Research suggests that levels of fibulin-3 in plasma and effusions may aid in determining the diagnosis and prognosis of pleural mesothelioma.
"The specificity and sensitivity of fibulin-3 in discriminating between asbestos-exposed persons, as well as patients with effusions not due to mesothelioma, and patients with mesothelioma are superior to those of other published markers," comment the researchers.
"In addition, high levels of fibulin-3 in effusions have a high positive predictive value for the presence of mesothelioma and appear to reflect the prognosis."
The investigators obtained plasma and effusion samples from two US cohorts of patients: the Detroit cohort (obtained at Wayne State University in Detroit, Illinois from 1998 through 2005) and the New York cohort (obtained at New York University Langone Medical Center from 2005 through 2011).
Plasma samples were collected from 92 patients with mesothelioma, 136 asbestos-exposed persons without cancer, 93 patients with effusions not due to mesothelioma, and 43 healthy controls. Effusions were collected from 74 patients with mesothelioma, 39 with benign effusions, and 54 patients with malignant effusions not due to mesothelioma.
As reported in The New England Journal of Medicine, the researchers found that plasma fibulin-3 levels did not differ according to age, gender, duration of asbestos exposure, or degree of radiographic changes.
Plasma fibulin-3 levels were significantly higher among patients with pleural mesothelioma than in asbestos-exposed individuals without mesothelioma, at 105 versus 15 ng/mL for the Detroit cohort and 113 versus 24 ng/mL for the New York cohort.
Effusion fibulin-3 levels were also significantly higher in patients with pleural mesothelioma than in patients with effusions not due to mesothelioma, at 694 versus 212 ng/mL for the Detroit cohort and 636 versuss 151 ng/mL for the New York cohort.
A plasma fibulin-3 level of 52.8 ng/mL discriminated between patients with and without mesothelioma with a sensitivity of 96.7% and a specificity of 95.5%. Furthermore, a plasma fibulin-3 level of 46.0 ng/mL discriminated between patients with stage I or II mesothelioma and those with asbestos exposure without mesotheliomawith a specificity of 94.0% and a sensitivity of 100.0%
Surprisingly, say the authors, effusion fibulin-3 levels did not correlate with plasma levels.
Harvey Pass (New York University Langone Medical Center) and team suggest that future investigations should explore why fibulin-3 is selectively elevated in mesothelioma, compared with other cancers.
They add: "These studies could potentially clarify the role of fibulin-3 in mesothelioma growth, invasion, and metastasis formation and determine whether the molecule might be targeted for specific cytotoxic or biologic therapies."
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