Osteopontin Levels May Identify Patients with Early Stage Mesothelioma
Researchers from several institutions have reported that serum osteopontin levels can be used to identify persons with asbestos exposure who do or do not have mesothelioma. The details of this study appeared in the October 13, 2005, issue of the New England Journal of Medicine .[1]
Mesothelioma is a relatively rare cancer caused predominantly by asbestos exposure. There are approximately 2,000-3,000 new cases per year in the United States and the increase in incidence has stimulated recent clinical trials aimed at improving outcomes. In England, the number of annual deaths from mesothelioma is expected to increase from 1,500 in the year 2000 to 3,000 in the year 2020. Because almost all cases are due to chronic asbestos exposure, the peak incidence will not occur until sometime between 2010 and 2020.
Mesothelioma usually presents as pleural nodules or diffuse involvement of the pleura, although up to 10% of all cases occur in the abdomen. The only curative treatment for mesothelioma is surgery. However, more than 70% of cases are advanced at the time of diagnosis and cannot be cured with surgery. The development of a blood test that would allow early diagnosis in patients at risk of mesothelioma, or that would accurately predict a response to treatment, would be a great advance in the management of this malignancy. A recent study suggested that measuring soluble mesothelin-related proteins (SMR) would discriminate between mesothelioma and benign conditions in patients exposed to asbestos. The current study evaluated measurement of osteopontin, which is a glycoprotein over-expressed in lung, breast, colorectal, gastric, ovarian cancer and melanoma.
Researchers involved in this study evaluated serum osteopontin levels in 76 patients with pleural mesothelioma and 69 patients with benign asbestos-related disease. They reported that serum levels of osteopontin were elevated in patients with pulmonary plaques and fibrosis but not in those with normal X-rays. They found very high levels of osteopontin in paitents with pleural mesothelioma compared to patients without mesothelioma who were exposed to asbestos. They were able to develop a nomogram which had a sensitivity of 77.5% and a specificity of 85.5%. The same sensitivity and specificity was achieved in patients with stage I mesothelioma, which is the stage one hopes to diagnose.
Comments: This test may or may not prove to be useful. In an accompanying editorial it was pointed out that is that much more testing will be required to confirm these findings.[2] More importantly, it must be demonstrated that earlier diagnosis will, in fact, improve outcome.
References
[1]Pass HI, Lott D, Lonardo F, et al. Asbestos exposure, pleural mesothelioma, and serum osteopontin levels. New England Journal of Medicine. 2005;353:1564-1573.
[2] Cullen MR. Serum osteopontin levels-is it time to screen asbestos-exposed workers for pleural mesothelioma. New England Journal of Medicine . 2005;353:1617-1618.
Mesothelioma is a relatively rare cancer caused predominantly by asbestos exposure. There are approximately 2,000-3,000 new cases per year in the United States and the increase in incidence has stimulated recent clinical trials aimed at improving outcomes. In England, the number of annual deaths from mesothelioma is expected to increase from 1,500 in the year 2000 to 3,000 in the year 2020. Because almost all cases are due to chronic asbestos exposure, the peak incidence will not occur until sometime between 2010 and 2020.
Mesothelioma usually presents as pleural nodules or diffuse involvement of the pleura, although up to 10% of all cases occur in the abdomen. The only curative treatment for mesothelioma is surgery. However, more than 70% of cases are advanced at the time of diagnosis and cannot be cured with surgery. The development of a blood test that would allow early diagnosis in patients at risk of mesothelioma, or that would accurately predict a response to treatment, would be a great advance in the management of this malignancy. A recent study suggested that measuring soluble mesothelin-related proteins (SMR) would discriminate between mesothelioma and benign conditions in patients exposed to asbestos. The current study evaluated measurement of osteopontin, which is a glycoprotein over-expressed in lung, breast, colorectal, gastric, ovarian cancer and melanoma.
Researchers involved in this study evaluated serum osteopontin levels in 76 patients with pleural mesothelioma and 69 patients with benign asbestos-related disease. They reported that serum levels of osteopontin were elevated in patients with pulmonary plaques and fibrosis but not in those with normal X-rays. They found very high levels of osteopontin in paitents with pleural mesothelioma compared to patients without mesothelioma who were exposed to asbestos. They were able to develop a nomogram which had a sensitivity of 77.5% and a specificity of 85.5%. The same sensitivity and specificity was achieved in patients with stage I mesothelioma, which is the stage one hopes to diagnose.
Comments: This test may or may not prove to be useful. In an accompanying editorial it was pointed out that is that much more testing will be required to confirm these findings.[2] More importantly, it must be demonstrated that earlier diagnosis will, in fact, improve outcome.
References
[1]Pass HI, Lott D, Lonardo F, et al. Asbestos exposure, pleural mesothelioma, and serum osteopontin levels. New England Journal of Medicine. 2005;353:1564-1573.
[2] Cullen MR. Serum osteopontin levels-is it time to screen asbestos-exposed workers for pleural mesothelioma. New England Journal of Medicine . 2005;353:1617-1618.
posted by Chris Placitella | 9:30 AM
0 Comments:
Post a Comment
<< Home