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Published on: October 2, 2015
Circulating activin A is a novel prognostic biomarker in malignant pleural mesothelioma - A multi-institutional study
Mir Alireza Hoda1, Yawen Dong2, Anita Rozsas3
1Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria; Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Introduction:
The deregulation of activin expression is often observed in various malignancies. Previous studies indicate that activin A plays a protumourigenic role in malignant pleural mesothelioma (MPM). The aim of the study was to evaluate circulating activin A level as a biomarker in MPM.
Methods:
Plasma samples were collected from 129 MPM patients in four institutions at the time of diagnosis or before surgical resection. Samples from 45 healthy individuals and from 16 patients with non-malignant pleural diseases served as controls. Circulating activin A was measured by enzyme-linked immunosorbent assay and correlated to clinicopathological variables.
Results:
Plasma activin A level was significantly elevated in MPM patients (862 ± 83 pg/ml) when compared to healthy controls (391 ± 21 pg/ml; P < 0.0001). Patients with pleuritis or fibrosis only showed a modest increase (versus controls; 625 ± 95 pg/ml; P = 0.0067). Sarcomatoid (n = 10, 1629 ± 202 pg/ml, P = 0.0019) and biphasic (n = 23, 1164 ± 233 pg/ml, P = 0.0188) morphology were associated with high activin A levels when compared to epithelioid histology (n = 94, 712 ± 75 pg/ml). The tumour volume showed a positive correlation with increased circulating activin A levels. MPM patients with below median activin A levels had a significantly longer overall survival when compared to those with high activin A levels (median survival 735 versus 365 d, P < 0.0001). Importantly, circulating activin A levels were exclusively prognostic in epithelioid MPM.
Conclusions:
Our findings suggest that the measurement of circulating activin A may support the histological classification of MPM and at the same time help to identify epithelioid MPM patients with poor prognosis.
Insights
Elevated circulating activin A levels are found in malignant pleural mesothelioma (MPM) patients. Higher activin A indicates poorer survival, especially in epithelioid MPM, suggesting its use as a prognostic biomarker.
Area of Science:
- Oncology
- Biomarker Discovery
- Proteomics
Background:
- Deregulation of activin expression is common in malignancies.
- Activin A has a known protumorigenic role in malignant pleural mesothelioma (MPM).
- The potential of circulating activin A as a biomarker in MPM requires evaluation.
Purpose of the Study:
- To assess circulating activin A levels in MPM patients.
- To correlate activin A levels with clinicopathological variables and patient survival.
- To determine the utility of activin A as a diagnostic or prognostic biomarker in MPM.
Main Methods:
- Plasma samples were collected from 129 MPM patients and controls (45 healthy, 16 non-malignant pleural disease).
- Circulating activin A was quantified using enzyme-linked immunosorbent assay (ELISA).
- Activin A levels were correlated with MPM histology, tumor volume, and overall survival.
Main Results:
- MPM patients exhibited significantly elevated plasma activin A compared to healthy controls (P < 0.0001).
- Higher activin A levels were associated with sarcomatoid and biphasic MPM histology and larger tumor volume.
- Low circulating activin A levels correlated with significantly longer overall survival (735 days vs. 365 days, P < 0.0001).
Conclusions:
- Circulating activin A levels can aid in the histological classification of MPM.
- Activin A serves as a prognostic biomarker, particularly for identifying epithelioid MPM patients with poor outcomes.
- Measurement of circulating activin A may improve MPM patient management and risk stratification.
