National Centre for Asbestos Related Diseases, University of Western Australia, School of Medicine and Pharmacology, Nedlands, Western Australia, Australia; The Australian Mesothelioma Tissue Bank, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Lung Cancer. 2013 Dec;82(3):491-8. doi: 10.1016/j.lungcan.2013.09.016. Epub 2013 Oct 9.
Malignant mesothelioma (MM), a primarily asbestos-induced tumour, has a poor prognosis, with over-all 5-year survival less than 5%. Tumour biomarkers are being intensely investigated in MM as aids to diagnosis and prognosis. Hyaluronic acid (HA) is produced in MM but its role in prognostication remains uncertain.
HA concentrations were determined in matching serum and pleural effusion of 96 MM patients, 26 lung cancer patients and 42 patients with benign effusions resulting from infectious, cardiac, renal, liver and rheumatoid diseases and compared to the current 'best practice' biomarker, mesothelin. Liver and kidney function were determined for each patient. Diagnostic accuracy was determined by area under the receiver operator characteristic curve (AUC) analysis following logistic regression modelling. Difference in survival between groups was determined by both log-rank test and Cox proportional hazards regression modelling.
For effusion HA, the AUC (IQ range) was 0.89 (0.82-0.94) and for effusion mesothelin, it was 0.85 (0.78-0.90). Serum HA was not diagnostically useful. A combined measure of effusion HA, and serum and effusion mesothelin had an AUC of 0.92 (0.86-0.96), which was significantly higher than effusion mesothelin alone. Effusion HA had a biphasic distribution in MM patients, dichotomised at a concentration of 75 mg/L. The median survival of MM patients with high effusion HA was 18.0 (13.7-22.4) months, significantly longer than those with low HA effusion levels (12.6 months (8.4-16.8), p=0.004). Serum HA, and effusion and serum mesothelin were not significant prognostic indicators.
This study demonstrates that a combined biomarker panel has greater diagnostic accuracy than effusion mesothelin alone, and that significant prognostic information is provided by effusion HA.
恶性间皮瘤（MM）是一种主要由石棉引起的肿瘤，预后较差，总体 5 年生存率低于 5%。肿瘤生物标志物在 MM 中被广泛研究，作为辅助诊断和预后的工具。透明质酸（HA）在 MM 中产生，但它在预后中的作用仍不确定。
测定了 96 例 MM 患者、26 例肺癌患者和 42 例良性胸腔积液患者的血清和胸腔积液中的 HA 浓度，这些胸腔积液分别来自感染、心脏、肾脏、肝脏和类风湿性疾病。并与当前的“最佳实践”生物标志物间皮素进行了比较。为每位患者测定了肝功能和肾功能。通过逻辑回归模型下的受试者工作特征曲线（ROC）分析确定诊断准确性。通过对数秩检验和 Cox 比例风险回归模型确定组间生存差异。
对于胸腔积液 HA，AUC（IQ 范围）为 0.89（0.82-0.94），胸腔积液间皮素为 0.85（0.78-0.90）。血清 HA 无诊断价值。胸腔积液 HA 与血清和胸腔积液间皮素的联合测量 AUC 为 0.92（0.86-0.96），明显高于单独胸腔积液间皮素。MM 患者胸腔积液 HA 呈双相分布，以 75mg/L 为界分为两部分。高胸腔积液 HA 的 MM 患者中位生存期为 18.0（13.7-22.4）个月，明显长于低 HA 胸腔积液水平的患者（12.6 个月（8.4-16.8），p=0.004）。血清 HA 以及胸腔积液和血清间皮素均不是显著的预后指标。
本研究表明，联合生物标志物谱比单独胸腔积液间皮素具有更高的诊断准确性，胸腔积液 HA 提供了重要的预后信息。
Zotero 插件