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Dr Blyth raises some important issues regarding the interpretation of malignant pleural mesothelioma (MPM) biomarker studies. First, the effects of confounders, including healing and/or inflammatory factors on biomarker levels; second, the reproducibility of biomarker results between centres.
In our independent evaluation of the proposed MPM biomarker fibulin-3, we considered some of the confounders he suggests—for instance, body mass index and renal function—which were not significant determinants of the diagnostic use of fibulin-3; and the neutrophil to lymphocyte ratio, which was reported and adjusted for in multivariate models. We agree that timing with respect to talc pleurodesis should be acknowledged in papers because of the potential effects …
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