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Written By: Devin Golden

Biphasic Mesothelioma Prognosis

The prognosis for biphasic mesothelioma, one of the three cell types of this rare cancer, fluctuates among patients due to the varying factors regarding this cell type. Patients who are diagnosed with biphasic mesothelioma should understand why their prognosis might be different from another patient’s prognosis.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse

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Important Facts About Biphasic Mesothelioma Prognosis

  • The two most important factors for a biphasic mesothelioma prognosis are where the mesothelioma forms (chest or abdominal cavity) and the ratio of epithelioid cells to sarcomatoid cells.
  • Other factors affecting a biphasic mesothelioma prognosis are the stage of the cancer and the patient’s overall health, both of which can dictate which treatment options are available.
  • The life expectancy for biphasic mesothelioma is often 9-13 months, but patients who have mostly epithelioid cells and receive surgery can have an extended life expectancy.

What is a Medical Prognosis?

The National Institutes of Health defines prognosis as “the prospect of recovering from injury or disease, or a prediction or forecast of the course and outcome of a medical condition,” such as cancer.

Mesothelioma is a rare and aggressive cancer. Surgery is often the best treatment option to remove most, if not all, of the tumors, but many patients do not qualify for surgery due to their overall health or the stage of their cancer. Chemotherapy, immunotherapy and radiation can slow or stop the spread of mesothelioma tumors, but they rarely kill the entire disease.

Due to these factors associated with mesothelioma, the prognosis for mesothelioma is often focused on how long a patient may survive.

What is the Expected Prognosis for Biphasic Mesothelioma?

The expected prognosis for biphasic mesothelioma depends on a few factors. The prognosis for this mesothelioma cell type is approximately 9-13 months.

However, aggressive treatment can improve the prognosis for this cell type. According to studies, surgery can improve the prognosis to 14-16 months for pleural mesothelioma and approximately five years for peritoneal mesothelioma.

Average Survival for Biphasic Pleural Mesothelioma

Pleural mesothelioma forms in the thin lining of the lungs called the pleura. This lining consists of mesothelial tissue cells, which can turn cancerous when asbestos fibers get stuck in the cells.

Due to the pleura’s proximity to the lungs, the prognosis for biphasic pleural mesothelioma is 1-2 years. For example, a 2018 study in Clinical Lung Cancer reports the average survival time for biphasic pleural mesothelioma patients is 9.5 months following their diagnosis. Another study reports an average survival of 13 months for this cell type of pleural mesothelioma.

Aggressive treatment options, including surgery, can give patients a more hopeful prognosis. Surgery for pleural mesothelioma involves removing all visible tumors from the chest cavity along with the lining of the affected lung or removing the entire diseased lung.

Average Survival for Biphasic Peritoneal Mesothelioma

Peritoneal mesothelioma forms in the lining of the abdominal cavity called the peritoneum. This lining is also made of mesothelial tissue cells, which can turn cancerous when irritated by asbestos fibers.

When patients have surgery, the initial prognosis for biphasic peritoneal mesothelioma is often better than the prognosis for biphasic pleural mesothelioma. Surgery for peritoneal mesothelioma involves removing all visible tumors from the abdominal cavity along with diseased tissue and organs, like the spleen.

A study published in the Annals of Surgical Oncology reported that patients with biphasic peritoneal mesothelioma benefited greatly from aggressive surgery. Patients who had a successful cytoreduction surgery with heated intraperitoneal chemotherapy (HIPEC) – meaning the medical team was able to remove all visible tumors – had an average survival of 6.8 years following the operation and a 5-year survival rate of 51%.

Factors Affecting Your Biphasic Mesothelioma Prognosis

The prognosis for biphasic mesothelioma can vary from patient to patient. In fact, this cell type has the most likelihood for variance – due to the presence of two different cell types making up this form of mesothelioma.

Ratio of Epithelioid Cells to Sarcomatoid Cells

One of the biggest factors affecting a biphasic mesothelioma prognosis is the ratio of epithelioid cells to sarcomatoid cells. This factor is unique to biphasic mesothelioma since it involves a mixture of both epithelioid and sarcomatoid cells.

For a case of mesothelioma to be considered biphasic, there must be at least 10% of both epithelioid and sarcomatoid cells. A diagnosis of epithelioid mesothelioma means the patient’s tumors consist of a large majority of epithelioid cells, and a diagnosis of sarcomatoid mesothelioma has more sarcomatoid cells.

Epithelioid cells are easier to identify, respond better to treatments and do not progress as quickly as sarcomatoid cells. For this reason, epithelioid mesothelioma typically has a better prognosis than sarcomatoid mesothelioma. Sarcomatoid cells are typically more aggressive which can result in a less favorable prognosis.

Therefore, a patient’s biphasic mesothelioma prognosis greatly depends on the percentage of epithelioid and sarcomatoid cells.

Stage

The stage of mesothelioma at the time of diagnosis also affects the patient’s prognosis. Stage 1 is the least advanced stage, meaning the cancer has not grown or spread to nearby tissues. The tumors are confined to the thoracic cavity (pleural mesothelioma) or the peritoneal cavity (peritoneal mesothelioma). It is usually not as difficult to treat and is associated with the best life expectancy. Stage 1 mesothelioma patients are likely surgical candidates, which means they have the best chance of removing all tumors.

Stage 4 is the most advanced stage, which means the cancer has likely grown and spread to other parts of the body and may be affecting vital organs. It is often difficult to treat and associated with the least promising life expectancy.

Treatment Options Available

A mesothelioma patient’s treatment plan can heavily impact their prognosis. Surgery, chemotherapy, immunotherapy and radiation are the four main treatment options for biphasic mesothelioma. Others, such as oncolytic virus therapy, are available through clinical trials.

Surgery gives patients the highest potential for long-term survival because experienced doctors at top cancer centers can usually remove most or all of the tumors with one operation. Even if there are a few remnant, hidden cells, the patient can benefit from surgery since the bulk of the disease no longer exists. Some patients have lived for more than five years after having surgery.

A report in the Annals of Thoracic Surgery reported that biphasic pleural mesothelioma patients in stage 1 or stage 2 who underwent surgery had an average survival of approximately 16 months. The study also tracked the average survival for patients who didn’t have surgery, which was 9.3 months, showing that surgery improves survival.

However, surgery is not always an option for patients. The surgeries for mesothelioma are major procedures – possibly involving the removal of a major organ such as a lung or the spleen – and not every patient is healthy enough for this treatment option. Patients with advanced-stage mesothelioma may not be candidates for surgery since the disease is too widespread to be removed with an operation.

Chemotherapy and immunotherapy are the most common options if surgery is not possible. Patients who receive one or both of these treatment options usually live for 1-2 years after their biphasic mesothelioma diagnosis.

Age and Overall Health Status

Age and overall health status are the last two main factors affecting a biphasic mesothelioma prognosis. They are usually, but not always, intertwined; the older a patient is, the more likely they are to be in poorer health.

Overall health status refers to whether the patient has other health issues, such as issues with weight or a health condition, such as diabetes or high blood pressure. These comorbidities can make recovery from mesothelioma treatment more challenging, which can affect prognosis.

Frequently Asked Questions About Biphasic Mesothelioma Prognosis

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What is the Average Prognosis for Biphasic Mesothelioma?

The average prognosis for biphasic mesothelioma is 9-13 months. Surgery is one treatment option that can greatly improve the prognosis for mesothelioma patients. Other factors affecting the prognosis include the stage of the cancer, the patient’s health status, and whether their tumors consist of mostly epithelioid cells or sarcomatoid cells.

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How Does the Rate of Epithelioid Cells to Sarcomatoid Cells Affect a Biphasic Mesothelioma Prognosis?

Epithelioid mesothelioma cancer cells are easier to identify, easier to treat and do not spread as quickly as sarcomatoid cells. Cases where the tumors consist of mostly epithelioid cells usually have a better prognosis than cases where sarcomatoid cells are more prevalent.

Sources & Author

  1. Survival results in biphasic malignant pleural mesothelioma patients: A multicentric analysis. Journal of Thoracic and Cardiovascular Surgery. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/31590954. Accessed: 10/22/19.
  2. Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry. Annals of Surgical Oncology. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/29260418?dopt=Abstract. Accessed: 10/22/19.
  3. Is There a Role for Cancer-Directed Surgery in Early-Stage Sarcomatoid or Biphasic Mesothelioma? Annals of Thoracic Surgery. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/30278171. Accessed: 10/23/19.
  4. Survival by Histologic Subtype of Malignant Pleural Mesothelioma and the Impact of Surgical Resection on Overall Survival. Clinical Lung Cancer. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/30224273. Accessed: 10/23/19.
  5. Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma. UpToDate. Retrieved from: https://www.uptodate.com/contents/presentation-initial-evaluation-and-prognosis-of-malignant-pleural-mesothelioma?topicRef=4625&source=see_link. Accessed: 04/17/19.
  6. Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging. UpToDate. Retrieved from: https://www.uptodate.com/contents/malignant-peritoneal-mesothelioma-epidemiology-risk-factors-clinical-presentation-diagnosis-and-staging. Accessed: 12/16/19.
Devin Golden

About the Writer, Devin Golden

Devin Golden is a content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.