Related Experiment Video
Updated: Sep 14, 2025
Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines
Published on: April 21, 2022
Serum mesothelin as a response biomarker in pleural mesothelioma
Geraldine A Lynch1, Jenny Symonds2, Anna Morley2
1Academic Respiratory Unit, University of Bristol, 2(nd) Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, United Kingdom; Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, United Kingdom.
Background:
CT scans are the current gold standard for disease monitoring for Pleural mesothelioma (PM), with radiology reported using the modified RECIST criteria. While mRECIST has its own challenges, attending for CT scans adds time and expense. A blood-based biomarker which tracks disease status could enable more responsive, community-based disease monitoring. This study evaluated the relationship between serial serum mesothelin (SM) levels and disease status.
Methods:
Patients with PM were recruited from Assess-Meso, a multi-centre prospective cohort study of patients with mesothelioma, between 28/2/2019 and 31/12/2023. Logistic regression, adjusted for sex, age, histology, performance status, eGFR and treatment, was used to assess the relationship between serial SM and radiological disease status. Prespecified sub-group analyses stratified participants by initial SM and treatment status.
Results:
156 patients had ≥ 2 SM measurements with paired CT scans. Rising SM was associated with disease progression in the coincident time period (Adj OR 1.11, 95 % CI 1.03-1.19) and the subsequent 6 months (Adj OR 1.13, 1.03-1.23), regardless of initial SM. A 25 % change in SM was the optimal threshold, with a 25 % rise associated with disease progression (Adj OR 2.68 (1.52-4.73)) with sensitivity and specificity of 48.7 % (43.1 %-54.4 %) and 75.7 % (70.8 %-80.5 %) respectively. For patients receiving treatment, falling SM predicted subsequent disease response (Adj OR 1.37, 1.16-1.61).
Conclusions:
Serial SM is a reliable response biomarker in PM, regardless of initial value and treatment status. These results support the use of SM in routine clinical care as an adjunct to CT scans, with several benefits over radiological monitoring.
