Serum mesothelin has a higher diagnostic utility than hyaluronic acid in malignant mesothelioma

Our plain-English summary of Serum mesothelin has a higher diagnostic utility than hyaluronic acid in malignant mesothelioma, by B. Grigoriu, B. Chahine, F. Zerimech, et al (Clinical Biochemistry, 2009).

The study

• Authors: B. Grigoriu, B. Chahine, F. Zerimech, M. Grégoire, M. Balduyck, M.C. Copin, P. Devos, P. Lassalle, A. Scherpereel
• Journal: Clinical Biochemistry
• Published: 2009;42(10-11):1046-50
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Unlabelled: We assessed comparatively the diagnostic value of two potential malignant pleural mesothelioma (MPM) markers: hyaluronic acid (HA) and soluble mesothelin.

Materials And Method: We measured serum and pleural fluid values of mesothelin and hyaluronic acid in 76 patients with MPM, 33 patients with pleural metastases of carcinomas (Mets group) and 27 patients with benign pleural effusion related to asbestos exposure (BPLAE).

Results: Using a serum HA cut-off of 100 microg/L, 8 patients/33 (24.2%) were positive in the Mets group versus 20/76 (26.3%) in the MPM group and only 1/27 BPLAE patients. The area under ROC curve for serum HA in MPM versus Mets or BPLAE groups was only 0.617 while it was 0.755 for mesothelin. In pleural fluid, both markers had similar diagnostic values.

Conclusions: Serum mesothelin is more sensitive than hyaluronic acid in diagnosing MPM and there is no benefit in combining both markers.

In plain English

This French study compared two possible markers of malignant pleural mesothelioma: hyaluronic acid and soluble mesothelin. Both were measured in blood and in pleural fluid (fluid around the lung). From May 2003, the authors recruited 136 consecutive suspected patients from 20 hospital departments. Biopsies showed 76 had mesothelioma, 33 had pleural spread of various carcinomas, and 27 had benign pleural lesions associated with asbestos exposure. In blood, mesothelin separated mesothelioma from the other conditions better than hyaluronic acid (area under the ROC curve 0.755, 95% CI 0.671 to 0.840, versus 0.617, 95% CI 0.520 to 0.714). Hyaluronic acid was significantly higher in mesothelioma than in benign cases, but not than in spread cancer. Among 36 mesothelioma patients with low blood mesothelin, 6 had high hyaluronic acid. Pleural fluid was available for only some patients. In that fluid, the two markers performed similarly and were highly correlated. The authors concluded that serum mesothelin had better diagnostic value than serum hyaluronic acid, and that in pleural fluid both were equally effective. They noted that mesothelin's sensitivity was only about 40% in this study.

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: Diagnostic accuracy study with consecutive recruitment of patients suspected of malignant pleural mesothelioma, comparing blood and pleural fluid markers against biopsy diagnosis
• Who was studied: 136 patients from 20 departments in northern and western France, recruited from May 2003. By biopsy, 76 had malignant pleural mesothelioma (60 epithelioid, 8 sarcomatoid, 8 mixed), 27 had benign pleural lesions associated with asbestos exposure, and 33 had pleural metastasis of various carcinomas. Some patients were also included in the authors' earlier report.
• Exposure: The study measured two markers (hyaluronic acid and soluble mesothelin) in serum and pleural fluid. Confirmed asbestos exposure was reported for 63 of 76 mesothelioma patients (82.9%), 22 of 27 benign-lesion patients (81.5%) and 11 of 33 metastasis patients (33.3%). No fiber types, products or doses were given.
• Main results:
  • Median serum hyaluronic acid was 48.5 μg/L (IQR 29.5 to 100.5) in mesothelioma patients, compared with 30.0 μg/L (IQR 13.0 to 56.0) in benign cases (p=0.009) and 45.0 μg/L (IQR 19.0 to 91.0) in the metastasis group (p=0.23, not significant).
  • For telling mesothelioma apart from all other pleural conditions, the area under the ROC curve for serum hyaluronic acid was 0.617 (95% CI 0.520 to 0.714).
  • Serum mesothelin had a higher area under the ROC curve than serum hyaluronic acid: 0.755 (95% CI 0.671 to 0.840) for mesothelioma versus all other conditions, and 0.774 (95% CI 0.681 to 0.867) for malignant versus benign lesions. The corresponding figure for hyaluronic acid in malignant versus benign lesions was 0.672 (95% CI 0.558 to 0.785).
  • A serum hyaluronic acid cut-off of 100 μg/L gave a specificity of 0.85 for mesothelioma versus other diseases, and 0.95 for cancer versus benign pleural involvement.
  • Of 36 mesothelioma patients with serum mesothelin below 1.75 nM, 6 (16.6%) had serum hyaluronic acid at or above 100 μg/L.
  • In the metastasis group, 4 of 23 patients (17.4%) had low serum mesothelin but high serum hyaluronic acid, as did 1 of 26 benign-lesion patients. The authors stated that serum hyaluronic acid could not tell mesothelioma apart from metastatic cancer.
  • In pleural fluid, the two markers performed similarly for mesothelioma versus other conditions: the area under the ROC curve was 0.832 for mesothelin and 0.810 for hyaluronic acid.
  • Pleural fluid levels of mesothelin and hyaluronic acid were highly correlated in the same patients (Spearman Rho=0.647, p=0.001).
• The authors' conclusion: The authors concluded that serum mesothelin had better diagnostic value than serum hyaluronic acid and may be considered the reference marker against which other candidates are compared in mesothelioma diagnosis. In pleural fluid, they found both markers equally effective.
• Limitations the authors state:
  • The sensitivity of soluble mesothelin was less than optimal, about 40% in this study.
  • Pleural fluid results were available for only part of each group: 20 metastasis, 13 benign-lesion and 26 mesothelioma patients.
  • Serum hyaluronic acid is also raised in liver fibrosis and inflammatory joint diseases such as rheumatoid arthritis, which reduces its value.
  • The authors judged the practical usefulness of adding hyaluronic acid in patients with low mesothelin to be debatable, because most of these patients still needed a thoracoscopy.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelin, Hyaluronic Acid, Malignant Mesothelioma, Pleural Mesothelioma, Carcinoma, Pleural Effusion, Asbestos Exposure.

Related studies

• Utility of osteopontin and serum mesothelin in malignant pleural mesothelioma diagnosis and prognosis assessment — B.D. Grigoriu, A. Scherpereel, et al. (2007)
• Utility of hyaluronic acid in pleural fluid for differential diagnosis of pleural effusions: likelihood ratios for malignant mesothelioma — S. Atagi, M. Ogawara, et al. (1997)
• Pleural effusion hyaluronic acid as a prognostic marker in pleural malignant mesothelioma — J. Creaney, I.M. Dick, et al. (2013)
• Soluble mesothelin-related peptides in the diagnosis of malignant pleural mesothelioma — A. Scherpereel, B. Grigoriu, et al. (2006)
• Is serum hyaluronic acid level useful for evaluating the clinical course of malignant mesothelioma of the tunica vaginalis? — K. Haga, N. Shinohara, et al. (1999)
• Hyaluronic acid in the pleural fluid of patients with malignant pleural mesothelioma — N. Fujimoto, K. Gemba, et al. (2013)

Browse return to medical research.