Scherpereel A, Grigoriu B-D, Astoul P
Service de Pneumologie et Oncologie Thoracique, Hôpital Calmette, CHRU de Lille, Lille, France.
Rev Mal Respir. 2008 Oct;25(8 Pt 2):3S183-90.
Malignant pleural mesothelioma (MPM) is a serious issue worldwide because of its increasing incidence and poor prognosis despite real recent improvements in the disease management. Most of the patients are diagnosed late in the course of the disease when radical treatment is no more an option. Therefore an earlier diagnosis of MPM is needed to significantly increase the survival of patients. Some soluble markers, including soluble mesothelin and osteopontin, have been previously proposed for MPM diagnosis but none has been validated yet. Soluble mesothelin, assessed in blood and in pleural effusion, seems to be the most promising candidate. However, even if it has a good diagnostic and prognostic value, it is quite specific for the epithelioid subtype, the most frequent one of mesothelioma, thus limiting its usefulness in practice. Despite sometimes a good sensitivity, other potential markers as osteopontin are of little interest for MPM diagnosis because of a low specificity. In conclusion, the present data do not justify the use of biology for MPM diagnosis in routine yet but rather suggest a need for a continuing evaluation of soluble mesothelin in clinical studies and the search for other potential tumor markers.
恶性胸膜间皮瘤（MPM）是一个全球性的严重问题，尽管近年来在疾病管理方面有了切实的改善，但其发病率仍在上升且预后较差。大多数患者在疾病晚期才被诊断出来，此时根治性治疗已不再是一种选择。因此，需要更早地诊断MPM以显著提高患者的生存率。此前已提出一些可溶性标志物，包括可溶性间皮素和骨桥蛋白，用于MPM诊断，但尚未有标志物得到验证。在血液和胸腔积液中评估的可溶性间皮素似乎是最有希望的候选标志物。然而，即使它具有良好的诊断和预后价值，它对间皮瘤最常见的上皮样亚型具有相当的特异性，因此在实际应用中限制了其效用。尽管有时敏感性良好，但其他潜在标志物如骨桥蛋白由于特异性较低，对MPM诊断的价值不大。总之，目前的数据尚不能证明在常规情况下使用生物学方法进行MPM诊断是合理的，而是表明需要在临床研究中持续评估可溶性间皮素，并寻找其他潜在的肿瘤标志物。
