Clinical significance of pleural effusion mesothelin in malignant pleural mesothelioma

Our plain-English summary of Clinical significance of pleural effusion mesothelin in malignant pleural mesothelioma, by S. Yamada, C. Tabata, R. Tabata, et al (Clinical Chemistry and Laboratory Medicine, 2011).

The study

• Authors: S. Yamada, C. Tabata, R. Tabata, K. Fukuoka, T. Nakano
• Journal: Clinical Chemistry and Laboratory Medicine
• Published: 2011;49(10):1721-6
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive malignant tumor of mesothelial origin associated with asbestos exposure. MPM has a limited response to conventional chemotherapy and radiotherapy, so early diagnosis of MPM is very important. This study investigated the pleural effusion mesothelin levels in patients with MPM and compared them to those of a population with a non-malignant pleuritis or lung cancer involving malignant pleural effusion.

Methods: The pleural effusion mesothelin concentrations were measured in 45 MPM patients and 53 non-MPM individuals (24 individuals with non-malignant pleural effusions and 29 individuals with lung cancer involving malignant pleural effusion).

Results: This study demonstrated that patients with MPM had significantly higher pleural effusion mesothelin levels than a population with non-malignant pleuritis or lung cancer involving malignant pleural effusion. The difference in overall survival between the groups with pleural effusion mesothelin levels lower and higher than the assumed cut-off of 10 nM was significant.

Conclusions: The data suggest that the pleural effusion mesothelin concentration could be useful as an aid for the diagnosis of MPM.

In plain English

This study from Japan measured mesothelin, a protein, in fluid that had collected around the lungs (pleural effusion) of 98 people seen at Hyogo College of Medicine Hospital between 1999 and 2007. Forty-five had malignant pleural mesothelioma (MPM), all with a documented asbestos exposure history; 24 had non-cancerous pleural effusions; and 29 had lung cancer with malignant pleural effusion. Mean mesothelin was 52.3 nM in the MPM group, versus 6.4 nM in the non-cancerous group and 5.7 nM in the lung cancer group, differences the authors reported as statistically significant. Using a 10 nM cut-off to separate MPM from non-cancerous effusions, sensitivity was 80.0% and specificity 83.3%. Among MPM patients, survival differed significantly between those below and above 10 nM. When patients were split at the median, lower levels showed a tendency toward poorer survival that did not reach significance (p = 0.053). In a multivariate analysis, age and tumor histology were the factors reported as independent predictors of survival. The authors concluded that pleural effusion mesothelin could be a useful diagnostic marker for MPM and that its prognostic value needs further examination.

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 pleural fluid mesothelin levels between patient groups, with survival follow-up of the mesothelioma patients
• Who was studied: 98 people with pleural effusion at Hyogo College of Medicine Hospital, Hyogo, Japan, 1999 to 2007: 45 with malignant pleural mesothelioma, 24 with non-malignant pleural effusions (including 2 with benign asbestos pleurisy), and 29 with lung cancer involving malignant pleural effusion
• Exposure: Not an exposure study. All 45 mesothelioma patients had a documented asbestos exposure history; no fiber types, jobs or doses were reported. The quantity measured was mesothelin in pleural fluid, using an ELISA kit (Mesomark).
• Main results:
  • Comparing the 45 MPM patients with the 24 non-malignant pleural effusion patients, the area under the ROC curve was 0.863 (95% CI 0.792 to 0.935). At a cut-off of 10 nM, sensitivity was 80.0% and specificity was 83.3%.
  • Mean pleural effusion mesothelin was significantly higher in MPM patients (52.3, plus or minus 57.6 nM) than in non-malignant pleural effusion patients (6.4, plus or minus 4.6 nM) and lung cancer patients with malignant pleural effusion (5.7, plus or minus 4.5 nM), p less than 0.001 for each comparison.
  • Among MPM patients, mesothelin levels did not differ significantly between histological groups or between clinical stages.
  • Mesothelin levels did not differ significantly between subjects with benign asbestos pleurisy and subjects with benign pleurisy without a history of asbestos exposure (6.4, plus or minus 4.2 nM versus 6.4, plus or minus 4.7 nM).
  • Among the 45 MPM patients, overall survival differed significantly between those with mesothelin below and above 10 nM (p = 0.014).
  • When MPM patients were split at the median level (39.05 nM), those with lower levels showed a tendency toward poorer prognosis (p = 0.053).
  • In Cox regression on the 45 MPM patients, the article reported independent significant prognostic effects for age group (split at 65 years; HR 5.72, 95% CI 1.54 to 21.23, p = 0.009) and histology (non-epithelioid vs epithelioid; HR 5.47, 95% CI 1.27 to 23.15, p = 0.022). Mesothelin level was not reported as an independent prognostic factor.
• The authors' conclusion: The authors concluded that higher pleural effusion mesothelin in MPM patients suggests mesothelin is a useful diagnostic marker for MPM. They regarded the tendency toward poorer prognosis with lower levels as needing further examination.
• Limitations the authors state:
  • The authors stated that the prognostic impact of pleural effusion mesothelin levels needs further evaluation.
  • The authors stated that it is unclear why patients with lower mesothelin levels tended to have a poorer prognosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Mesothelin, Pleural Mesothelioma, Asbestos Exposure, Chemotherapy, Lung Cancer, Overall Survival.

Related studies

• A prospective trial evaluating the role of mesothelin in undiagnosed pleural effusions — C.E. Hooper, A.J. Morley, et al. (2013)
• 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 peptide as a diagnostic marker of malignant pleural mesothelioma effusions: its contribution to cytology — P.A. Canessa, M.C. Franceschini, et al. (2013)
• Clinical significance of serum vascular endothelial growth factor in malignant pleural mesothelioma — A. Yasumitsu, C. Tabata, et al. (2010)
• Clinical significance of serum mesothelin in patients with mesothelioma and lung cancer — A. Cristaudo, R. Foddis, et al. (2007)
• Pleural effusion VEGF levels as a prognostic factor of malignant pleural mesothelioma — N. Hirayama, C. Tabata, et al. (2011)

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