Kersten M J, Evers L M, Dellemijn P L, van den Berg H, Portegies P, Hintzen R Q, van Lier R A, von dem Borne A E, van Oers R H
Department of Hematology and Neurology, Academic Medical Centre, Amsterdam, The Netherlands.
Blood. 1996 Mar 1;87(5):1985-9.
Diagnosis of meningeal localization of lymphoid malignancies by means of cytologic examination of the cerebrospinal fluid (CSF) can be difficult. Thus far no reliable CSF tumor markers have been identified. CD27 is a transmembrane disulfide-linked 55-kD homodimer present on most peripheral blood T cells and on a subset of B cells. CD27 is also expressed on human malignant B cells and high levels of soluble CD27 can be present in the serum of patients with B-cell malignancies. The aim of this study is to determine prospectively the diagnostic value of CSF sCD27 as a tumor marker in patients with meningeal localization of lymphoid malignancies. CSF sCD27 levels were determined by sandwich enzyme-linked immunosorbent assay. The optimal cut-off value using receiver operator characteristics curves was found to be 10 U/mL. sCD27 levels were normal in all 50 control patients (lumbar disc protrusion) and in 39 of 40 samples obtained from patients with either solid tumors or acute myeloid leukemia. Of 104 CSF samples from 70 children with acute lymphoblastic leukemia (ALL) or non-Hodgkin's lymphoma (NHL) undergoing routine central nervous system (CNS) staging, sCD27 was false positive and false negative in only one sample each. In 70 samples from 45 patients suspected of meningeal localization of ALL or NHL, the sCD27 test had an excellent sensitivity (100%) and specificity (82%). In 7 patients with positive CSF studied longitudinally, sCD27 levels correlated very well with remission and relapse. sCD27 levels were not nonspecifically increased by the administration of cytostatic drugs. Finally, sCD27 was also elevated in the 4 patients studied with primary central nervous system lymphoma (PCNSL). CSF sCD27 is a promising tumor marker in patients with either meningeal localization of lymphoid malignancies or PCNSL, and can be useful in the differential diagnosis of CNS involvement by either lymphoid malignancies or solid tumors.
通过脑脊液（CSF）细胞学检查诊断淋巴系统恶性肿瘤的脑膜转移可能存在困难。迄今为止，尚未发现可靠的脑脊液肿瘤标志物。CD27是一种跨膜二硫键连接的55-kD同源二聚体，存在于大多数外周血T细胞和一部分B细胞上。CD27也在人类恶性B细胞上表达，B细胞恶性肿瘤患者血清中可出现高水平的可溶性CD27（sCD27）。本研究旨在前瞻性地确定脑脊液sCD27作为淋巴系统恶性肿瘤脑膜转移患者肿瘤标志物的诊断价值。采用夹心酶联免疫吸附测定法测定脑脊液sCD27水平。利用受试者工作特征曲线确定的最佳截断值为10 U/mL。50例对照患者（腰椎间盘突出症）以及40例实体瘤或急性髓系白血病患者样本中的39例，其sCD27水平均正常。在70例接受常规中枢神经系统（CNS）分期的急性淋巴细胞白血病（ALL）或非霍奇金淋巴瘤（NHL）患儿的104份脑脊液样本中，sCD27仅在各1份样本中出现假阳性和假阴性。在45例疑似ALL或NHL脑膜转移患者的70份样本中，sCD27检测具有出色的敏感性（100%）和特异性（82%）。在7例纵向研究的脑脊液阳性患者中，sCD27水平与缓解和复发情况高度相关。细胞毒性药物的使用并未非特异性地升高sCD27水平。最后，在4例原发性中枢神经系统淋巴瘤（PCNSL）患者的研究中，sCD27水平也升高。脑脊液sCD27对于淋巴系统恶性肿瘤脑膜转移或PCNSL患者是一种有前景的肿瘤标志物，可用于鉴别淋巴系统恶性肿瘤或实体瘤累及中枢神经系统。
