Mesothelioma Update

By Mark Block, MD; and Alice M. Boylan, MD

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Prognosis and Staging

Staging is another controversial issue related to this disease. Prior to the proposal of a TNM-based staging system by the International Mesothelioma Interest Group,¹² there had been at least six other systems proposed for staging of mesotheliomas. None of the six was clearly shown to accurately predict survival, including the most widely used, proposed by Butchart et al. ¹² The TNM-based staging system is organized in a manner similar to the system currently in use for non-small cell carcinoma of the lung. Analysis of a prospective surgical database by one institution supported the prognostic value of this system, but analysis of another database did not.

Overall, the median survival for patients is between 9 and 12 months from the time of diagnosis. Regardless of therapy, patients with the epithelial cell type do best and those with the sarcomatous cell type the worst, with mixed or biphasic falling between the two other types. In addition, advanced age (≥ 75 years), poor performance status, and a high lactate dehydrogenase level (≥ 500 IU) have all been associated with a worse prognosis.¹³

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