Juuso Paajanen, MD, PhD
Rank
Fellow
Department
Surgery
Thoracic Surgery
Authors
Juuso Paajanen*, Ahmed Sadek, William G. Richards, Emanuele Mazzola, Yue Xie, Kristina Sidopoulos, John Kuckelman, Ritu R.Gill, Raphael Bueno
Principal Investigator
Raphael Bueno
Twitter / Website
Categories
Background: Tumor recurrence remains the main barrier to survival after surgery for pleural mesothelioma (PM). We evaluated the utility of previously established blood-based biomarkers, soluble mesothelin-related protein (SMRP) and cancer antigen 125 (CA-125), for disease monitoring following pleurectomy decortication (PD).
Methods: Patients who achieved complete macroscopic resection after PD with available preoperative SMRP levels were included. Biomarker levels were determined within 60 days of three timepoints: pre-operation, post-operation, and recurrence. Average follow-up surveillance levels were calculated for patients without recurrence. SMRP over 1.5 nmol/L and CA-125 levels over 46 U/mL were categorized as “positive”.
Results: Of 356 available patients, 276 (78%) had recurrence by end of follow-up. Higher preoperative rates of positive SMRP levels were associated with epithelioid histology (P=0.002) and higher TNM stage (P=0.024). Radiographcially measured tumor volume correlated positively with preoperative SMRP levels (rho 0.303, P<0.001). Pre-operative CA-125 levels were not significantly associated with clinical covariates. Positive pre-operative CA-125 (P=0.032) was associated with shorter survival. Positive surveillance SMRP was associated with pleural recurrence (P=0.018), whereas positive CA-125 was related to abdominal recurrence (P=0.002). Among patients with pre-operation, post-operation, and recurrence timepoints available, SMRP levels (N=94) decreased by an average 1.85 nmol/L (P<0.001) post-operatively and increased at the time of recurrence by an average of 0.76 nmol/L (P<0.001). CA-125 levels (N=64) similarly decreased after surgery by an average 32.07 U/mL (P=0.036), but the average change between post-operative and recurrence levels was nonsignificant (29.74 U/mL, P=0.865).
Conclusion:
SMRP and CA-125 levels closely follow the radiographic presence of the disease. Longitudinal changes in levels of SMRP and CA-125 corresponded with respective thoracic and abdominal sites of recurrence. SMRP surveillance could aid the detection of otherwise radiologically subtle local recurrences, whereas CA-125 could be helpful in recognizing abdominal recurrences. Prospective validation of these results is warranted.
