Prognostic significance of soluble mesothelin in malignant pleural mesothelioma: a meta-analysis

Our plain-English summary of Prognostic significance of soluble mesothelin in malignant pleural mesothelioma: a meta-analysis, by L. Tian, R. Zeng, X. Wang, et al (Oncotarget, 2017).

The study

• Authors: L. Tian, R. Zeng, X. Wang, C. Shen, Y. Lai, M. Wang, G. Che
• Journal: Oncotarget
• Published: 2017;8(28):46425-46435
• Type of article: Meta-analysis
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Soluble mesothelin is beneficial to detect the progression and the treatment response of malignant pleural mesothelioma. However, the prognostic value of soluble mesothelin in malignant pleural mesothelioma remains unclear.

Methods: Hazard ratio with 95% CI was used to evaluate the prognostic value of soluble mesothelin and the effect of clinicopathological characteristics on the survival of malignant pleural mesothelioma.

Results: Eight eligible studies involving 579 patients were selected for this meta-analysis. The results showed that soluble mesothelin level was significantly correlated with the survival of malignant pleural mesothelioma (pooled HR: 1.958, 95%CI: 1.531-2.504, p = 0.000; heterogeneity test: I2 = 1.1%, p = 0.421). In addition, the survival of malignant pleural mesothelioma was significantly correlated with some clinicopathological characteristics such as tumor histology (HR = 3.214, 95% CI = 2.071-4.988, p = 0.000; heterogeneity test: I2 = 0.0%, p = 0.623) and tumor stage (HR = 2.007; 95% CI = 1.477-2.727; p = 0.000; heterogeneity test: I2 = 0.0%, p = 0.966).

Conclusions: The survival of malignant pleural mesothelioma is significantly correlated with tumor histology and tumor stage. Furthermore, high soluble mesothelin level may lead to a poor prognosis for malignant pleural mesothelioma patients.

In plain English

This meta-analysis combined results from published studies and collected no new patient data. The authors searched medical databases, updated in November 2016, and included 8 studies covering 579 patients, all of them Caucasian. Most had malignant pleural mesothelioma, but one study also included 4 peritoneal cases and another did not report tumor site. Soluble mesothelin was measured in blood serum in 7 studies and in pleural effusion fluid in 1. Across all 8 studies, high soluble mesothelin was linked with poorer overall survival (pooled hazard ratio 1.958, 95% CI 1.531-2.504). In the 4 studies that used multivariate analysis the figure was 1.925 (95% CI 1.466-2.528). In analyses of 3 studies each, tumor histology (hazard ratio 3.214, 95% CI 2.071-4.988) and tumor stage (2.007, 95% CI 1.477-2.727) were also significantly linked with survival. Age and gender were not. Asbestos exposure was not analysed. The authors concluded that high soluble mesothelin level may lead to a poor prognosis and called it an independent prognostic marker. Listed limitations included few, small studies, hazard ratios estimated from survival curves, Caucasian-only patients, and possible confounding.

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: Meta-analysis of published studies (performed according to PRISMA)
• Who was studied: 8 published studies including 579 patients described as having malignant pleural mesothelioma. Study sizes ranged from 36 to 107 patients, and all patients were Caucasian. The studies came from the UK, Italy, Australia, France/USA and Germany and were published 2007 to 2014. One study (Linch et al., 53 patients) included 49 pleural and 4 peritoneal cases, and one study (Creaney et al. 2007) did not report tumor site.
• Exposure: The factor studied was soluble mesothelin level (high versus low), measured with Mesomark ELISA kits in serum (7 studies) or pleural effusion (1 study). Age, gender, tumor histology and tumor stage were also analysed. Asbestos exposure and fiber types were not analysed.
• Main results:
  • Across all 8 studies, high soluble mesothelin level was linked with poorer overall survival: pooled HR 1.958 (95% CI 1.531-2.504), with low heterogeneity (I2 = 1.1%).
  • In the subgroup of studies that used multivariate survival analysis (4 studies), the HR for high soluble mesothelin was 1.925 (95% CI 1.466-2.528).
  • The single study that measured mesothelin in pleural effusion had an HR of 0.73 (95% CI 0.17 to 3.07).
  • Pooled HRs for survival were: age 1.256 (95% CI 0.907-1.739, p = 0.170, not significant); gender 0.932 (95% CI 0.168-5.17, p = 0.936, not significant); tumor histology, epithelioid versus non-epithelioid, 3.214 (95% CI 2.071-4.988); tumor stage, I-II versus III-IV, 2.007 (95% CI 1.477-2.727). Histology and stage were each based on 3 studies, age on 3 and gender on 2.
  • The authors interpreted the histology and stage results as showing that non-epithelioid histology and advanced tumor stage predicted poorer survival.
  • Begg's test showed no significant publication bias (p = 0.711). In the sensitivity analysis, no single study significantly changed the pooled result.
• The authors' conclusion: The authors concluded that survival in malignant pleural mesothelioma is significantly correlated with tumor histology and tumor stage. They also concluded that high soluble mesothelin level may lead to a poor prognosis, and regarded soluble mesothelin as an independent prognostic marker and a potential therapeutic target.
• Limitations the authors state:
  • The number of included studies and the sample size of each study were relatively small.
  • Some hazard ratios were reconstructed from Kaplan-Meier survival curves, which may have introduced errors.
  • All patients were Caucasian, so ethnic bias may exist.
  • Not all included studies used multivariate analysis, so confounding factors may exist.
  • Potential heterogeneity between studies could not be fully ruled out.

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: Mesothelin, Pleural Mesothelioma, Meta-Analysis, Hazard Ratio, Histology, Prognosis.

Related studies

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• Biomarkers in malignant mesothelioma: diagnostic and prognostic role of soluble mesothelin-related peptide — N. Dipalma, V. Luisi, et al. (2011)
• Diagnostic values of soluble mesothelin-related peptides for malignant pleural mesothelioma: updated meta-analysis — A. Cui, X.G. Jin, et al. (2014)
• Diagnostic value of soluble mesothelin-related peptides for malignant mesothelioma: a meta-analysis — L. Luo, H.Z. Shi, et al. (2010)
• Soluble Mesothelin-Related Peptides to Monitor Recurrence After Resection of Pleural Mesothelioma — B.M. Burt, H.S. Lee, et al. (2017)
• Serum soluble mesothelin concentrations in malignant pleural mesothelioma: relationship to tumor volume, clinical stage and changes in tumor burden — J. Creaney, R.J. Francis, et al. (2011)

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