Improving mesothelioma survival rates has been at the forefront of research for years, as the cancer has long been recognized for its poor prognosis due to a number of factors like difficulties in early detection and aggressive cell types. A recent study from the University of Pittsburgh has discovered six factors that they believe are associated with improved survival among mesothelioma patients and can help drive future research efforts to improve patient life expectancy. Currently, most mesothelioma patients live an average of 12 – 21 months following diagnosis. The team from UPMC set out to understand why patient survival varies so widely to help pinpoint research areas and drive future clinical trials.
Analyzing Data to Improve Mesothelioma Survival
Using the National Mesothelioma Virtual Bank (NMVB), the researchers were able to analyze 888 mesothelioma patients between 1990 and 2017 to decipher what characteristics led to more favorable outcomes for certain patient populations. Patients analyzed in the study were diagnosed with pleural mesothelioma and peritoneal mesothelioma, and showed a range of ages, cell type, stages and other characteristics.
The study’s use of NMVB was especially impactful because the database is one of only a few that includes data from New York and Pennsylvania. The states are noted for having among the most mesothelioma-related deaths in the country. The latest CDC data notes that between 1999 and 2017, New York experienced 2,606 mesothelioma deaths and Pennsylvania experienced 3,092 deaths caused by mesothelioma.
After reviewing the NMVB data, the researchers found that the strongest factors impacting a mesothelioma patient’s survival include:
- Receiving a diagnosis before age 45
- Gender, with female patients showing better survival
- A diagnosis of epithelioid mesothelioma (the most common cell type)
- A diagnosis of peritoneal mesothelioma
- A diagnosis of stage 1 mesothelioma
- A treatment plan including both surgery and chemotherapy
Overall, the data didn’t necessarily feature many surprises, as doctors and researchers have long recognized the survival benefits of factors like an early-stage diagnosis and a multimodal treatment plan. However, this analysis helps confirm such ideas and reports that have been discussed previously in the mesothelioma community, but didn’t necessarily have enough data to conclusively support them.
In their analysis, the researchers confirmed the impact of age on mesothelioma survival. They found that patients between the ages of 18 – 44 had a median survival of 59 months, while patients 75 years and older survived 10 months on average. Researchers also noted the difference in survival for males versus females. Female patients in the study had a median survival of 22 months. Comparatively, male patients achieved a median survival of 14 months. The researchers believe this disparity in survival among the genders is impacted by women more likely experiencing secondary or para-occupational asbestos exposure.
Regardless of patient sex and age, specific cell subtype was also supported as having a profound impact on patient survival. Those with epithelioid mesothelioma were shown to have the best survival periods, with patients surviving 18 months on average. Patients with biphasic mesothelioma, a combination of both epithelioid and sarcomatoid cell types, had a median survival of 10 months, while malignant sarcomatoid mesothelioma patients had a median survival of seven months.
Impact of Treatment on Survival Period
In addition to patient characteristics and specifics of the patient’s unique case, researchers found the type of treatment impacted patient survival times, as well as the stage of disease when treatment could be administered. As many studies have shown in the past, this study confirmed that patients with disease in the early stages have longer survival times. For patients in the analysis, researchers noted a median survival period of 20 months for patients with stage 1 mesothelioma. Patients with either stage 3 or stage 4 disease experienced a survival period of about one year.
Independent of stage, the study found that using a multimodal treatment approach was associated with a longer survival period, an idea that has been suggested through numerous clinical trials testing different multimodal approaches. Of the more than 800 patients analyzed, researchers compared the efficacy of surgery alone, surgery combined with chemotherapy and surgery applied with both chemotherapy and radiation.
Patients that underwent a combination of surgery and chemotherapy treatment had the most favorable survival periods, achieving a median overall survival of 23 months. According to the data, survival periods ranged from 21 – 27 months. Adding radiation therapy to the surgery/chemotherapy combination was found to not improve survival rates. Patients treated with all three forms of treatment had a median survival rate of 10 – 21 months. Mesothelioma patients treated with surgery alone experienced an 8 – 14 month survival period.
Areas Requiring Further Research
Upon evaluating their findings and the limitations of the study, researchers concluded there is still much work to be done to improve mesothelioma survival rates and work towards a cure. While their results help to further identify patients that may be more tolerating of advanced treatment modalities, more research is required in order to best treat the majority of the mesothelioma patient population.
Most notably, the researchers suggest that more time is spent evaluating the efficacy of non-surgical treatment options for mesothelioma patients. Many mesothelioma patients are of advanced age, when surgical procedures become increasingly dangerous and may no longer be a viable option. Additionally, the researchers believe more work can be done to understand the most at-risk populations and deciphering what factors are associated with mortality among mesothelioma patients to avoid pursuing treatment types that may create more harm than good.
Being mindful of these factors associated with improved survival may help to more accurately treat patients using the most aggressive treatments that they can safely tolerate. The hope is that with advancements in mesothelioma research, the prognosis for mesothelioma patients will continue to improve.