Mesothelioma Surgery for Nonepithelioid Malignant Mesothelioma Remains Up for Debate

Thursday, May 6th, 2010

A study recently published in The Annals of Thoracic Surgery examined whether surgical treatment for nonepithelioid is worthwhile for the patient.

The debate still remains regarding the prognostic importance of histologic subtype for malignant mesothelioma. In general, the epithelioid (also referred to as epithelial) subtype of mesothelioma is known for responding better to treatment efforts. The biphasic subtype is typically less responsive to treatment than epithelioid and the sarcomatoid subtype is known for being the least responsive to therapeutic efforts.

Much research has been and will continue to be conducted on this topic because it can significantly affect mesothelioma life expectancy. Typically, mesothelioma patients diagnosed with epithelioid mesothelioma have a better prognosis than patients diagnosed with sarcomatoid mesothelioma regardless of treatment efforts. Thus, studying the veracity of treatment plans based upon histologic subtype may improve medical understanding of mesothelioma treatment efforts and may help doctors assess which treatments are best for individual mesothelioma patients.

This study reviewed the medical details of 312 cases of malignant pleural mesothelioma and a comparison was made regarding the survival from the three major subtypes. A total of 195 patients underwent radical surgical treatment, and 117 underwent nonradical surgery. Histologic subtype was documented as epithelioid in 218 patients, biphasic in 66 patients, and sarcomatoid in 28 patients. Median survival was 15.3 months in epithelioid patients, 10.1 months in biphasic patients, and 5.0 months in sarcomatoid patients.

Upon analyzing the data, the researchers found, "The extremely poor prognosis of sarcomatoid malignant pleural mesothelioma is independent of the extent of surgery unlike other cell types. Patients with sarcomatoid histology should therefore be considered separately in trials evaluating radical procedures and adjuvant treatment. The treatment of biphasic pleural mesothelioma remains debatable."

Additional information on mesothelioma may be found through the Mesothelioma Center.