Surviving Three Years With Mesothelioma
A recent study captures some of the traits of mesothelioma patients, and their tumors, that are linked to a higher likelihood of surviving three years after surgery.
The research, published this year in the European Journal of Cardio-thoracic Surgery, examined a selection of patient- and tumor-related factors in people who had been diagnosed with malignant pleural mesothelioma, a cancer in the lining of the lung. All of the patients had undergone an extraplural pneumonectomy, an extensive operation that removes the diseased lung and adjacent tissue. Most had also undergone various other mesothelioma treatments.
Dr. David Sugarbaker, chief of thoracic surgery at Brigham and Women’s Hospital in Boston and founder of the hospital’s International Mesothelioma Program (IMP), led the research team. The researchers looked back at almost 20 years of patient records, beginning in January 1988, and found 636 patients who had undergone the extensive mesothelioma surgery. In all, nearly 20 percent of the patients had survived at least three years, a rate that was comparable to that of patients who had surgery for other malignancies in the chest.
Unexpectedly, quite a few of those survivors had more advanced disease—stage III and stage IV mesothelioma tumors. When classified according to American Joint Committee on Cancer/International Union Against Cancer guidelines, 67 percent of the three-year survivors had stage III, and 7 percent had stage IV, tumors.
One key factor that was linked to survival was how the mesothelioma tumor was classified when its cells were examined under a microscope. Patients whose tumors were labeled epithelioid—typically 50 to 60 percent of all malignant mesothelioma patients—represented 91 percent of the three-year survivors.
Having normal blood tests before surgery—specifically, normal levels of white cells (which fight infection), hemoglobin (the proteins in red cells that carry oxygen) or platelets (which are involved in clotting)—was linked to much better odds of surviving at least three years. Patients who were female or who were in the younger half of the study population—59 or under at the time of surgery—were also more likely to pass the three-year milestone.
People with pleural mesothelioma who survive three years have roughly 50-50 odds of surviving to five years, the researchers estimated, adding that some patients in their study survived 10 years or more. While successfully treating malignant mesothelioma remains a challenge, the investigators noted that five-year survival rates are improving as doctors get better at selecting the right patients for the right therapies, and as scientists search for better treatments to target stray tumor cells that remain dangerous after surgery.
“The treatment of MPM [malignant pleural mesothelioma] is positioned for a major advance,” the researchers wrote, “based not only on improved patient selection, but also on the development of systemic, immunologic, biologic, hormonal, and/or loco-regional therapies that would eradicate or chronically control microscopic disease.”
Baron and Budd was a cornerstone donor and Executive Advisory Board Member of IMP.
