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Prognosis of Mesothelioma

The prognosis of someone diagnosed with pleural mesothelioma is usually poor, but it is improving steadily because innovations in research and treatment are extending survival rates.

About 10 percent of pleural mesothelioma patients live longer than three years after being diagnosed. Of those survivors, a little more than half can expect to live five years beyond diagnosis. The majority of mesothelioma patients typically survive about a year after learning they have the disease.

Even though long-term prognosis generally remains poor for anyone diagnosed with pleural mesothelioma, some patients can survive much longer than forecast. Where many people measure their survival time by months, some do live years after diagnosis. Pleural mesothelioma specialists are managing the disease successfully in many patients, allowing people to far surpass original prognosis.

Funding for prognostic studies on pleural mesothelioma is low, resulting in a limited number of studies on the topic. Additionally, the incidence of mesothelioma and its short survival time make it challenging for researchers to find participants. Despite these challenges, mesothelioma researchers discovered that not all prognostic factors have a clinically relevant impact on prognosis. Some factors have a measurable and consistent impact, while other factors don’t have a predictable effect on some patients. That makes a clinical outcome for each patient challenging to predict even when unifying prognostic factors are present. This diversity in disease expression makes the clinical application of prognostic factors challenging for doctors.

Factors Affecting Prognosis

Among the prognostic factors studied in pleural mesothelioma, the ones with the most impact include cancer stage, tumor cell type, overall health, gender, age and blood characteristics.

Stage of Cancer Development

The stage of the tumor is among the most impactful prognostic factors for pleural mesothelioma. Patients diagnosed in Stage I or II generally have a better prognosis than patients diagnosed in Stage III or IV.

As pleural mesothelioma progresses from Stage I to Stage IV, the tumor grows larger and begins to move into other areas of the body. As this happens, it becomes much more difficult to treat and therefore has a significant impact on a patient's prognosis.

In a Netherlands study on pleural mesothelioma, researchers studied the effects of staging — among other factors — on prognosis. The researchers reported that patients with Stage I disease survived the longest, while patients with Stage II survived longer than those with Stages III and IV.

	Stage I	Stage II	Stage III and IV
Median Survival in Days	359	147	112

Cell Type Can Affect Prognosis

The type of cell that makes up a pleural mesothelioma tumor can impact one's prognosis. Three main types of mesothelioma cells typically make up pleural mesotheliomas: epithelial, sarcomatoid or biphasic.

Biphasic pleural mesothelioma has a combination of the other two cell types. Some facts gleaned from medical research:

The epithelial cell type comes with the best prognosis
The sarcomatoid type has the worst prognosis
Epithelial cells respond best to treatment
Sarcomatoid cells generally don’t respond as well to treatment.
The prognosis for a patient with biphasic pleural mesothelioma depends upon the ratio of cells present. The more epithelial cells present, the more favorable the likely prognosis.

In the same Netherlands study, epithelial pleural mesothelioma patients survived for 252 days, biphasic patients for 190 days, and sarcomatoid patients for 207 days. Other studies report that the difference in survival for each type can vary by 200 days, depending upon the case.

Overall Health

Doctors measure a patient's overall health with a “performance status.” The performance status considers things such as physical abilities and signs of disease such as pain levels. Higher scores indicate a greater state of health and are associated with a better prognosis.

According to researchers J.A. Burgers and J.P. Hegmans, “All [malignant pleural mesothelioma] studies that included performance status data in their analysis showed a significant effect on the survival, with a better performance correlating with a better survival.”

Sex

Women with pleural mesothelioma tend to have a slightly better prognosis than men, although researchers cannot explain the disparity. Men were exposed to asbestos more than women because of the occupations they held in the 20th century. In addition, men tended to experience heavier levels of exposure than women who were exposed (again because of their occupations). Some studies show that heavy asbestos exposure is associated with more aggressive cases of pleural mesothelioma, and thus a poorer prognosis.

Age

Most patients diagnosed at a younger age tend to have a better prognosis, but this trend isn’t proven in every scientific study that examines age as a prognostic factor. Some studies report that patients older than 65 or 75 years have a poorer prognosis, while other studies say prognosis becomes negatively affected near age 50 or 60.

Blood characteristics

Certain biomarkers found in blood may have prognostic value for assessing pleural mesothelioma patients. Biomarkers like COX-2, MIB-1, white blood cells (WBC) and platelet counts have varying effects on prognosis. For example, high WBC and platelet counts could lead to a shorter life span, while high levels of the protein COX-2 could extend survival.

These characteristics vary with each patient and could one day play a pivotal role in optimizing treatment plans for individual patients.

Improving Pleural Mesothelioma Prognosis

Taking action to manage pleural mesothelioma, whether in the form of conventional treatments or lifestyle changes, can change a prognosis and increase the patient’s life span.

Treatment May Affect Prognosis

When developing a treatment strategy, doctors will determine if a patient is eligible for potentially curative treatments or palliative treatments. Doctors determine eligibility by evaluating the stage and cell type of the cancer, while keeping in mind the patient’s gender, age and overall health.

Traditional Treatment

If a patient is eligible for a potentially curative treatment, the treatment plan will usually be a form of multimodal therapy. Multimodal therapy is any combination of surgery, chemotherapy and radiation therapy. Alone, each of these treatments can improve life expectancy. Combining them, however, has proven effective and is associated with a higher survival rate than any one treatment alone.

Patients who qualify for surgeries that aim to remove the bulk of the tumor may live longer than patients who do not qualify for surgery. A 2011 study found median survival for patients treated with surgery was 710 days vs. 288 days for patients who didn’t undergo surgery. This improved survival could be influenced by the fact that early stage patients tend to qualify for debulking surgery. Someone with early stage pleural mesothelioma usually lives longer than someone diagnosed with the disease in Stage III or IV.

Complementary and Alternative Treatment

A unifying thread among many pleural mesothelioma survivors is their integration of complementary and alternative medicines (CAM). Natural therapies like massage, acupuncture, nutritional therapy and meditation have proven effective for numerous survivors.

Patients can work with a holistic doctor and/or an oncologist who is knowledgeable in integrative oncology, which is a harmony of traditional and alternative therapies to treat cancer.

Lifestyle Changes

Some pleural mesothelioma survivors recommend lifestyle changes to improve prognosis. Some lifestyle changes that survivors commend include quitting smoking, improving diet, becoming vegetarian or vegan, and integrating mind-body therapies on a regular basis (such as practicing gentle yoga weekly).

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