Abstract
BackgroundWe evaluated possible diagnostic and prognostic values of serum midkine in malignant pleural mesothelioma in comparison with those of serum mesothelin, a well-established diagnostic biomarker.MethodsSerum mesothelin and midkine levels were determined with an enzyme-linked immunosorbent assay. We examined specimens from 95 Turkish cases with malignant pleural mesothelioma, 56 metastatic cancers to pleura, 27 other types of benign pleural diseases and 20 benign asbestos pleurisy. The cut-off values were 1.5 nmol/L for mesothelin and 421 pg/mL for midkine.ResultsSensitivity and specificity of mesothelin were 51.6 and 71.4%, 51.6 and 85.2%, and 51.6 and 85% for differentiating mesothelioma from metastatic cancers to pleura, other benign pleural diseases and benign asbestos pleurisy, respectively. Sensitivity and specificity of midkine were 61.1 and 41.1%, 61.1 and 48.1%, and 61.1 and 75% to distinguish mesothelioma from metastatic cancers to pleura, other benign pleural diseases and benign asbestos pleurisy, respectively. Combination of both biomarkers did not improve the differential diagnostic efficacy. Mesothelin levels were elevated in the epitheloid type and in the advanced cases, but were not related to the prognosis. In contrast, elevated baseline levels of midkine were independently associated with a poor prognosis of mesothelioma patients after adjusting for the stage, the histological subtypes and treatment schedules (HR = 1.84; 95% CI: 1.09-3.09) (p = 0.022).ConclusionsSerum mesothelin showed moderate sensitivity and high specificity to differentiate malignant pleural mesothelioma from metastatic malignancy to pleura and from benign pleural diseases. In contrast, midkine was a useful marker for predicting prognosis of mesothelioma patients.
Highlights
We evaluated possible diagnostic and prognostic values of serum midkine in malignant pleural mesothelioma in comparison with those of serum mesothelin, a well-established diagnostic biomarker
We investigated in the present study to compare mesothelin, a wellestablished biomarker for mesothelioma, with midkine, a possible novel marker, in the diagnosis and the prognosis of malignant pleural mesothelioma
We compared the diagnostic ability of mesothelin and midkine to differentiate mesothelioma from other pleural disease, and we firstly demonstrated to our knowledge that serum midkine levels possessed a prognostic value in mesothelioma
Summary
We evaluated possible diagnostic and prognostic values of serum midkine in malignant pleural mesothelioma in comparison with those of serum mesothelin, a well-established diagnostic biomarker. Malignant pleural mesothelioma is an aggressive tumor with poor prognosis and remains a worldwide health problem. The diagnosis of mesothelioma is based on an immunohistochemical staining of pleural tissues obtained from biopsy [1]. Differentiation between mesothelioma and other pleural diseases is difficult in some cases even with the staining of biopsy specimens. There are not clinical and laboratory markers available which can predict prognosis of the patients. Development of such relevant markers is desirable for precise diagnosis and for improving the treatment protocol. A less invasive method for collecting clinical specimens is favorable for senior patients as are often found in mesothelioma
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