Research Papers:

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

Jae-Won Hyun, Ji Hyun Park, Boo Gil Kang, Eun Young Park, Boram Park, Jungnam Joo, Jong Kuk Kim, Su-Hyun Kim, Jee Hyang Jeong, Hyang Woon Lee, Kee Duk Park, Kyung Gyu Choi, Sang-Hyun Hwang, Ho-Shin Gwak and Ho Jin Kim _

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Oncotarget. 2017; 8:53326-53335. https://doi.org/10.18632/oncotarget.18405

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Jae-Won Hyun1,6, Ji Hyun Park2, Boo Gil Kang3, Eun Young Park4, Boram Park4, Jungnam Joo4, Jong Kuk Kim5, Su-Hyun Kim1, Jee Hyang Jeong6, Hyang Woon Lee6, Kee Duk Park6, Kyung Gyu Choi6, Sang-Hyun Hwang3,7, Ho-Shin Gwak7 and Ho Jin Kim1,7

1Department of Neurology, National Cancer Center, Goyang, Korea

2Department of Oncology, Konkuk University of Medical College, Seoul, Korea

3Department of Laboratory Medicine, National Cancer Center, Goyang, Korea

4Biometric Research Branch, National Cancer Center, Goyang, Korea

5Department of Neurology, Dong-A University College of Medicine, Busan, Korea

6Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea

7Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea

Correspondence to:

Ho Jin Kim, email: hojinkim@ncc.re.kr

Keywords: leptomeningeal carcinomatosis, diagnosis, prognosis, CSF, CYFRA 21-1

Received: November 30, 2016     Accepted: May 18, 2017     Published: June 08, 2017


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.

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