KEY TAKEAWAYS
- The study aimed to investigate the prognostic value of CSF-TC density in patients with LMD from solid tumors.
- Researchers noticed that integrating CSF-TC density into risk-stratification holds promise for guiding more informed and personalized treatment decisions.
In managing leptomeningeal disease (LMD) in brain cancer, treatment decisions hinge on patient risk stratification due to the absence of objective prognostic tools. While rare cell capture technology, like the CNSide assay, enhances cerebrospinal fluid tumor cell (CSF-TC) identification sensitivity, its prognostic utility remains uncertain.
Andrew B. Barbour and his team aimed to assess the prognostic significance of CSF-TC density in patients diagnosed with LMD from solid tumors.
They performed an inclusive analysis through a retrospective cohort study, encompassing patients with newly diagnosed or previously treated LMD from a single institution. Utilizing CNSide assay testing for CSF-TCs conducted between 2020 and 2023, univariable and multivariable survival analyses were carried out employing Cox proportional-hazards modeling. The determination of an optimal cutpoint for CSF-TC density and survival was achieved using maximally-selected rank statistics.
About 29 out of 31 patients tested positive for CSF-TCs on CNSide, with a median IQR CSF-TC density of 67.8 (4.7–639) TCs/mL. Positive CSF cytology was observed in 16 out of the 29 patients with positive CNSide results, indicating a diagnostic sensitivity of 93.5% and a negative predictive value of 85.7%. The median IQR survival from the time of CSF-TC detection was 176 (89–481) days.
Both univariable and multivariable analyses revealed a significant association between CSF-TC density and survival. An optimal cutpoint for dichotomizing survival based on CSF-TC density was determined to be 19.34 TCs/mL. The time-dependent sensitivity and specificity for survival using this stratification were 76% and 67% at 6 months and 65% and 67% at 1 year, respectively.
The study concluded that the prognostic value of CSF-TC density in patients with LMD from solid tumors supports its potential integration into risk stratification strategies. This could offer valuable insights to guide more informed and personalized treatment decisions for individuals with LMD. Funding was not applicable.
Source: https://link.springer.com/article/10.1007/s11060-024-04615-4#Abs1
Barbour, A.B., Blouw, B., Taylor, L.P. et al. (2024). “Prognostic value of cerebrospinal fluid tumor cell count in leptomeningeal disease from solid tumors.’’ J Neurooncol. https://doi.org/10.1007/s11060-024-04615-4.
