Chinese expert consensus on the diagnosis and treatment of malignant pleural mesothelioma

Our plain-English summary of Chinese expert consensus on the diagnosis and treatment of malignant pleural mesothelioma, by Q. Wang, C. Xu, W. Wang, et al (Thoracic Cancer, 2023).

The study

• Authors: Q. Wang, C. Xu, W. Wang, Y. Zhang, Z. Li, Z. Song, J. Wang, J. Yu, J. Liu, S. Zhang, X. Cai, W. Li, P. Zhan, H. Liu, T. Lv, L. Miao, L. Min, J. Li, B. Liu, J. Yuan, Z. Jiang, G. Lin, X. Chen, X. Pu, C. Rao, D. Lv, Z. Yu, X. Li, C. Tang, C. Zhou, J. Zhang, H. Guo, Q. Chu, R. Meng, X. Liu, J. Wu, X. Hu, J. Zhou, Z. Zhu, X. Chen, W. Pan, F. Pang, W. Zhang, Q. Jian, K. Wang, L. Wang, Y. Zhu, G. Yang, X. Lin, J. Cai, H. Feng, L. Wang, Y. Du, W. Yao, X. Shi, X. Niu, D. Yuan, Y. Yao, J. Huang, X. Wang, Y. Zhang, P. Sun, H. Wang, M. Ye, D. Wang, Z. Wang, Y. Hao, Z. Wang, B. Wan, D. Lv, J. Yu, J. Kang, J. Zhang, C. Zhang, L. Wu, L. Shi, L. Ye, G. Wang, Y. Wang, F. Gao, J. Huang, G. Wang, J. Wei, L. Huang, B. Li, Z. Zhang, Z. Li, Y. Liu, Y. Li, Z. Liu, N. Yang, L. Wu, Q. Wang, W. Huang, Z. Hong, G. Wang, F. Qu, M. Fang, Y. Fang, X. Zhu, K. Du, J. Ji, Y. Shen, J. Chen, Y. Zhang, S. Ma, Y. Lu, Y. Song, A. Liu, W. Zhong, W. Fang
• Journal: Thoracic Cancer
• Published: 2023;14(26):2715-2731
• Type of article: Consensus statement
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a malignant tumor originating from the pleura, and its incidence has been increasing in recent years. Due to the insidious onset and strong local invasiveness of MPM, most patients are diagnosed in the late stage and early screening and treatment for high-risk populations are crucial. The treatment of MPM mainly includes surgery, chemotherapy, and radiotherapy. Immunotherapy and electric field therapy have also been applied, leading to further improvements in patient survival. The Mesothelioma Group of the Yangtze River Delta Lung Cancer Cooperation Group (East China LUng caNcer Group, ECLUNG; Youth Committee) developed a national consensus on the clinical diagnosis and treatment of MPM based on existing clinical research evidence and the opinions of national experts. This consensus aims to promote the homogenization and standardization of MPM diagnosis and treatment in China, covering epidemiology, diagnosis, treatment, and follow-up.

© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This article is a clinical guideline, not a new study. It set out an expert consensus on diagnosing and treating malignant pleural mesothelioma (MPM) in China. The Mesothelioma Group of the Yangtze River Delta Lung Cancer Cooperation Group developed it from published evidence, NCCN/ESMO guidelines and expert discussion. In its background, the document cited other sources relating asbestos exposure to 80% of MPM cases; it did not name asbestos fiber types. Recommendations included screening high-risk populations and areas, enhanced chest and abdominal CT first, and histopathology (tissue examination) as the diagnostic gold standard. BAP1 gene testing was recommended for young patients "without a history of asbestos exposure or a family history of tumors". Surgery was recommended for patients with operable epithelioid mesothelioma; those in stages I–IIIA were described as good candidates. For stage IIIB–IV and unresectable stage I–IIIA patients, the recommended first-line options were pemetrexed with platinum-based drugs and bevacizumab, or nivolumab with ipilimumab; for the "sarcoma type", nivolumab with ipilimumab was preferred. CT re-examination was recommended every 3–6 months after active treatment. The authors noted limited evidence on the choice of surgical procedure and on follow-up.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Expert consensus / clinical guideline, based on existing literature, NCCN/ESMO guidelines and expert discussion. Not an original study.
• Who was studied: No study population. The guidance addresses the diagnosis and treatment of malignant pleural mesothelioma patients in China.
• Exposure: Not studied directly. In its background the document cites other sources on causes of MPM: asbestos (fiber types not named), erionite, ionizing radiation, and gene mutations such as BAP1.
• Main results:
  • Citing the 2019 China Cancer Registration Annual Report, the consensus stated that China had 583 new mesothelioma cases in 2016, including 330 new MPM cases. These figures come from that report, not from this article.
  • Recommendation: screen for MPM in high-risk populations and high-risk areas.
  • The consensus stated there is no evidence that low-dose spiral CT screening reduces MPM mortality in high-risk populations.
  • Recommendation: use enhanced CT of the chest and abdomen first for clinical staging.
  • Recommendation: histopathology is the gold standard for diagnosis.
  • Recommendation (Consensus 5): BAP1 gene testing for young patients 'without a history of asbestos exposure or a family history of tumors' (the article's wording). The molecular-diagnosis section also lists peritoneal mesothelioma, no asbestos exposure, younger age and previous tumor history as reasons for BAP1 testing.
  • Recommendation: surgery for patients with operable epithelioid mesothelioma; patients with epithelioid mesothelioma in stages I–IIIA are described as good candidates.
  • Recommendation: patients who need oxygen therapy after surgery should not consider adjuvant radiotherapy, because it cannot improve their survival.
  • Recommendation: tumor treating fields (TTFields) therapy may be used where conditions permit.
  • Recommendation (Consensus 9): for stage IIIB–IV and unresectable stage I–IIIA patients, first-line treatment with pemetrexed plus platinum-based drugs and bevacizumab, or with nivolumab plus ipilimumab.
  • Recommendation (Consensus 9): for the 'sarcoma type', nivolumab plus ipilimumab is preferred.
  • Recommendation: drug therapy is the preferred method for managing cancer pain.
  • Recommendation: chest and/or abdominal CT re-examination every 3–6 months after active treatment.
• The authors' conclusion: The authors stated that the consensus was formed to help turn new developments in MPM diagnosis and treatment into practical clinical benefits, and to standardize MPM care in China.
• Limitations the authors state:
  • There is no high-level evidence for how MPM patients should be followed up.
  • The choice of surgical procedure is controversial because large randomized controlled trials are lacking.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleura, Chemotherapy, Immunotherapy, Mesothelioma, Lung Cancer, Epidemiology.

Related studies

• Epidemiology and clinical characteristics of mesothelioma in the Chinese population: a multicenter study — S. Yang, Y. Hao, et al. (2025)
• Inclusion of anti-vascular therapy as a promising option for later-line treatment of malignant pleural mesothelioma: a retrospective study — K. Shao, D. Wu, et al. (2025)
• Survival prediction in peritoneal mesothelioma: a nomogram based on SEER data and a Chinese cohort — Y. Fang, M. Xiang, et al. (2024)
• Case Report: tuberculous pleurisy mimicking mesothelioma in a 37-year-old Chinese woman — X. Liu, T. Cao, et al. (2025)
• Mesothelin (MSLN) methylation and soluble mesothelin-related protein levels in a Chinese asbestos-exposed population — M. Yu, Y. Zhang, et al. (2015)
• Expert opinions of the first italian consensus conference on the management of malignant pleural mesothelioma — C. Pinto, A. Ardizzoni, et al. (2011)

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