Kwon Ji-Woong, Shim Youngbo, Gwak Ho-Shin, Park Eun Young, Joo Jungnam, Yoo Heon, Shin Sang-Hoon
Neuro-oncology Clinic, National Cancer Center, Goyang, Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2021 Jul;64(4):631-643. doi: 10.3340/jkns.2020.0300. Epub 2021 Jun 29.
Here, we evaluated whether cerebrospinal fluid (CSF) profiles and their changes after intraventricular chemotherapy for leptomeningeal carcinomatosis (LMC) could predict the treatment response or be prognostic for patient overall survival (OS) along with clinical factors.
Paired 1) pretreatment lumbar, 2) pretreatment ventricular, and 3) posttreatment ventricular samples and their CSF profiles were collected retrospectively from 148 LMC patients who received Ommaya reservoir installation and intraventricular chemotherapy. CSF profile changes were assessed by calculating the differences between posttreatment and pretreatment samples from the same ventricular compartment. CSF cell counts were further differentiated into total and other based on clinical laboratory reports.
For the treatment response, a decreased CSF 'total' cell count tended to be associated with a 'controlled' increase in intracranial pressure (ICP) (p=0.059), but other profile changes were not associated with either the control of increased ICP or the cytology response. Among the pretreatment CSF profiles, lumbar protein level and ventricular cell count were significantly correlated with OS in univariable analysis, but they were not significant in multi-variable analysis. Among CSF profile changes, a decrease in 'other' cell count showed worse OS than 'no change' or increased groups (p=0.001). The cytological response was significant for OS, but the hazard ratio of partial remission was paradoxically higher than that of 'no response'.
A decrease in other cell count of CSF after intraventricular chemotherapy was associated with poor OS in LMC patients. We suggest that more specific CSF biomarkers of cancer cell origin are needed.
在此，我们评估了脑脊液（CSF）特征及其在脑室内化疗治疗柔脑膜癌病（LMC）后的变化是否能够预测治疗反应，或与临床因素一起对患者总生存期（OS）进行预后评估。
回顾性收集了148例接受Ommaya储液器植入和脑室内化疗的LMC患者的配对样本，包括1）治疗前腰椎脑脊液样本、2）治疗前脑室脑脊液样本和3）治疗后脑室脑脊液样本及其CSF特征。通过计算同一脑室区域治疗后和治疗前样本之间的差异来评估CSF特征变化。根据临床实验室报告，CSF细胞计数进一步分为总数和其他类型。
对于治疗反应，CSF“总数”细胞计数的减少往往与颅内压（ICP）的“受控”升高相关（p = 0.059），但其他特征变化与ICP升高的控制或细胞学反应均无关。在治疗前的CSF特征中，单变量分析显示腰椎蛋白水平和脑室细胞计数与OS显著相关，但在多变量分析中不显著。在CSF特征变化中，“其他”细胞计数减少组的OS比“无变化”组或增加组更差（p = 0.001）。细胞学反应对OS有显著影响，但部分缓解的风险比反常地高于“无反应”组。
脑室内化疗后CSF中其他细胞计数的减少与LMC患者的OS较差相关。我们建议需要更具特异性的癌细胞来源的CSF生物标志物。
