Predicting Malignant Mesothelioma by Analyzing Serum N-ERC/Mesothelin, C-ERC/Mesothelin, Hyaluronan, Osteopontin, and Syndecan-1 Levels

Objective: Tumor biomarkers are promising study areas for the early or differential diagnosis of malignant pleural mesothelioma (MPM). This study aimed to determine the effectiveness of analyzing serum N-ERC/mesothelin, C-ERC/mesothelin, hyaluronan, osteopontin, and syndecan-1 levels for distinguishing patients with MPM from those with metastatic malignant pleural diseases (MMPDs), benign pleural diseases (BPDs), and benign asbestos pleurisy (BAP).

Methods: Tumor biomarker levels of serum samples of 230 cases were analyzed by enzyme-linked immunosorbent assays.

Results: All investigated biomarkers did not reveal sufficient diagnostic information to distinguish MPM from MMPD. N-ERC/mesothelin showed moderate ability to distinguish MPM from BPDs and particularly BAP (sensitivities of 67% and 73%, respectively, and specificities of 84% and 86%, respectively). C-ERC/mesothelin had a lower efficacy than N-ERC/mesothelin, whereas osteopontin had a high specificity for distinguishing MPM from other pleural diseases (80%) but with a poor sensitivity (32%). Hyaluronan and syndecan-1 had only limited effects as individual biomarkers. However, logistic regression analysis indicated that all the studied biomarkers could contribute, and a logistic model improved their performance, with the receiver operating characteristic curve plot showing an area under the curve of 0.75. Thus, the investigated biomarkers were unable to provide sufficient sensitivity and specificity levels; however, they all may contribute as a basis for an expanded logistic multiparameter model.

Conclusion: Patients with high N-ERC/mesothelin and C-ERC/mesothelin levels have a high risk for MPM; appropriate invasive procedures should be performed. The patients who have high tumor biomarker levels and undefinite histopathological investigation results at the first-line procedure, should be managed using further invasive procedures.