Level of mesothelin expression can indicate the prognosis of malignant pleural mesothelioma

Our plain-English summary of Level of mesothelin expression can indicate the prognosis of malignant pleural mesothelioma, by F. Feng, H. Zhang, Y. Zhang, et al (Translational Cancer Research, 2020).

The study

• Authors: F. Feng, H. Zhang, Y. Zhang, H. Wang
• Journal: Translational Cancer Research
• Published: 2020;9(12):7479-7485
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a fatal, treatment-resistant tumor. The median survival of MPM is 9-12 months and its early prognostic markers remains uncertain. The objective of this study was to determine that the level of mesothelin expression can be as a predictor of prognosis in MPM patients.

Methods: Level of mesothelin expression was detected in 38 MPM tissue specimens by immunohistochemistry analysis. The relationship of MPM prognosis and mesothelin expression was evaluated by univariate and multivariate Cox regression, Kaplan-Meier survival curves.

Results: High level of mesothelin expression was significantly associated with non-epithelioid type of MPM and smoking. Meanwhile, higher level of mesothelin expression indicated a shorter total survival.

Conclusions: The present study suggested that mesothelin is a dependent prognostic factor in MPM patients and might be a novel potential target for immunotherapy in MPM.

2020 Translational Cancer Research. All rights reserved.

In plain English

This study looked at tumor tissue from 38 patients diagnosed with malignant pleural mesothelioma at the Second Hospital of Shandong University in Jinan, China, between May 2007 and December 2014. Patients were followed up to August 2015. The authors reviewed the cases retrospectively. They stained the tissue for mesothelin, a protein found on the surface of cells, and graded it as low (26 patients) or high (12 patients). High mesothelin was more common in smokers and in non-epithelioid tumors (sarcomatoid and biphasic types). Overall survival was 7.47±1.48 months in the high-mesothelin group and 14.72±1.30 months in the low-mesothelin group (P=0.005). When several factors were analyzed together, high mesothelin and non-epithelioid tumor type were each linked to shorter survival. The article did not report patients' asbestos exposure. The authors concluded that mesothelin was an independent negative prognostic factor and could serve as a promising biomarker and possible treatment target. They suggested that the small number of cases might explain why sex and stage showed no statistically significant survival differences.

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: Retrospective study of tumor tissue (immunohistochemistry) with survival analysis (Kaplan-Meier curves, univariate and multivariate Cox regression) at a single hospital
• Who was studied: 38 patients with malignant pleural mesothelioma (30 males, 8 females) diagnosed at the Second Hospital of Shandong University, China, May 2007 to December 2014, followed up to August 2015. 26 (68%) had a smoking history and 29 (76%) had epithelioid type.
• Exposure: The study did not report asbestos exposure or fiber types. The factor studied was mesothelin protein level in tumor tissue, scored 0 to 3+ by the percentage of positive cells. Scores of 0 and 1+ counted as low, and 2+ and 3+ as high.
• Main results:
  • High mesothelin expression was significantly associated with smoking (P=0.030) and non-epithelioid type (P=0.002). Among non-smokers, 1 of 13 had high expression; among smokers, 11 of 25. Among epithelioid cases, 5 of 29 had high expression; among non-epithelioid cases, 7 of 9.
  • Overall survival was 7.47±1.48 months for patients with high mesothelin expression and 14.72±1.30 months for those with low expression (P=0.005).
  • Overall survival was 9.63±1.11 months for smokers and 17.02±1.47 months for non-smokers (P=0.014). It was 14.62±1.32 months for epithelioid type and 6.17±1.37 months for non-epithelioid type (P<0.001).
  • In univariate Cox analysis, the overall survival hazard ratio for low versus high mesothelin expression was 0.348 (95% CI 0.158–0.765, P=0.009).
  • In multivariate Cox analysis, non-epithelioid type (hazard ratio epithelioid versus non-epithelioid 0.330, 95% CI 0.116–0.935, P=0.037) and high mesothelin expression (hazard ratio low versus high 0.377, 95% CI 0.150–0.947, P=0.038) were independent negative prognostic factors. Smoking was not significant in this analysis (P=0.911).
  • No statistically significant difference in overall survival was found by gender, age or stage.
• The authors' conclusion: The authors concluded that mesothelin was an independent negative prognostic factor for overall survival in MPM. They said it could serve as a promising prognostic biomarker, easily detected by immunohistochemistry, and a possible target for new therapy.
• Limitations the authors state:
  • The small number of enrolled cases may explain why survival did not differ significantly by gender or by stage. The authors said a larger multi-institutional study will be performed.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelin, Prognosis, Pleural Mesothelioma, Median Overall Survival, Immunohistochemistry, Non-epithelioid, Immunotherapy.

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