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Background <p>Malignant mesothelioma (MM) is a rare, aggressive malignancy with dismal outcomes. Data from India integrating histopathology, immunohistochemistry (IHC), and multivariate survival analysis remain scarce. This study evaluates clinicopathological features, prognostic determinants, and survival outcomes in an Indian cohort.</p> Methods <p>A retrospective multidisciplinary institutional study of 35 histologically and immunohistochemically confirmed MM cases managed at a tertiary cancer referral center in North India between 2019 and 2025 was conducted using archived paraffin blocks along with comprehensive clinical, radiological, treatment, and follow-up data. Histologic subtypes were classified as per WHO 2021 criteria, and a comprehensive IHC panel distinguished MM from mimickers. Clinical, radiological, and lifestyle data were retrieved from electronic medical records. Kaplan–Meier and multivariate Cox regression analyses were performed to identify independent prognostic factors.</p> Results <p>Median age was 59 years (range 26–84), with a male-to-female ratio of 2.2:1. The pleura was the most common biopsy site (60%), followed by peritoneum (22.85%). Epithelioid MM was the predominant morphology (80%). Mesothelial markers (WT1, calretinin, D2-40, HBME1) were positive in &gt; 88% of cases. Platinum-based chemotherapy was administered to 88.2% of patients. Median overall survival (OS) was 9 months (95% CI: 6–12). Desmoplastic histology emerged as a potent independent adverse predictor (HR = 11.0; 95% CI: 1.92–63.4; <i>p</i> = 0.007), while behavioral and exposure-related factors were not prognostic.</p> Conclusions <p>Histologic subtype is a dominant determinant of survival in MM. Epithelioid morphology confers relative survival advantage, whereas desmoplastic differentiation predicts dramatically poorer outcomes. These findings underscore the importance of tumor biology over environmental factors in survival and highlight the need for early detection and novel therapeutic strategies in MM.</p>

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Histological Spectrum and Determinants of Survival in Malignant Mesothelioma: Multivariate Analysis from a Five-Year North Indian Tertiary Cancer Center Cohort

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Pallavi Majumdar,
  • Sonal Tripathi,
  • Paramita Paul,
  • Shashikant CU Patne,
  • Zachariah Chowdhury,
  • Akhil Kapoor,
  • Mayank Tripathi,
  • Ankita Pal

摘要

Background

Malignant mesothelioma (MM) is a rare, aggressive malignancy with dismal outcomes. Data from India integrating histopathology, immunohistochemistry (IHC), and multivariate survival analysis remain scarce. This study evaluates clinicopathological features, prognostic determinants, and survival outcomes in an Indian cohort.

Methods

A retrospective multidisciplinary institutional study of 35 histologically and immunohistochemically confirmed MM cases managed at a tertiary cancer referral center in North India between 2019 and 2025 was conducted using archived paraffin blocks along with comprehensive clinical, radiological, treatment, and follow-up data. Histologic subtypes were classified as per WHO 2021 criteria, and a comprehensive IHC panel distinguished MM from mimickers. Clinical, radiological, and lifestyle data were retrieved from electronic medical records. Kaplan–Meier and multivariate Cox regression analyses were performed to identify independent prognostic factors.

Results

Median age was 59 years (range 26–84), with a male-to-female ratio of 2.2:1. The pleura was the most common biopsy site (60%), followed by peritoneum (22.85%). Epithelioid MM was the predominant morphology (80%). Mesothelial markers (WT1, calretinin, D2-40, HBME1) were positive in > 88% of cases. Platinum-based chemotherapy was administered to 88.2% of patients. Median overall survival (OS) was 9 months (95% CI: 6–12). Desmoplastic histology emerged as a potent independent adverse predictor (HR = 11.0; 95% CI: 1.92–63.4; p = 0.007), while behavioral and exposure-related factors were not prognostic.

Conclusions

Histologic subtype is a dominant determinant of survival in MM. Epithelioid morphology confers relative survival advantage, whereas desmoplastic differentiation predicts dramatically poorer outcomes. These findings underscore the importance of tumor biology over environmental factors in survival and highlight the need for early detection and novel therapeutic strategies in MM.