Sex-Specific Patterns of Asbestos Exposure and Prognostic Biomarkers in Surgically Treated Pleural Mesothelioma: A Retrospective Cohort Study

Our plain-English summary of Sex-Specific Patterns of Asbestos Exposure and Prognostic Biomarkers in Surgically Treated Pleural Mesothelioma: A Retrospective Cohort Study, by N. Pinzon, S. Gulati, A.D. Re, et al (Cancers, 2026).

The study

• Authors: N. Pinzon, S. Gulati, A.D. Re, E. Taioli, R. Flores, A.S. Wolf, S. Tuminello
• Journal: Cancers
• Published: 2026;18(16)
• Read it: PubMed · Publisher · Free full text

Abstract

Background/objectives: Sex-based differences in asbestos exposure and tumor biology in pleural mesothelioma (PM) remain incompletely characterized. As an expert tertiary center, we sought to systematically characterize asbestos exposure by sex and assess biomarker prognostic relevance in surgically treated pleural mesothelioma.

Methods: We conducted a retrospective, single-center cohort encompassing all patients who underwent surgical intervention for PM at our institution. Demographic characteristics, asbestos exposure history, tumor biomarker profiles, and survival outcomes were extracted from this database and supplemented by review of the electronic medical record. Sex differences in asbestos exposure and biomarker expression were assessed using Fisher's exact test on an available-case basis, while logistic regression was used to identify predictors of documented asbestos exposure. Overall survival was estimated using Kaplan-Meier analysis; independent associations between biomarkers and mortality were determined via multivariable Cox proportional hazards models adjusted for age, sex, and histological subtype.

Results: Between 2015 and 2024, 106 patients (75% males) underwent surgical intervention for PM, with a median follow-up of 4.4 years. The mean age at surgery was 67.5 years (Standard Deviation [SD], 11). The cohort predominantly consisted of patients with epithelioid histology (n = 86, 81%), followed by biphasic (n = 16, 15%), and sarcomatoid (n = 4, 4%) subtypes. Thirty (28.3%) were alive at last follow-up. Median overall survival was 15.6 months (95% Confidence Interval [CI], 13.8-25.4 months), and 5-year survival was 17.8%. Of 92 patients with available exposure data, 66 (72%) had documented exposure histories. Although most of these exposures were occupational (46, 78%), a striking disparity was observed between occupational exposures in males vs. females (44 [86%] vs. 2 [25%]; n = 8 classifiable females; p < 0.001). Multivariable analysis demonstrated that male sex was associated with increased odds of asbestos exposure (Adjusted Odds Ratio [ORadj], 5.45; 95% Confidence Interval [CI], 1.90-16.35). PD-L1, Ki-67, or BAP1 expression were not associated with sex, age, or asbestos exposure. High Ki-67 (>15%) and PD-L1 (>15%) were associated with a four-fold and three-fold increased risk of mortality (Hazard Ratioadj [HRadj], 4.33 [95% CI, 1.85-10.13] and HRadj, 2.80 [95% CI, 1.39-5.64], respectively), whereas BAP1 loss was not (HRadj, 0.80; 95% CI, 0.45-1.44).

Conclusions: Our findings underscore the potential value of sex-sensitive screening protocols that more comprehensively assess non-occupational asbestos exposure pathways and offer additional evidence regarding the prognostic relevance of PD-L1, Ki-67, and BAP1 in surgical patients.

In plain English

This retrospective study reviewed records of all 106 patients operated on for pleural mesothelioma at Mount Sinai, New York, in 2015 to 2024. Men made up 79 (75%). No fiber types are named. Likely asbestos exposure was documented for 57 of 70 men (81%) and 9 of 22 women (41%) with exposure information. Where the source was classifiable, it was occupational for 44 of 51 exposed men (86%) and 2 of 8 exposed women (25%). Adjusted for age and tumor subtype, men had higher odds of documented exposure (odds ratio 5.45; 95% CI 1.90 to 16.35). Median survival from surgery was 15.6 months (95% CI 13.8 to 25.4). Ki-67 above 15% (49 tested; adjusted hazard ratio 4.33, 95% CI 1.85 to 10.13) and PD-L1 above 15% (68 tested; 2.80, 95% CI 1.39 to 5.64), each versus 15% or less, were associated with higher risk of death. BAP1 loss was not significantly associated with survival. The authors concluded current approaches may miss non-occupational exposure routes in women. They noted exposure histories may be incomplete or misclassified, and stage and treatment were not considered.

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: Single-center retrospective cohort study
• Who was studied: All 106 consecutive patients who had surgery for pleural mesothelioma at Mount Sinai, New York, between 2015 and 2024: 79 men (75%) and 27 women. Follow-up ran to 15 January 2026.
• Exposure: Asbestos exposure as documented in medical records. It was classified as likely occupational exposure (for example construction, shipyard, factory or electrical work, or an occupation where asbestos was common) or as non-occupational exposure (household or partner, environmental, childhood). No fiber types or doses are reported. The study also examined the tumor biomarkers PD-L1, Ki-67 and BAP1.
• Main results:
  • Among men with available exposure data, 57 of 70 (81%) had a likely asbestos exposure.
  • Among women with available exposure data, 9 of 22 (41%) had a likely asbestos exposure (p less than 0.001 for the comparison with men).
  • The source of exposure could be classified for 59 of the exposed patients (51 men, 8 women). It was occupational for 44 of 51 men (86%) and 2 of 8 women (25%), p less than 0.001.
  • After adjustment for age and histological subtype, male sex was associated with higher odds of likely asbestos exposure: adjusted odds ratio 5.45 (95% CI 1.90 to 16.35).
  • Overall survival was measured from the date of surgery to death from any cause.
  • For the whole surgical cohort, median overall survival was 15.6 months (95% CI 13.8 to 25.4 months) and 5-year survival was 17.8%.
  • In separate models adjusted for age, sex and histological subtype, each comparing above 15% with 15% or less, Ki-67 above 15% was associated with a higher risk of death (adjusted hazard ratio 4.33; 95% CI 1.85 to 10.13). PD-L1 above 15% was also associated with a higher risk of death (adjusted hazard ratio 2.80; 95% CI 1.39 to 5.64).
  • The survival models included only patients with biomarker results: 49 for Ki-67 (35 deaths), 68 for PD-L1 (47 deaths) and 81 for BAP1 (57 deaths).
  • BAP1 loss was not statistically significantly associated with overall survival (adjusted hazard ratio 0.80; 95% CI 0.45 to 1.44).
  • Ki-67 status was not significantly associated with sex, age or asbestos exposure.
• The authors' conclusion: The authors concluded that current clinical approaches to characterizing asbestos exposure in pleural mesothelioma may prioritize occupational exposures and miss non-occupational exposure routes in female patients.
• Limitations the authors state:
  • The study took place at a single center and included only patients selected for surgery, which limits how far the findings apply to other patients.
  • Deaths were not checked against a cancer registry or the National Death Index, so some deaths may have been missed.
  • Indirect, household, childhood and environmental asbestos exposures may have been incompletely documented or misclassified.
  • Data were missing for asbestos exposure (14 patients) and for biomarkers, especially Ki-67 (57 patients).
  • The models did not account for disease stage, extent of surgery, treatment, performance status, comorbidities, lifestyle or socioeconomic status.
  • Because subgroups were too small, the authors did not test whether the biomarkers' link to survival differs by sex.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Biomarker, Pleural Mesothelioma, Cohort Study, Overall Survival, Histological Subtype, Epithelioid, Histology.

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