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Oncotarget. 2017 Jun 8;8(32):53326-53335. doi: 10.18632/oncotarget.18405. eCollection 2017 Aug 8.

Diagnostic and prognostic values of cerebrospinal fluid CYFRA 21-1 in patients with leptomeningeal carcinomatosis.

Author information

1
Department of Neurology, National Cancer Center, Goyang, Korea.
2
Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.
3
Department of Oncology, Konkuk University of Medical College, Seoul, Korea.
4
Department of Laboratory Medicine, National Cancer Center, Goyang, Korea.
5
Biometric Research Branch, National Cancer Center, Goyang, Korea.
6
Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
7
Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Abstract

OBJECTIVES:

To investigate the diagnostic and prognostic values of cerebrospinal fluid (CSF) CYFRA 21-1 in patients with leptomeningeal carcinomatosis (LMC).

METHODS:

Concentration of CSF CYFRA 21-1 was detected using electro-chemiluminescent immunoassay. The difference in level of CYFRA 21-1 between 61 patients with LMC and 200 patients with other neurological disease was evaluated, and diagnostic performance of CSF CYFRA 21-1 was investigated. In LMC patients treated with ventriculo-lumbar perfusion (VLP) chemotherapy, prognostic performance of CSF CYFRA 21-1 was evaluated.

RESULTS:

The CSF CYFRA 21-1 was significantly higher in LMC patients than that in patients with other neurological diseases (p<0.001). The sensitivity, specificity, accuracy, and positive and negative predictive values were 80.3%, 95.0%, 91.6%, 83.1%, and 94.1% for CSF CYFRA 21-1, and 65.6%, 100%, 92.0%, 100%, and 90.5% for CSF cytology, respectively. The use of high CSF CYFRA 21-1 and/or positive CSF cytology findings resulted in an increased sensitivity of 85.3%, without compromising specificity. LMC patients with high CSF CYFRA 21-1 were more frequently accompanied by positive CSF cytology results than those with low CSF CYFRA 21-1. The median overall survival was longer in LMC patients with low CSF CYFRA 21-1 than in those with high CSF CYFRA 21-1 (p=0.031). During VLP chemotherapy, the clinical responses were found to be correlated with the biological responses, including the level of CSF CYFRA 21-1 and intracranial pressure.

CONCLUSIONS:

CSF CYFRA 21-1 might be regarded as an additional diagnostic tool for LMC and a potential significant prognostic biomarker in LMC patients treated with VLP chemotherapy.

KEYWORDS:

CSF; CYFRA 21-1; diagnosis; leptomeningeal carcinomatosis; prognosis

Conflict of interest statement

CONFLICTS OF INTEREST Hyun, Park JH, Joo, Park EY, Park B, Kang, Kim JK, Kim SH, Lee, Jeong, Choi, Park KD, Hwang, Gwak report no conflict of interest. Dr. HJ Kim has lectured, consulted, and received honoraria from Bayer Schering Pharma, Biogen, Genzyme, HanAll BioPharma, MedImmune, Merck Serono, Novartis, Teva-Handok, and UCB; received a grant from the Ministry of Science, ICT & Future Planning; and accepted research funding from Genzyme, Kael-GemVax, Merck Serono, Teva-Handok, and UCB; serves on a steering committee for MedImmune; is a co-editor for the Multiple Sclerosis Journal – Experimental, Translational, and Clinical, and an associated editor for the Journal of Clinical Neurology.

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