Persistence burden and poor survival of pleural mesothelioma in central Italy, 2013–2022: a population-based study thirty years after asbestos ban

Background: Pleural Mesothelioma (PM) is an asbestos-related cancer with poor prognosis. Despite the 1992 national asbestos ban, new cases continue to occur due to the long latency of the disease. The study aim was to evaluate incidence and survival trends of pleural mesothelioma in the Marche Region, central Italy, between 2013 and 2022. Methods: This population-based incidence study included adult residents of the Marche Region between 2013 and 2022. Incident PM cases were identified from the Cancer Registry of Marche Region. Incidence rates per 100,000 person-years (py) were calculated and stratified by sex, age, and province of residence. Temporal trend and covariates effect were assessed with Poisson regression. Overall survival was estimated using the Kaplan-Meier method and compared across subgroups; adjusted hazard ratios (HR) were obtained from multiple Cox regression model. Results: Between 2013 and 2022, there were 322 incident PM cases (82% male; median age 77 years). The crude incidence rate was 2.1 per 100,000 py (95% CI: 1.9–2.4), with no temporal change over the study period. The highest rates were observed in men, in age-group 75–79 years, and in the province of Ancona. One- and five-year survival rates were 48.8% and 8.3%, respectively. Older age and non-epithelioid histology were independently associated with higher mortality. Conclusions: The incidence of pleural mesothelioma in the Marche Region remained stable between 2013 and 2022, with a peak in 2018 requiring further observation to confirm it. The persistently high burden among men, older adults, and those living in industrialized coastal areas reflects the legacy of historical asbestos exposure. Continued population-based surveillance, integrated with follow-up of previously exposed workers, remains essential to monitor disease trends and support timely diagnosis and appropriate care pathways.