Pericardial Mesothelioma: Diagnostic and Therapeutic Management, a Population-Based Study in Italy

Our plain-English summary of Pericardial Mesothelioma: Diagnostic and Therapeutic Management, a Population-Based Study in Italy, by S. Stella, D. Consonni, G.L. Ceresoli, et al (Cancers, 2025).

The study

• Authors: S. Stella, D. Consonni, G.L. Ceresoli, B. Dallari, R. Perduri, C. Storchi, E. Migliore, M. Gangemi, C. Genova, L. Benfatto, V. Comiati, V. Zabeo, S. Piro, L. Giovannetti, I. Grappasonni, C. Pascucci, F. Larese Filon, F. D'Agostin, L. Vimercati, I. Cozzi, F. Calista, G. Cascone, I.F. Angelillo, A. Binazzi, A. Marinaccio, C. Mensi
• Journal: Cancers
• Published: 2025;17(23)
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pericardial mesothelioma (PM) is an extremely rare cancer with a poor prognosis and no consensus on diagnostic and therapeutic management. We conducted a registry-based study on PM cases in Italy diagnosed between 1993 and 2021.

Methods: Based on data from the Italian National Mesothelioma Registry (ReNaM), we performed a descriptive analysis of PM cases including clinical presentation, diagnostic work-up, asbestos exposure, and therapeutic management. Overall survival was calculated. Hazard ratios (HRs) and 95% confidence intervals (CI) for selected variables were estimated with univariate and multivariate Cox models.

Results: We identified 72 cases (46 men and 26 women). Median age was 66 years (range 22-89). The most frequent histological subtypes were epithelioid and unspecified mesothelioma. Almost two-thirds of cases had been exposed to asbestos. The most common clinical presentation was pericardial effusion. Overall median survival was 2.8 months (95% CI 1.2-6.6) and older age at diagnosis was a negative prognostic factor. Clinical and treatment data were available for 47 patients (65%). Approximately one out of two patients underwent surgery (palliative, in one-third of cases). Adjuvant therapy was administered to seven patients (15%). In cases with treatment information, sarcomatoid subtype (HR 2.74, 95% CI: 1.06-7.06) was a negative prognostic factor; adjuvant therapy was associated with better survival (HR 0.38, 95% CI 0.14-1.02), but confounding by indication cannot be excluded.

Conclusions: We confirmed the very poor prognosis of PM. An international network collecting PM cases with treatment information is needed to improve patient quality of life and survival.

In plain English

This population-based study used Italy's National Mesothelioma Registry (ReNaM) to describe pericardial mesothelioma cases diagnosed from 1993 to 2021. The registry recorded 72 cases (46 men, 26 women); median age at diagnosis was 66 years. Crude incidence was 0.60 per 10 million person-years in men and 0.30 in women. Of 55 cases with interview data, 32 (58%) had occupational asbestos exposure: 27 of 35 men and 5 of 20 women. Among the 47 cases with detailed clinical data, the commonest presentation was pericardial effusion (30 cases). Seven were diagnosed at autopsy, 23 had surgery, and 7 received adjuvant therapy. Median overall survival for all 72 cases was 2.8 months (95% CI 1.2–6.6). Age 75 or older was linked to worse survival (hazard ratio 2.76, 95% CI 1.10–6.92). Among the 47, sarcomatoid subtype was also linked to worse survival (HR 2.74, 95% CI 1.06–7.06). Adjuvant therapy was associated with better survival (HR 0.38, 95% CI 0.14–1.02), but the authors said patient selection could explain this. Complete clinical information existed for only 65% of patients. The authors concluded that prognosis is very poor and called for an international case network.

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: Population-based registry study: descriptive analysis of cases with survival analysis (Kaplan–Meier and Cox models)
• Who was studied: 72 cases of pericardial mesothelioma (46 men, 26 women) recorded by the Italian National Mesothelioma Registry (ReNaM), diagnosed January 1993 to December 2021. Vital status was followed to 31 December 2023. Detailed clinical and treatment data were available for 47 cases.
• Exposure: Lifetime occupational and non-occupational asbestos exposure, assessed by a standardised questionnaire given to patients or their next of kin and classified under ReNaM guidelines. Fiber types are not reported.
• Main results:
  • Crude incidence rates were 0.60 per 10 million person-years in men and 0.30 in women.
  • Among the 55 cases with interview data, 32 (58%) had occupational asbestos exposure.
  • Occupational exposure was more frequent in men (27 of 35, 77%) than in women (5 of 20, 25%).
  • Among the 47 cases with treatment information, 41 (87%) had a recorded clinical presentation. The most common were pericardial effusion, heart failure or pericardial tamponade, and pericarditis or pleural effusion.
  • Among the 47 cases, 7 (15%) were diagnosed at autopsy.
  • Among the 47 cases, 23 (49%) underwent surgery: 15 had a major procedure and 8 a palliative procedure.
  • Among the 47 cases, 7 (15%) received adjuvant treatment: chemotherapy, or in one case chemotherapy plus radiotherapy.
  • Median overall survival for all 72 cases was 2.8 months (95% CI 1.2–6.6).
  • Across all 72 cases, age 75 or older was associated with worse prognosis (HR 2.76, 95% CI 1.10–6.92). In the 47 cases with treatment information the HR was 4.59 (95% CI 1.38–15.24).
  • In the 47 cases with treatment information, sarcomatoid histology had a hazard ratio of 2.74 (95% CI 1.06–7.06).
  • In the 47 cases with treatment information, adjuvant therapy was associated with a reduced risk of death (HR 0.38, 95% CI 0.14–1.02).
  • The authors found no evidence that metastases at diagnosis were associated with reduced survival.
• The authors' conclusion: The authors concluded that pericardial mesothelioma is an extremely rare and aggressive cancer with a poor prognosis. They said an international network collecting cases with diagnosis and treatment data is needed.
• Limitations the authors state:
  • Complete clinical information was available for only 47 of 72 patients (65%), which risks selection and limits how far the prognostic findings apply.
  • Exposure assessment relied mostly on interviews with next of kin, who may not know exposure details. This may underestimate asbestos-attributable cases.
  • The apparent survival benefit of adjuvant therapy may reflect confounding by indication, meaning healthier patients were selected for treatment.
  • The finding on metastases may be influenced by the small number of patients with metastasis and by incomplete staging information.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Prognosis, Mesothelioma, Asbestos Exposure, Overall Survival, Hazard Ratio, confidence interval, Histological Subtype.

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