Prognostic Factors and Survival in Pericardial Mesothelioma: A Systematic Review and Quantitative Analysis

Our plain-English summary of Prognostic Factors and Survival in Pericardial Mesothelioma: A Systematic Review and Quantitative Analysis, by M. Kapałka, E. Pazek, M. Krawiec, et al (Cancers, 2026).

The study

• Authors: M. Kapałka, E. Pazek, M. Krawiec, M. Sikorski, G. Hirnle, T. Hrapkowicz
• Journal: Cancers
• Published: 2026;18(16)
• Type of article: Review
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Primary pericardial mesothelioma (PPM) is a rare and aggressive tumor. We aimed to analyze diagnostic pathways and factors influencing survival.

Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420261277326). MEDLINE, Web of Science, and EMBASE were searched up to March 2025. Case reports and case series published from 2010 onwards de- scribing histologically confirmed PPM were included. Data were extracted independently by multiple reviewers. Risk of bias was assessed using Joanna Briggs Institute tools. Individual patient data were pooled. Survival was analyzed using Kaplan-Meier and log-rank tests, and factors associated with survival ≥12 months were evaluated using univariable logistic regression.

Results: A total of 120 patients were included (108 case reports, 4 case series). Diffuse pericardial involvement predominated (74.2%), while localized tumors occurred in 30.8%. Constrictive pericarditis was present in 31.7%. Median overall survival from diagnosis was 7.4 months (IQR 1.75-13.5). Use of CT and PET in the diagnostic process was associated with longer survival (CT: 9.1 vs. 1.5 months, p = 0.02; PET: 14 vs. 6 months, p = 0.04). Chemotherapy was associated with improved survival (OR 3.3; 95% CI 1.3-8.4; p = 0.01). Greater pericardial effusion volume was also associated with longer survival (OR 1.56; 95% CI 1.05-2.32; p = 0.028). Worse outcomes were observed in patients with constrictive pericarditis (p = 0.01) and diffuse disease (p = 0.04).

Conclusions: PPM carries a poor prognosis. Chemotherapy and advanced imaging are associated with longer survival, whereas constrictive pericarditis and diffuse involvement indicate worse outcomes. Early recognition may reduce diagnostic delay. Findings should be interpreted with caution due to limitations of case-based data.

In plain English

This was a systematic review that pooled data on individual patients with primary pericardial mesothelioma (PPM) from 108 case reports and 4 case series published from 2010 onwards, totaling 120 patients. Suspected or confirmed asbestos exposure was reported for 11.67% of patients, but only 71 reports said whether exposure had occurred. Among patients with usable follow-up data, median survival from diagnosis was 7.4 months. Patients given chemotherapy were more likely to survive 12 months or longer from diagnosis (odds ratio 3.3; 95% CI 1.3 to 8.4). In an adjusted model, diffuse disease was associated with a higher risk of death (hazard ratio 2.08; 95% CI 1.02 to 4.25) and chemotherapy with a lower risk (0.40; 95% CI 0.21 to 0.77). Patients with constrictive pericarditis had significantly lower survival. Use of CT or PET scans was associated with longer survival, but the authors stated they do not claim that scans prolong survival. The authors said case-report data are open to bias. They concluded that the findings should be interpreted with caution and are primarily exploratory.

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: Systematic review with pooled individual patient data from published case reports and case series, with survival analyses (Kaplan-Meier, logistic regression, Cox regression)
• Who was studied: 120 patients with histologically confirmed primary pericardial mesothelioma described in 108 case reports and 4 case series published 2010 to 2025, found by searching MEDLINE, Web of Science and EMBASE in March 2025. Of these, 55.8% were men (n = 67) and 44.2% women (n = 53). Survival from diagnosis was analysed in 70 patients with sufficient data, of whom 49 died during follow-up.
• Exposure: The review studied clinical, diagnostic and treatment factors in relation to survival, not asbestos exposure as such. Suspected or confirmed asbestos exposure was reported in 11.67% of patients (n = 14), with only 71 reports stating whether exposure had occurred. No fiber types were given.
• Main results:
  • Median survival from diagnosis was 7.4 months (IQR 1.75 to 13.5) in the survival analysis cohort.
  • The survival analysis from diagnosis included 70 patients, of whom 49 died during follow-up.
  • Chemotherapy was associated with survival of 12 months or longer from diagnosis (OR 3.3; CI 1.3 to 8.4; p = 0.01).
  • In the multivariable Cox model, diffuse pericardial disease was associated with a higher risk of death (aHR 2.08, 95% CI 1.02 to 4.25; p = 0.045) and chemotherapy with a reduced mortality risk (aHR 0.40, 95% CI 0.21 to 0.77; p = 0.006).
  • On Kaplan-Meier analysis from diagnosis, patients with constrictive pericarditis (p = 0.019) and diffuse pericardial involvement (p = 0.04) had significantly lower survival.
  • Median survival from symptom onset was 16 months in patients who received chemotherapy versus 4.75 months in those who did not (p = 0.0006).
  • Use of PET (median 14 vs. 6 months, p = 0.04) or CT (median 9.125 vs. 1.5 months, p = 0.02) in the diagnostic process was associated with longer survival from symptom onset.
  • Greater amount of pericardial fluid was associated with survival of 12 months or longer from symptom onset (OR 1.56; CI 1.05 to 2.32; p = 0.028).
  • Initial misdiagnosis was reported in 34.2% of cases. Patients with constrictive pericarditis had a median diagnostic delay of 8 months, compared with 3 months in those without it.
• The authors' conclusion: The authors concluded that their findings should be interpreted with caution and considered primarily exploratory, pointing to possible clinical patterns rather than establishing causal relationships. They stated that they do not claim that PET/CT or cardiac MRI prolongs survival.
• Limitations the authors state:
  • The analysis was based only on published case reports, which are a low level of evidence and subject to multiple biases.
  • Selective reporting is likely, so the dataset may not reflect the full clinical spectrum of the disease.
  • Many reports had follow-up shorter than 12 months with patients alive at the end, which may have overestimated survival.
  • Data were heterogeneous and incomplete, which limited standardized comparative analyses.
  • The associations between imaging and longer survival may reflect lead-time, selection and immortal-time bias rather than a benefit of imaging.
  • The chemotherapy findings are constrained by selection, survivor and treatment eligibility biases.
  • Case report datasets suffer from publication bias, with successful outcomes reported more often than rapid deaths.
  • No accepted criteria exist for classifying PPM as diffuse or localized.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Systematic Review, Pericardial, Median Overall Survival, Chemotherapy, Pericardial Effusion, Prognosis.

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