Molecular markers for malignant pleural mesothelioma in Mexico

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a lethal cancer. There is an epidemic of MPM in Mexico with 500 cases per year. The diagnosis remains a challenge, so it is relevant to develop inexpensive and less invasive diagnostic tests. Methods: Case-control study from 3 different hospitals; MPM cases were confirmed by immunohistochemistry and histopathology. Asbestos exposure was assessed using a clinical and occupational questionnaire. Biomarkers levels were measured using ELISA. Based on ROC curves and the highest sensitivity, cut-off points were established for each biomarker. A logistic regression model was built to obtain odds ratios (OR) and 95% confidence intervals for each biomarker. Results: 101 MPM cases and 457 controls were included. Biomarkers mean levels were statistically different between cases and controls and between sexes. Area under the curve (AUC), sensitivity and cut-off points were determined: mesothelin 0.91, 90.9% and 1.59 nmol/l; calretinin 0.85, 94% and 0.69 nmol/l; and thrombomodulin 0.56, 55.8% and 0.68 nmol/l. In the logistic model for both sexes, based on cut-off points, the OR were: mesothelin >0,74 nmol/l: OR=13.5 (5.7-33.5); calretinin >0.23 ng/ml: OR=10 (4.6-21.7); thrombomodulin was discarded from the model. Models weighted by sex showed differences between men and women in calretinin levels, which showed a poor performance in women. Conclusions: Mesothelin and calretinin showed a good performance in men. Cut-off points support the diagnostic accuracy differentiated by sex in MPM cases. Cut-off points and biomarkers levels should be analyzed separately by sex.