Diagnostic and prognostic significance of flow cytometry immunophenotyping in patients with leptomeningeal carcinomatosis
Diagnostic and prognostic significance of flow cytometry immunophenotyping in patients with leptomeningeal carcinomatosis
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DOI：
10.1007/s10585-015-9716-3
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发表时间：
2015-04-01
影响因子：
4
通讯作者：
Bruna, J.
中科院分区：
文献类型：
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作者：
Subira, D.;Simo, M.;Bruna, J.
一些患有上皮细胞癌的患者发展为软脑膜癌病（LC），这是一种难以诊断的严重并发症，预后不良。本研究旨在探讨流式细胞术免疫表型（FCI）在LC诊断和预后中的作用。使用FCI研究了诊断为LC的患者的脑脊液（CSF）样本。上皮细胞粘附分子（EpCAM）的表达是用于鉴定上皮细胞的标准。为了测试诊断的准确性，144例患者（94例诊断为LC）被纳入。在72例诊断为LC并符合治疗条件的患者中评估FCI的预后价值。与细胞学检查相比，FCI显示出更高的敏感性和阴性预测值（分别为79.79 vs. 50%; 68.85 vs. 51.55%），但特异性和阳性预测值较低（分别为84 vs. 100%; 90.36 vs. 100%）。多变量分析显示，CSF EpCAM+细胞的百分比预测死亡风险增加（HR：1.012，95% CI 1.000-1.023; p = 0.041）。CSF中8% EpCAM+细胞的截止值区分了两组患者，总生存期（OS）具有统计学显著差异（p = 0.018）。无论绝对CSF细胞计数如何，该临界值均保持其统计学显著性。CSF的FCI研究提高了诊断LC的敏感性，但需要改进该技术以提高特异性。此外，CSF EpCAM+细胞的定量显示是适合治疗的LC患者OS的独立预后因素。8%的临界值有助于预测治疗开始前的临床进展。
Some patients with epithelial-cell cancers develop leptomeningeal carcinomatosis (LC), a severe complication difficult to diagnose and with an adverse prognosis. This study explores the contribution of flow cytometry immunophenotyping (FCI) to the diagnosis and prognosis of LC. Cerebrospinal fluid (CSF) samples from patients diagnosed with LC were studied using FCI. Expression of the epithelial-cell adhesion molecule (EpCAM) was the criterion used to identify the epithelial cells. To test the diagnostic precision, 144 patients (94 diagnosed with LC) were included. The prognostic value of FCI was evaluated in 72 patients diagnosed with LC and eligible for therapy. Compared with cytology, FCI showed greater sensitivity and negative predictive value (79.79 vs. 50 %; 68.85 vs. 51.55 %, respectively), but lower specificity and positive predictive value (84 vs. 100 %; 90.36 vs. 100 %, respectively). The multivariate analysis revealed that the percentage of CSF EpCAM+ cells predicted an increased risk of death (HR: 1.012, 95 % CI 1.000-1.023; p = 0.041). A cut-off value of 8 % EpCAM+ cells in the CSF distinguished two groups of patients with statistically significant differences in overall survival (OS) (p = 0.018). This cut-off value kept its statistical significance regardless of the absolute CSF cell-count. The FCI study of the CSF improved the sensitivity for diagnosing LC, but refinement of the technique is needed to improve specificity. Furthermore, quantification of CSF EpCAM+ cells was revealed to be an independent prognostic factor for OS in patients with LC eligible for therapy. An 8 % cut-off value contributed to predicting clinical evolution before initiation of therapy.