Sensitivity of urinary mesothelin in patients with malignant mesothelioma.
BACKGROUND
Malignant mesothelioma (MM) is an aggressive, uniformly fatal tumor usually caused by exposure to asbestos. Soluble mesothelin has been intensively investigated in the serum as a biomarker for this disease. As urine is less complex and less invasive to collect than serum and may be a more acceptable specimen for large-scale screening studies of asbestos-exposed individuals, we determined whether the sensitivity and specificity for MM could be improved by measuring soluble mesothelin in the urine.


METHODS
Soluble mesothelin concentrations were determined using the MESOMARK assay in concurrent serum and urine samples from 70 patients with pleural MM, 111 patients with asbestos-related lung or pleural disease, and 45 patients with benign nonasbestos-related lung and pleural disease. Only patients with serum creatinine levels within the normal range were included in the study. Sensitivities were determined and receiver operator characteristic curves were generated to compare the diagnostic accuracy of mesothelin in the serum and urine.


RESULTS
At a specificity of 95% relative to individuals with benign lung or pleural disease, serum mesothelin had a sensitivity of 66% and area under the curve of 0.882, whereas urinary mesothelin corrected for urine creatinine concentration had a sensitivity of 53% and area under the curve of 0.787.


CONCLUSIONS
The sensitivity of urinary mesothelin does not warrant the use of urine as a biomarker specimen for MM diagnosis.
Creaney
Jenette
J
National Centre for Asbestos Related Diseases, Western Australian Institute of Medical Research, School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia. creaneyj@cyllene.uwa.edu.au
Musk
Arthur W
AW
Robinson
Bruce W S
BW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000009:adverse effects*; D001195:Asbestosis / Q000097:blood / Q000652:urine; D014408:Biomarkers, Tumor / Q000378:metabolism / Q000652:urine*; D016022:Case-Control Studies; D003404:Creatinine / Q000652:urine; D005260:Female; D058851:GPI-Linked Proteins / Q000097:blood / Q000652:urine; D005919:Glomerular Filtration Rate; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000097:blood / Q000139:chemically induced / Q000652:urine; D015151:Immunoblotting; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood / Q000652:urine*; D000090204:Mesothelin; D008654:Mesothelioma / Q000097:blood / Q000188:drug therapy / Q000652:urine*; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000097:blood / Q000188:drug therapy / Q000652:urine*; D011379:Prognosis; D012372:ROC Curve; D017565:Sarcoidosis, Pulmonary / Q000097:blood / Q000139:chemically induced / Q000652:urine; D012680:Sensitivity and Specificity; D015996:Survival Rate; D055815:Young Adult
D014408:Biomarkers, Tumor; D058851:GPI-Linked Proteins; D008562:Membrane Glycoproteins; D001194:Asbestos; D003404:Creatinine; D000090204:Mesothelin