Biomarkers in malignant mesothelioma: diagnostic and prognostic role of soluble mesothelin-related peptide

Our plain-English summary of Biomarkers in malignant mesothelioma: diagnostic and prognostic role of soluble mesothelin-related peptide, by N. Dipalma, V. Luisi, F. Di Serio, et al (The International Journal of Biological Markers, 2011).

The study

• Authors: N. Dipalma, V. Luisi, F. Di Serio, A. Fontana, P. Maggiolini, B. Licchelli, E. Mera, L. Bisceglia, I. Galise, M. Loizzi, M.A. Pizzigallo, R. Molinini, L. Vimercati
• Journal: The International Journal of Biological Markers
• Published: 2011;26(3):160-5
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Soluble mesothelin-related peptide (SMRP) is a biomarker that has been proposed for differential diagnosis from pleural metastatic cancer, as well as prognosis and treatment monitoring of malignant pleural mesothelioma (MM). The aim of this study was to evaluate the role of SMRP in clinic management of MM. We assayed the SMRP concentrations in 354 subjects: 109 healthy volunteers with no history of exposure to asbestos, 26 patients with previous occupational asbestos exposure but who were free from pleural or parenchymal disease, 48 patients with asbestosis, 110 patients with pleural plaques, 25 patients with lung cancer, and 36 patients with MM. We also tested SMRP titers in 2 patients with MM at 5 different times of the disease, to evaluate the trend of the biomarker in the course of therapy. Our data confirm previous experiences with the use of SMRP as a diagnostic marker of MM. Low SMRP levels at diagnosis seem to have a positive prognostic significance.

In plain English

This study, from Bari University Hospital in Italy, measured a blood marker called soluble mesothelin-related peptide (SMRP) in 354 people recruited during 2006-2008. They were 36 patients with malignant pleural mesothelioma, 25 lung cancer patients not exposed to asbestos, 110 people with pleural plaques, 48 with asbestosis and pleural plaques, 26 asbestos-exposed workers without pleural or lung disease, and 109 unexposed healthy blood donors. The median SMRP level in the mesothelioma patients (1.55 nMol/L) was significantly higher than in every other group, including the lung cancer patients (0.78 nMol/L). When mesothelioma patients were compared with asbestos-exposed people with benign disease or no disease, a cutoff of 1.2 nMol/L gave a sensitivity of 61.11% and a specificity of 79.35%. Among only 13 mesothelioma patients who were followed up, levels above 1.2 nMol/L before therapy predicted poorer survival (hazard ratio 5.99). The authors concluded that SMRP can be useful for diagnosis, prognosis and judging treatment response. They said it should not be used for screening until further studies support its cost-benefit ratio. They also cautioned that, because of the test's low sensitivity, negative results must be interpreted carefully.

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: Hospital-based diagnostic biomarker study comparing blood SMRP levels across six groups, with a survival analysis in a subset of mesothelioma patients and an exploratory set of repeated measurements in 2 patients
• Who was studied: 354 subjects recruited during 2006-2008 at Bari University Hospital, Italy: 36 patients with malignant pleural mesothelioma (MM), 25 lung cancer patients not exposed to asbestos, 26 patients with previous occupational asbestos exposure but no pleural or parenchymal disease, 48 patients with asbestosis and pleural plaques, 110 patients with pleural plaques only, and 109 healthy blood donors not exposed to asbestos
• Exposure: Asbestos exposure (occupational for the healthy exposed group). The article gives no fiber types or doses. The mesothelioma patients and all participants from the Occupational Medicine Unit (n=220) had been exposed. The 109 healthy blood donors were unexposed, as verified by a validated questionnaire.
• Main results:
  • Median SMRP in MM patients (1.55 nMol/L) was significantly higher than in all other groups (p less than 0.01), including lung cancer patients (median 0.78 nMol/L)
  • The comparison between subjects with pleural plaques and healthy nonexposed subjects was at the limits of statistical significance (p=0.047)
  • Within MM, SMRP levels were higher in epithelioid mesothelioma and in stage II disease, but the differences among stages and histological types were not statistically significant
  • For MM patients versus asbestos-exposed subjects (healthy and with benign asbestos-related disease), the optimal cutoff of 1.2 nMol/L gave sensitivity 61.11%, specificity 79.35%, and 76.36% correctly classified (AUC printed as 73.59%; 95% CI 0.633-0.839)
  • Among the 13 MM patients followed up, SMRP above 1.2 nMol/L before therapy predicted poor survival (hazard ratio 5.99; p=0.0042)
  • In 2 MM patients with serial measurements, SMRP stayed steady in the patient with stable disease. In the other patient it declined while the cancer mass shrank and rose at treatment failure and before death.
• The authors' conclusion: The authors concluded that SMRP can be a useful biomarker for diagnosis, prognosis and treatment response evaluation. They said its use for screening cannot be advised until further studies support the cost-benefit ratio.
• Limitations the authors state:
  • Only 13 MM patients were followed up for the survival analysis
  • The small number of MM cases likely limited the study's power to tell histotypes apart
  • The test's sensitivity was low (61%), and some mesothelin gene variants may lower SMRP, so negative results need caution
  • Serial measurements were possible in only 2 patients and were exploratory

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Biomarker, Malignant Mesothelioma, Mesothelin, Soluble Mesothelin-Related Peptides (SMRP), Differential Diagnosis, Prognosis, Pleural Mesothelioma, Asbestos Exposure.

Related studies

• Evaluation of soluble mesothelin-related peptide as a diagnostic marker of malignant pleural mesothelioma effusions: its contribution to cytology — P.A. Canessa, M.C. Franceschini, et al. (2013)
• Association of MiR-126 with soluble mesothelin-related peptides, a marker for malignant mesothelioma — L. Santarelli, E. Strafella, et al. (2011)
• Soluble Mesothelin-Related Peptides to Monitor Recurrence After Resection of Pleural Mesothelioma — B.M. Burt, H.S. Lee, et al. (2017)
• Two novel polymorphisms in 5' flanking region of the mesothelin gene are associated with soluble mesothelin-related peptide (SMRP) levels — A. Cristaudo, R. Foddis, et al. (2011)
• Diagnostic value of soluble mesothelin-related peptides in pleural effusion for malignant pleural mesothelioma: An updated meta-analysis — R. Gao, F. Wang, et al. (2019)
• Evaluation of soluble mesothelin-related peptides and MSLN genetic variability in asbestos-related diseases — K. Goricar, V. Kovac, et al. (2020)

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