Epidemiological and Prognostic Differences in Malignant Mesothelioma Between Eastern China and SEER Database

Our plain-English summary of Epidemiological and Prognostic Differences in Malignant Mesothelioma Between Eastern China and SEER Database, by N. Li, R. Wang, W. Zhang, et al (Cancer Science, 2026).

The study

• Authors: N. Li, R. Wang, W. Zhang, Z. Shao, H. Lin, G. Bao, W. Mao, Z. Chen
• Journal: Cancer Science
• Published: 2026;117(11):3146-3159
• Read it: PubMed · Publisher · Free full text

Abstract

Eastern China malignant mesothelioma (MM) presents distinct features-younger age, female predominance, and moremalignant peritoneal mesothelioma (MPeM)-contrasting with the Western profile of older males with malignant pleural mesothelioma (MPM). Robust survival data for this population are still unavailable. This retrospective study included 253 MM patients from Zhejiang Cancer Hospital (2010-2024; 222 from Zhejiang Province, ZJ cohort) to update regional epidemiology and compare survival with the Surveillance, Epidemiology, and End Results program (SEER). The ZJ cohort exhibited a younger median age at diagnosis (58 vs. 74 years), a higher proportion of females (62% vs. 24%), and a higher prevalence of MPeM (54% vs. 11%) relative to the SEER cohort. Overall survival (OS) was significantly prolonged in the ZJ cohort (median OS: 22 vs. 10 months), with survival benefits consistently observed across sex, age, and MPM subgroups. Multivariate Cox analysis revealed age as the only consistent independent prognostic factor in both ZJ and SEER cohorts. Following propensity score matching to minimize confounding, the ZJ cohort maintained a significantly longer survival in MPM but exhibited worse outcome in MPeM relative to SEER. Collectively, this study not only updated epidemiologic features for MM in Eastern China but also reported the unique survival patterns, uncovering inter-population heterogeneity. These findings emphasize the value of region-specific prognostic evidence and the limitations of directly applying Western data to Asian populations.

© 2026 The Author(s). Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

In plain English

This retrospective study reviewed 253 malignant mesothelioma patients diagnosed at Zhejiang Cancer Hospital, Eastern China, from 2010 to 2024; 222 lived in Zhejiang Province (the ZJ cohort). They were compared with 2,599 US SEER registry cases. ZJ patients were younger at diagnosis (median 58 vs. 74 years), more often female (62% vs. 24%) and more often had peritoneal mesothelioma (55% vs. 11%). Before matching, median overall survival was 22 months in ZJ versus 10 months in SEER, with no significant difference for peritoneal mesothelioma (15 vs. 16 months). Older age was linked to shorter survival in both groups. After matching on age, sex, tumor site and surgery, the overall difference lost statistical significance, but ZJ pleural mesothelioma patients still survived longer. Matched ZJ peritoneal mesothelioma patients had shorter survival, though the text and Table 2 disagree on statistical significance. Asbestos exposure was not analysed directly; detailed data existed for only 32 patients. Residence in Ningbo, which has a history of asbestos textile industry, was linked to shorter survival only before adjustment. The authors concluded the ZJ advantage was largely driven by pleural mesothelioma.

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 single-hospital cohort study, compared with US SEER registry cases, including Cox regression and 1:2 propensity score matching
• Who was studied: 253 malignant mesothelioma patients diagnosed at Zhejiang Cancer Hospital, China, January 2010 to September 2024: 222 Zhejiang residents (ZJ cohort) and 31 from 14 other provinces. The comparison group was 2599 SEER cases diagnosed 2010 to 2022.
• Exposure: Asbestos exposure was not analysed directly; detailed exposure data were available for only 32 cases. Residence in Ningbo, a city with a history of asbestos textile industry, was examined as a prognostic variable.
• Main results:
  • Median age at diagnosis was 58 years in the ZJ cohort vs. 74 years in SEER (p < 0.001)
  • Females made up 62% of the ZJ cohort vs. 24% of SEER (p < 0.001)
  • Peritoneal mesothelioma (MPeM) made up 55% of ZJ cases vs. 11% of SEER cases (the abstract and discussion give 54% for ZJ)
  • Median overall survival was 22 months in the ZJ cohort vs. 10 months in SEER (p < 0.001), before matching
  • Before matching, peritoneal mesothelioma survival did not differ significantly between ZJ and SEER (15 vs. 16 months, p = 0.544)
  • Older age (per year) was an independent unfavorable prognostic factor in both cohorts: ZJ HR 1.04 (95% CI 1.03 to 1.06); SEER HR 1.02 (95% CI 1.02 to 1.03)
  • In SEER, male sex was an independent unfavorable factor (HR 1.19, 95% CI 1.04 to 1.35); sex showed no prognostic value in the ZJ cohort
  • In the ZJ cohort, residence in Ningbo was associated with shorter survival in univariate analysis (HR 1.50, 95% CI 1.07 to 2.11, p = 0.020) but not in multivariate analysis (HR 1.27, 95% CI 0.90 to 1.80, p = 0.176)
  • After propensity score matching, the overall survival difference between ZJ and SEER was not statistically significant (Table 2: 22 vs. 17 months, p = 0.230)
  • After matching, ZJ pleural mesothelioma patients survived longer than matched SEER patients. The text gives 31 vs. 14 months, p < 0.001; Table 2 gives 31 vs. 15 months, p = 0.001.
  • After matching, peritoneal mesothelioma survival was shorter in ZJ than in SEER. The text gives 12 vs. 24 months, p < 0.001; Table 2 gives 13 vs. 24 months with p = 0.059, which is not statistically significant.
  • Among surgically treated peritoneal mesothelioma patients (before matching), SEER patients had longer median survival than ZJ patients (54 vs. 19 months, p = 0.027)
• The authors' conclusion: The authors concluded that the ZJ cohort had better survival than SEER, largely driven by better outcomes in pleural mesothelioma. They also concluded that older age was a consistent unfavorable factor and that region-specific prognostic stratification is needed.
• Limitations the authors state:
  • Single-center, hospital-based study that may introduce selection bias
  • Detailed asbestos exposure information was unavailable, so exposure could not be analysed directly against survival
  • SEER lacked treatment details such as surgery type and chemotherapy
  • Small subgroup sizes may have produced unstable estimates

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, SEER, Peritoneal Mesothelioma, Pleural Mesothelioma, Epidemiology, Overall Survival, Confounding.

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