Distinct epidemiologic patterns of mesothelioma: evidence from a 16-year provincial cohort in China

Our plain-English summary of Distinct epidemiologic patterns of mesothelioma: evidence from a 16-year provincial cohort in China, by S. Yin, T. Hu, X. Li, et al (BMC Cancer, 2026).

The study

• Authors: S. Yin, T. Hu, X. Li, D. Xu, Y. Shu
• Journal: BMC Cancer
• Published: 2026;26(1)
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Epidemiologic data on mesothelioma in China remain limited, particularly with respect to long-term, province-level characterization of demographic features and survival outcomes.

Methods: We conducted a 16-year retrospective cohort study of mesothelioma patients diagnosed at a major provincial tertiary referral center in China between 2009 and 2025. Among 128 identified cases, 93 met strict pathological criteria and were included for analysis. We evaluated sex distribution, anatomic site, age at diagnosis, and survival outcomes, and compared these features with representative cohorts from the United States, Europe, and Japan.

Results: Our 16-year provincial cohort showed a nearly equal male-to-female ratio that markedly distinct from the male predominance reported in Western populations. Peritoneal mesothelioma accounted for 33.3% of cases, a proportion higher than that typically reported in global cohorts. The higher proportion of female patients was observed across both pleural and peritoneal mesothelioma. The median age at diagnosis was significantly younger than that observed in the United States. The median progression-free survival (PFS) and overall survival (OS) were 10 months and 16 months, with a notable survival advantage for females with peritoneal mesothelioma. Notably, only 7.5% of patients had documented asbestos exposure, indicating additional environmental and/or genetic contributors maybe relevant in this setting.

Conclusions: This long-term provincial cohort delineates mesothelioma epidemiology at the province level in China, marked by a near-equal sex distribution with substantial female representation across disease subtypes, a high proportion of peritoneal cases, younger age at diagnosis and a low prevalence of documented asbestos exposure. These findings show clear region-specific evidence, underscoring potential geographic heterogeneity in mesothelioma epidemiology.

© 2026. The Author(s).

In plain English

This retrospective cohort study reviewed mesothelioma patients diagnosed from January 2009 to December 2025 at Jiangsu Province Hospital in eastern China. About 80% of patients lived in Jiangsu. Of 128 identified cases, 93 were pathologically confirmed and analyzed: 50 men and 43 women, a roughly 1:1 ratio. Published reports from the United States, Europe and Japan showed ratios of 3.48:1 to 5.17:1. Pleural mesothelioma made up 61.29% of cases and peritoneal mesothelioma 33.33%. The article gives the median age at diagnosis as 56.67 years (95% CI 53.59 to 59.74), compared with 71.7 years reported for the United States. Median progression-free survival was 10 months (95% CI 7 to 15) and median overall survival 16 months (95% CI 12 to 28). Survival did not differ significantly by sex or site overall. Among peritoneal cases, women's median overall survival was 33 months versus 16 months for men (P = 0.03). Only 7.5% of patients reported a definite history of asbestos exposure, based on self-report. The authors concluded that the province shows a distinct mesothelioma profile. They cautioned that exposure may have been underreported and the cohort may not represent the full disease spectrum.

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: Retrospective cohort study of patients at a single provincial tertiary referral center, compared with published cohorts from the United States, Europe and Japan
• Who was studied: 93 patients with pathologically confirmed mesothelioma (50 males, 43 females), selected from 128 identified cases, aged 18 to 85, diagnosed 2009 to 2025 at Jiangsu Province Hospital, Nanjing, China. About 80% lived in Jiangsu; the others came from Anhui, Shanghai, Shandong and other provinces.
• Exposure: Self-reported (documented) history of asbestos exposure, collected from follow-up data. No fiber types, products or doses were reported for this cohort. Imaging signs often linked to asbestos (pleural plaques, lung fibrous streaks) were reviewed in pleural cases.
• Main results:
  • Sex ratio in the cohort was about 1:1 (50 males, 43 females). Published ratios were 3.48:1 for the United States, 5.17:1 for Europe and 3.51:1 for Japan.
  • Of the 93 cases, 61.29% were pleural, 33.33% peritoneal and 5.38% at other sites. The pleura-to-peritoneum ratio was about 1.83:1, versus 8.90:1 reported for the United States and 7.71:1 for Japan.
  • The article gives the cohort's median age at diagnosis as 56.67 years (95% CI 53.59 to 59.74). The authors reported this as significantly lower than the 71.7-year median reported for the United States (P less than 0.001). The confidence interval the article prints for the US figure (77.97 to 78.35) does not contain 71.7 years. European and Japanese age data were not available for comparison.
  • In the text, mean age at diagnosis was 53.4 years for females (95% CI 48.6 to 58.2) and 59.5 years for males (95% CI 55.5 to 63.5), P = 0.047. The Figure 2 legend assigns these values the other way round. Age did not differ significantly between pleural (58.4 years) and peritoneal (54.2 years) cases (P = 0.216).
  • In the whole cohort, median progression-free survival was 10 months (95% CI 7 to 15) and median overall survival was 16 months (95% CI 12 to 28).
  • Survival did not differ significantly between males and females overall, nor between pleural and peritoneal cases. There was also no sex difference among pleural cases.
  • Among peritoneal mesothelioma patients, females had longer median overall survival than males: 33 vs 16 months, P = 0.03 (P = 0.034 in the figure legend). Progression-free survival did not differ significantly.
  • Among the 57 pleural mesothelioma patients, imaging showed: non-calcified pleural nodules in 47.4% (27/57), calcified pleural plaques in 5.26% (3/57), pleural thickening in 43.9% (25/57), pleural masses in 10.5% (6/57), and fibrotic streaks in the lung in 47.4% (27/57).
  • Histological subtype was known for 36 of 93 patients: epithelioid 23/36 (63.89%), sarcomatoid 12/36 (33.34%), biphasic 1/36 (2.78%).
  • Genomic profiling was done in 17 of 93 patients. Of these, 11 had detectable alterations and 8 had clinically significant (Tier I to II) somatic variants. One patient had germline variants in BAP1 and BARD1.
  • Annual numbers of mesothelioma cases treated at the hospital rose overall from 2009 to 2024.
• The authors' conclusion: The authors concluded that this province-level cohort shows a distinct mesothelioma profile that differs from international series. They described it as near-equal numbers of men and women, a high share of peritoneal cases, younger age at diagnosis and little documented asbestos exposure, and said this points to geographic differences.
• Limitations the authors state:
  • Asbestos exposure data came from patient self-report and may be affected by underreporting or recall bias.
  • There were no detailed exposure questionnaires, which may have led to an underestimate of how common asbestos exposure was.
  • Lung tissue was too limited to check for ferruginous bodies, a marker of asbestos exposure.
  • Treatments varied between patients and were not standardized, which may have influenced survival results.
  • Because misdiagnosis has been reported in eastern China, the cohort may not represent the full range of disease.
  • Genetic testing covered few patients and mostly used panels designed for lung cancer rather than mesothelioma.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Cohort Study, Peritoneal Mesothelioma, Progression-Free Survival, Overall Survival, Asbestos Exposure, Epidemiology.

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