Clinical and prognostic factors in pleural mesothelioma: insights from a Latin American cohort

BACKGROUND: Pleural mesothelioma (PM) remains a lethal but preventable disease whose burden is shifting toward low- and middle-income countries (LMICs) where asbestos use has persisted or has only recently been banned. This study describes the clinical characteristics, management patterns, and prognostic factors of PM in a contemporary Colombian cohort. METHODS: We conducted a retrospective cohort study of adults with histologically confirmed pleural mesothelioma diagnosed at a tertiary referral cancer center in Bogotá, Colombia, from January 1, 2011, to December 31, 2023. Overall survival (OS) was defined from the histologic diagnosis date to death from any cause; patients without a recorded death were censored at the last documented oncologic contact. Real-world progression-free survival (PFS) was defined from diagnosis to documented progression (radiologic or clinician-documented) or death, whichever occurred first; patients without progression or death were censored at last contact. Survival was estimated using Kaplan-Meier methods and modeled using Cox proportional hazards regression. RESULTS: The cohort included 106 patients (mean age, 63.2 years; 73.6% male; 84.9% epithelioid histology). There were 105 deaths (1 OS censor). Median OS was 9.9 months (95% CI, 7.1-14.1), with 12- and 24 month OS of 46.2% and 12.3%. Real-world PFS included 105 events (1 PFS censor). Median PFS was 8.1 months (95% CI, 6.2-9.4), with 12- and 24 month PFS of 30.2% and 6.6%. In multivariable analyses focused on baseline prognostic factors, ECOG performance status 2-3 was associated with shorter OS and PFS. CONCLUSIONS: In this contemporary Colombian cohort, OS and PFS were short, and baseline functional status was strongly associated with outcomes. Treatment-stratified survival patterns are reported descriptively and should not be interpreted as comparative effectiveness. These data add regional evidence for pleural mesothelioma prognosis in routine practice.