Epidemiology and clinical characteristics of mesothelioma in the Chinese population: a multicenter study

Our plain-English summary of Epidemiology and clinical characteristics of mesothelioma in the Chinese population: a multicenter study, by S. Yang, Y. Hao, K. Wang, et al (Therapeutic Advances in Medical Oncology, 2025).

The study

• Authors: S. Yang, Y. Hao, K. Wang, H. Xu, L. Huang, L. Xu, R. Meng, B. Li, J. Huang, Y. Zhu, X. Shi, D. Wang, Z. Yang, Z. Guo, J. Wu, W. Li, J. Fu, Y. Ji, Z. Yu, M. Li, H. Feng, L. Wang, Q. Ji, W. Tang, Z. Song, C. Xu, Q. Wang
• Journal: Therapeutic Advances in Medical Oncology
• Published: 2025;17:17588359251378879
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma is a rare and highly aggressive tumor that causes severe damage. However, there is a lack of systematic reports on the incidence and clinical characteristics of mesothelioma in the Chinese population.

Objectives: This study aims to characterize the epidemiological features of mesothelioma in the Chinese population and to evaluate the effectiveness of current treatment strategies, to inform clinical decision-making and improve patient care.

Designs: The epidemiological characteristics of patients were collected by regional study centers according to the predefined inclusion and exclusion criteria. Asbestos exposure status was clearly identified for each patient, and treatment strategies were analyzed across mesothelioma cases with different primary tumor sites.

Methods: Data on mesothelioma patients and their treatment information were collected from 11 hospitals across China between January 2006 and December 2024. Epidemiological data and baseline characteristics were summarized using descriptive methods. The Kaplan-Meier method was used to analyze progression-free survival (PFS) and overall survival (OS). Key response indicators included the objective response rate (ORR) and disease control rate (DCR).

Results: A total of 927 patients from 11 provinces in China were included in the analysis. The major types of mesothelioma observed were pleural mesothelioma (n = 537), peritoneal mesothelioma (n = 240), pericardial mesothelioma (n = 5), and mesothelioma of the tunica vaginalis testis (n = 5). Among these patients, 163 had confirmed asbestos exposure. For pleural mesothelioma, 45.6% (n = 245) of patients were from Yunnan Province. For peritoneal mesothelioma, 62.5% (n = 150) of patients were from Zhejiang Province. The median PFS rates for pleural and peritoneal mesothelioma patients were 6.6 and 5.7 months, respectively. The median OS was 16.6 months for pleural mesothelioma and 12.1 months for peritoneal mesothelioma. The ORR for pleural mesothelioma was 15%, with a DCR of 85.9%, while the ORR for peritoneal mesothelioma was 14.4%, with a DCR of 84.7%.

Conclusion: The incidence of mesothelioma in China exhibits distinct regional characteristics. Pleural mesothelioma is predominantly associated with crocidolite asbestos exposure in Yunnan Province, while peritoneal mesothelioma is linked to hand-spun chrysotile asbestos exposure in Zhejiang Province, with notable sex differences observed. No significant differences in treatment outcomes were identified between pleural and peritoneal mesothelioma patients undergoing first-line therapy. These findings highlight the importance of region-specific strategies for the diagnosis and treatment of mesothelioma in China.

© The Author(s), 2025.

In plain English

This retrospective study used hospital records on 927 patients with pathologically confirmed mesothelioma from 11 Chinese provinces, January 2006 to December 2024. Of these, 537 had pleural mesothelioma, 240 peritoneal, 5 pericardial and 5 of the tunica vaginalis testis; the origin was uncertain for about 140. Confirmed asbestos exposure was recorded for 163 patients (144 from Yunnan, 18 from Zhejiang, 1 from Fujian), lasting more than 10 years in 107. The authors reported crocidolite as the main exposure in Yunnan, where all cases were pleural, and hand-spun chrysotile in Zhejiang, which supplied 62.5% (150) of peritoneal cases. Pleural patients were 60.5% male; peritoneal patients 70.4% female. Among patients given systemic treatment, median overall survival was 16.6 months (95% CI 14.3 to 18.9) for pleural (345 patients) and 12.1 months (95% CI 7.9 to 16.3) for peritoneal mesothelioma (178 patients). Within each group, survival did not differ significantly between chemotherapy alone, chemotherapy with anti-angiogenic drugs, and immunotherapy-containing regimens. The authors concluded that mesothelioma in China shows regional characteristics tied to these asbestos types. They noted that hospital-based data cannot measure true incidence.

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 multicenter study of hospital medical records, with descriptive statistics and Kaplan-Meier survival analysis
• Who was studied: 927 patients with pathologically confirmed mesothelioma treated at hospitals in 11 Chinese provinces (mainly Zhejiang 350, Yunnan 245, Fujian 196), January 2006 to December 2024; 488 male and 439 female
• Exposure: Asbestos exposure taken from electronic medical records. The authors described crocidolite (linked by them to mining) as the main exposure in Yunnan, and hand-spun chrysotile (made in small home workshops) as the main exposure in Zhejiang. Exposure duration was recorded as more or less than 10 years. Treatment groups were chemotherapy alone, chemotherapy plus anti-angiogenic therapy, and regimens containing immunotherapy.
• Main results:
  • Sites of origin among all 927 patients: pleural 537, peritoneal 240, pericardial 5, tunica vaginalis testis 5; origin uncertain for approximately 140
  • 163 patients had confirmed asbestos exposure: 144 from Yunnan, 18 from Zhejiang and 1 from Fujian. Of these 163, 107 (65.6%) had been exposed for more than 10 years and 56 for less than 10 years.
  • All mesothelioma cases from Yunnan were pleural. Of the pleural mesothelioma cases, 45.6% (n = 245) came from Yunnan and 31.7% (n = 170) from Zhejiang.
  • Of the 240 peritoneal mesothelioma cases, 62.5% (n = 150) came from Zhejiang
  • Pleural mesothelioma patients were 60.5% male and 39.5% female. Peritoneal mesothelioma patients were 29.6% male and 70.4% female (p less than 0.0001 in Table 2).
  • Pleural mesothelioma patients who received systemic therapy (n = 345): median progression-free survival 6.6 months (95% CI 5.6 to 7.6) and median overall survival 16.6 months (95% CI 14.3 to 18.9), measured from the start of systemic therapy
  • Peritoneal mesothelioma patients who received systemic therapy (n = 178): median progression-free survival 5.7 months (95% CI 4.6 to 6.9) and median overall survival 12.1 months (95% CI 7.9 to 16.3)
  • In pleural mesothelioma, survival did not differ significantly between chemotherapy alone, chemotherapy plus anti-vascular therapy, and immunotherapy-containing regimens. Progression-free survival was 6.2 vs 8.0 vs 8.1 months (p = 0.263). Overall survival was 15.0 vs 25.2 vs 14.9 months (p = 0.052).
  • In peritoneal mesothelioma, survival did not differ significantly across the same three regimen groups. Progression-free survival was 5.7 vs 6.6 vs 3.9 months (p = 0.444). Overall survival was 11.1 vs 22.3 months vs not reached (p = 0.104).
  • Tumor response in pleural mesothelioma (220 patients evaluated): objective response rate 15% and disease control rate 85.9%
  • Tumor response in peritoneal mesothelioma (118 patients evaluated): objective response rate 14.4% and disease control rate 84.7%
• The authors' conclusion: The authors concluded that mesothelioma incidence in China shows regional characteristics. They attributed pleural mesothelioma in Yunnan mainly to inhaled crocidolite from mining, and peritoneal mesothelioma in Zhejiang mainly to hand-spun chrysotile, with accidental ingestion in small workshops. They reported that pleural disease mostly affected males and peritoneal disease mostly affected females, and that no significant survival difference was observed between treatment regimens.
• Limitations the authors state:
  • Patient data from some areas of China were not collected
  • Some basic information, such as smoking history, was unavailable
  • Some therapy subgroups were too small, especially the combination regimen, and pericardial and tunica vaginalis mesothelioma were little studied
  • Tumor origin and pathological subtype were unknown for a share of cases, which the authors said may introduce bias and limit subgroup analyses
  • Data came from selected hospitals, not all cancer centers, so the study cannot accurately assess true incidence in the general population

Topics

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

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