EFEMP1 and Pleural effusion: Research into the prognostic value of fibulin-3 in MPM remains limited.28 While some Slovenian and international studies suggest that plasma fibulin-3 may have value in assessing disease progression and survival, our results did not demonstrate a significant correlation between plasma fibulin-3 levels and survival outcomes.19,21,28,36 In contrast, higher pleural effusion fibulin-3 levels were associated with worse survival in our cohort, consistent with prior findings.