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- Title
Mesothelin Expression Is a Predictive Factor for Peritoneal Recurrence in Curatively Resected Stage III Gastric Cancer.
- Authors
Shin, Su‐Jin; Park, Sejung; Kim, Min Hwan; Nam, Chung Mo; Kim, Hyunki; Choi, Yoon Young; Jung, Min Kyu; Choi, Hye Jin; Rha, Sun Young; Chung, Hyun Cheol
- Abstract
Background: Mesothelin is overexpressed in many solid tumors, and recent studies have shown that mesothelin expression is associated with poor outcomes in several malignant tumors and may play a role in cancer progression. Clinical trials of mesothelin‐targeted immunotherapies are currently under way, but the correlation between mesothelin expression and gastric cancer prognosis is still unclear. Subjects, Materials, and Methods: Mesothelin expression in tumor cells was evaluated immunohistochemically in 958 patients with advanced gastric cancer and interpreted according to the intensity and extent of staining. Samples were scored from 0 to 2, with high expression defined as a score of 2. Clinicopathological factors, overall survival (OS), recurrence‐free survival (RFS), and sites of initial recurrence, including peritoneal recurrence, were evaluated. Staging was performed according to the American Joint Committee on Cancer 7th edition. Results: High mesothelin expression was observed in 49.7% of patients and significantly associated with high pathologic T (p =.021) and peritoneal recurrence (p =.018). Multivariate survival analysis showed that high mesothelin expression was independently associated with poor RFS (p =.001), OS (p =.001), and peritoneal recurrence (p =.002) in addition to stage, lymphovascular invasion, and Lauren classification. In a subgroup analysis of peritoneal recurrence, high mesothelin expression was also an independent prognostic factor in stage III (p =.013) and diffuse/mixed type gastric cancer (p =.010). Conclusion: High mesothelin expression is correlated with poor outcomes. In addition, mesothelin expression, Lauren classification, and stage are meaningful predictive factors for peritoneal recurrence. Moreover, mesothelin was a significant predictor of a high risk of peritoneal recurrence in patients with stage III gastric cancer. Implications for Practice: This study demonstrates that high mesothelin expression correlates with poor outcomes and is a significant predictor of peritoneal recurrence in patients with stage III gastric cancer. This study provides instrumental evidence for designing anti‐mesothelin antibody‐drug conjugate clinical trials in patients with diffuse‐type gastric cancer to reduce their high risk of peritoneal carcinomatosis. This article examines mesothelin expression with a focus on its potential as a predictive biomarker of peritoneal recurrence after curative surgery and its prognostic significance and association with clinicopathological factors in gastric cancer.
- Subjects
GLYCOPROTEIN analysis; STOMACH tumors; CANCER invasiveness; IMMUNOHISTOCHEMISTRY; CANCER relapse; PERITONEUM tumors; RISK assessment; CANCER patients; TUMOR classification; TREATMENT effectiveness; GLYCOPROTEINS; SURVIVAL analysis (Biometry); DESCRIPTIVE statistics; DISEASE risk factors; SYMPTOMS
- Publication
Oncologist, 2019, Vol 24, Issue 11, pe1108
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2018-0896