioma patients survived for five years or more.

Mesothelioma Staging System “Limited”

Notably, the researchers found no significant survival difference between patients in the several top TNM cancer staging categories, suggesting that stage alone may not give a clear prognostic picture. Instead, surgery seemed to have a bigger impact on mesothelioma survival.

“A significant difference in survival was observed in patients undergoing surgery versus no surgery…and treatment with chemotherapy alone versus chemotherapy with surgery,” reports study author Andreas Domen with the Department of Thoracic and Vascular Surgery at Antwerp University Hospital.

Understanding the TNM Staging System

TNM staging is a method for predicting outcomes and selecting mesothelioma treatment options based on three factors – the size of the original tumor (T), the level of lymph node (N) involvement, and metastasis (M) or spread of the cancer. TNM is developed and maintained by the Union for International Cancer Control as a way to standardize cancer classification across the globe.

The other factors with the biggest impact on mesothelioma outcomes in the Antwerp study were smoking and histological subtype. Smokers tended to have worse outcomes as did patients with non-epithelioid (sarcomatoid or biphasic) mesothelioma.

“Descriptive and survival analysis of our patient database confirmed the limitations of the current staging system and were concordant with literature regarding malignant pleural mesothelioma,” concludes the report in the Belgian journal Acta Chirugica Belgica.


Domen, A, et al, “Malignant pleural mesothelioma: single-institution experience of 101 patients over a 15-year period”, June 2017, Acta Chirugica Belgica, pp. 157-163

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