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Biomerkers voor mesothelioom

27-06-2007 00:00

Biomerkers als Soluble mesothelin-related peptide (SMRP), osteopontine en megakaryocyte potentiating factor (MPF) zijn nog niet voldoende accuraat om cytohistologie als gouden standaard voor de diagnose van maligne mesothelioom te vervangen. Aldus een overzichtsartikel en een onderzoeksverslag. Biomerkers zijn eiwitten in het bloed die iets kunnen zeggen over de aanwezigheid of verloop van sommige ziektes. Bron: Scherpereel, A. &. Lee, G. (2007). Biomarkers for mesothelioma. Current Opinion in Pulmonary Medicine 2007, 13:339. Grigoriu, B.D. et al., (2007). Utility of Osteopontin and SerumMesothelin in Malignant Pleural Mesothelioma Diagnosis and Prognosis Assessment. Clin Cancer Res 13 (10), may 15, p 2928-35-343.
Scherpereel, A. &. Lee, G. (2007). Biomarkers for mesothelioma. Current Opinion in Pulmonary Medicine 2007, 13:339-343.

Purpose of review


Mesothelioma is an incurable cancer and its global incidence continues to increase. There has been strong interest in the search for a biomarker that would be of value for the diagnosis, prognosis and disease monitoring of mesothelioma. Large series evaluating the use of novel candidate markers have recently been published.

Recent findings

To date, global gene profiling studies have failed to find a molecule that reliably captures all subtypes of mesothelioma, and differentiates it from benign pathologies and metastatic carcinomas. Soluble mesothelin-related peptide (SMRP), osteopontin and megakaryocyte potentiating factor have been assessed as markers. SMRP testing is clinically available and provides reasonable diagnostic sensitivity and specificity when applied to serum or pleural fluid. Elevated SMRP levels can occur in metastatic, especially ovarian and pancreatic, adenocarcinomas. False negatives are common with sarcomatoid mesothelioma. SMRP levels may reflect tumor load and disease progression. The role of SMRP in predicting mesothelioma development in subjects exposed to asbestos has raised interest. Osteopontin lacks specificity as a diagnostic marker for mesothelioma but may have value in disease monitoring.

Summary

The proposed markers have insufficient accuracy to replace cytohistology as the gold standard for diagnosis for mesothelioma. Elevated SMRP levels raise suspicion of mesothelioma although negative values do not exclude disease. Its role in disease monitoring in patients and in predicting disease development in at-risk individuals warrant further study.



Grigoriu, B.D. et al., (2007). Utility of Osteopontin and SerumMesothelin in Malignant Pleural Mesothelioma Diagnosis and Prognosis Assessment. Clin Cancer Res 13 (10), may 15, p 2928-35

Abstract

Purpose:
Malignant mesothelioma is a highly aggressive tumor and is often diagnosed too late for a curative treatment.We compared diagnostic and prognostic values ofmesothelin and osteopontin in172 patients suspected ofmalignant pleuralmesothelioma (MPM) and in a control group

of 112 asymptomatic asbestos-exposed subjects.

Experimental Design: Osteopontin and mesothelin were assayed with commercial ELISA kits in a series of 43 patients with pleural metastases of various carcinomas, 33 patients with benign pleural lesions associated with asbestos exposure, 96 patients with MPMs, and 112 asbestos-exposed healthy subjects. Results were correlated with patient's diagnosis and survival.

Results: Serumosteopontin level was higher in MPMpatients compared with healthy asbestos exposed subjects and had a good capability to distinguish between these two populations. However, osteopontin was unable to distinguish between MPM and pleural metastatic carcinoma or benign pleural lesions associated with asbestos exposure. Neither plasma nor pleural fluid osteopontin were more powerful in this respect. Serum mesothelin had a good ability for diagnosing MPM but was unable to identify patients with nonepithelioid mesothelioma subtypes. Survival analysis identified tumor histologic subtype along with serum osteopontin and serum mesothelin as independent prognostic factors in mesothelioma patients.

Conclusions: Osteopontin has a lower diagnostic accuracy than mesothelin in patients suspected of MPM. Insufficient specificity limits osteopontin utility as diagnosticmarker. Bothmolecules have a potential value as prognostic markers.