What Are Mesothelioma Survival Rates?
Survival rate typically refers to the percentage of people with cancer who live one and five years after initial diagnosis. These measures are referred to as the one-year and five-year mesothelioma survival rates.
When discussing survival rates, you may hear other related terms such as life expectancy, which is the average time a person is expected to live based on birth year, current age, gender and other factors.
Mesothelioma affects life expectancy because the cancer reduces the number of years a patient is expected to live.
Factors Affecting Mesothelioma Survival Rates
There are several things that affect how long a person will live after a mesothelioma diagnosis.
Individual Characteristics and Mesothelioma Survival
- Tumor Location
- Stage of disease
- Mesothelioma cell type
- Age at diagnosis and overall health
- Gender
- Race/Ethnicity
A 2018 analysis of 888 cases in the National Mesothelioma Virtual Bank cohort identified median overall survival of 15 months, on average, for pleural and peritoneal patients combined.
The most important factors associated with better survival were age (less then 45), female gender, epithelioid cell type, stage 1 disease, peritoneal occurrence and treatment combining surgery with chemotherapy.
Mesothelioma Tumor Location
There are four types of mesothelioma, and the site where the cancer originates affects patient outcomes. Survival is significantly better for peritoneal patients.
Half of peritoneal patients who undergo HIPEC live longer than five years.
An advanced peritoneal mesothelioma therapy called hyperthermic intraperitoneal chemotherapy (HIPEC) has significantly improved survival rates for this cancer.
The procedure combines cytoreductive surgery and heated chemotherapy. Not everyone qualifies for this aggressive procedure, but more than half who do live at least five years.
This compares to a median survival of less than 12 months for patients with pleural tumors. In select studies, heated chemotherapy has boosted peritoneal survival to between 40 and 92 months.
A 2015 meta-study published in Translational Oncology analyzed 20 years of data, collected from 1992 to 2012. The five-year survival rate for peritoneal mesothelioma patients was more than five-times higher than the rate for pleural patients.
| Year(s) | Pleural | Peritoneal |
|---|---|---|
| 1 year | 73% | 92% |
| 3 years | 23% | 74% |
| 5 years | 12% | 52% |
| 10 years | 4.7% | 39% |
Source: “Changing Pattern in Malignant Mesothelioma Survival,” Translational Oncology, 2015. | ||
The remaining two types of this asbestos-related cancer are pericardial and testicular. Together, these account for less than 2% of all cases. Median survival for testicular mesothelioma, the rarest type, is 24 months.
Pericardial mesothelioma is very rare, with only 200 documented cases in the medical literature. It develops on the lining of the heart and has a median survival ranging from six weeks to 15 months.
Stage of Disease
The stage of cancer at diagnosis is a strong predictor of overall survival. People with stage 1 mesothelioma, before cancer has spread, have the best survival rates.
Early-stage patients who receive prompt treatment experience improved survival. They are more likely to qualify for surgery and other aggressive treatments. More aggressive therapies are associated with better outcomes.
At these stages, the tumor is large or has spread beyond the original cancer location. Being diagnosed at later stages mean the disease is more difficult to treat and is associated with poorer survival rates.
There is no established cancer staging system for peritoneal mesothelioma. Some researchers have developed their own systems based on TNM staging. In TNM, T = tumor size, N = lymph node involvement and M = metastasis (cancer spread) to describe the extent of cancer.
One example is the peritoneal cancer index (PCI), which places this tumor type into three stages instead of the usual four for other cancers. A 2011 international study involving 294 patients treated with cytoreductive surgery and HIPEC, used PCI to describe patient survival.
| PCI Stage | Year 1 | Year 5 |
|---|---|---|
| Stage 1 | 95% | 87% |
| Stage 2 | 87% | 53% |
| Stage 3 | 66% | 29% |
Source: “A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database*,” Cancer, 2011. | ||
Pleural mesothelioma does not have favorable survival rates when compared with the survival rates of peritoneal disease. The pleural disease can be harder to treat.
Patients often are not diagnosed early enough to receive the most aggressive available cancer therapies and may not be healthy enough to withstand invasive surgeries in particular.
| Stage 1 | Stage 2 | Stage 3 | Stage 4 | ||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 22.2 months | 20 months | 17.9 months | 14.9 months | ||||||||||||||||||||||||||||||||||||||||||||||
Source: “The IASLC mesothelioma staging project,” Journal of Thoracic Oncology, 2016. Mesothelioma Cell Type (Tumor Histology)The mesothelioma cell type, or tumor histology, impacts patient survival. The cancer has three primary cell types: Epithelioid, sarcomatoid and biphasic. The most common cell type is epithelioid, which is also the least aggressive. It responds best to treatment. Median survival for patients with this cell type is 12 to 24 months. Sarcomatoid mesothelioma is the most aggressive cell type. Patients with this diagnosis have a median survival of six to eight months. Biphasic tumors have epithelioid and sarcomatoid features. More epithelial cells means a better prognosis. If the tumor is mostly sarcomatoid cells, life expectancy is decreased. Patients with a biphasic cell diagnosis have a median survival of around 13 months. Age at Diagnosis and Overall HealthOlder mesothelioma patients have lower survival rates, on average, compared with younger patients. More than 55% of patients diagnosed before the age of 50 live one year. Less than 30% of patients 75 or older live the same amount of time.
Patients diagnosed before age 50 have an estimated 25% chance of surviving a decade. That drops to 5.4% for patients between the ages of 50 and 64. The five-year survival rate for mesothelioma patients diagnosed between ages 65-74 is 6.7%. That rate falls to 3.8% for people 75 and older at diagnosis. Younger patients tend to be healthier than older patients, which means they are eligible for more aggressive and effective therapies. Younger patients also are less likely to suffer from other chronic conditions such as pulmonary disease, diabetes or a history of other cancers. Better general health allows for enrollment in clinical trials, too. GenderMost asbestos exposures occur in the workplace. Industrial jobs traditionally held by men present the highest risk. This helps explain why men account for the majority of all cases. However, even though men make up most cases of the disease, women with mesothelioma appear to survive longer than men regardless of age, cancer stage, race or type of treatment. For every age group studied in the SEER program, women fared significantly better than men.
There are several possible reasons why women fare better than men. Some researchers believe the improved survival could be explained by hormonal differences between sexes. Women are more likely to be diagnosed with peritoneal mesothelioma, too. This tumor type has better survival compared with pleural tumors, which are more common among men. This skews the survival rates to favor women living longer, on average. Race/EthnicityMesothelioma is almost exclusive to white individuals, who make up 95% of patients. Part of this difference is because black and Hispanic individuals are less likely to be diagnosed with any type of cancer, including mesothelioma. Also, non-white individuals historically may have been less likely to hold industrial jobs associated with heavy asbestos exposure. Data from SEER shows blacks and Hispanics account for only 8% of all cancer diagnoses.
A 2015 study of 13,734 pleural mesothelioma cases in the SEER database found black patients lived longer than white patients despite being less likely to undergo aggressive surgery. How Do Mesothelioma Survival Rates Apply to Me?Thanks to advances in mesothelioma treatments, many patients are beating the odds and living beyond average survival rates. Cancer survival rates also do not take into account recent advances in treatment, such as immunotherapy and other targeted therapies available through clinical trials. Survival rates only considers people diagnosed in the past. Anyone diagnosed today may have more available treatment options and a better prognosis going forward. What Steps Can Improve Mesothelioma Survival Rates?Many long-term mesothelioma survivors attribute their success living with the disease to a multidisciplinary approach to treatment. Many in this group include the following factors as helping them do well after diagnosis.
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