RESUMO
BACKGROUND@#Leptomeningeal metastasis (LM) is one of the most common causes of death in patients with advanced non-small cell lung cancer (NSCLC), which is defined as malignant cells spreading to meninges and cerebrospinal fluid (CSF). Therefore, early diagnosis and timely treatment are essential. CSF cytology is the gold standard for LM diagnosis, however, it has a low sensitivity for diagnosis and can't be used to evaluate the treatment effect. The aim of this study was to assess the clinical value of serum and CSF tumor markers (TM) in the diagnosis and treatment of NSCLC patients with LM.@*METHODS@#Nineteen patients with NSCLC-LM and 27 patients with nonmalignant neurological diseases (NMNDs) were included. We tested the levels and positive rates of carbohydrate antigen (CEA), carbohydrate antigen-125 (CA125), cytokeratin 19 fragments (CYFRA21-1) and neurone specific enolase (NSE) in CSF and serum, compared the sensitivity and specificity in the diagnosis of LM between different groups, and analyzed the correlation of detection between serum and CSF. Finally, we measured serum and CSF TM dynamically in 2 patients with NSCLC developing LM in an attempt to correlate these with the treatment response of extracranial and intracranial, respectively.@*RESULTS@#The levels and positive rates of TM in CSF and serum in LM group were higher than those in NMNDs (P0.05). In CSF, CYFRA21-1 has the highest sensitivity (88.2%) and CEA has the best specificity (92.3%) to distinguish patients between LM and NMNDs. For combined detection of CEA, CA125, CYFRA 21-1 and NSE in CSF, when at least CEA or NSE was positive in patients with LM, the sensitivity and negative predictive value were 100.0%, and the specificity was 74.1%. When both CYFRA21-1 and NSE were positive, the specificity and positive predictive value were 100.0%, and the sensitivity was 78.9%. Furthermore, subgroup analysis showed that the detection rates of TM in CSF cytology positive population was higher than that in typical abnormalities magnetic resonance imaging population, but there was no statistical difference (P>0.05). The detection of TM between serum and CSF in LM patients had no significant correlation. Moreover, biochemical properties of CSF from ventricle and lumbar puncture are similar, therefore evaluating the levels of TM in serum and CSF dynamically can be used to assess the extracranial and intracranial treatment effect, respectively.@*CONCLUSIONS@#Our study demonstrates that Serum and CSF TM can work as an auxiliary clinical diagnostic tool, which has a potential value in early diagnosis of NSCLC patients with LM. Serial measurement of TM may play an important role in the clinical management of NSCLC patients with LM, which is worthy of further promotion and clinical application.
RESUMO
Leptomeningeal metastasis (LM) is one of the most severe complications of non-small-cell lung cancer (NSCLC), and its incidence is increasing gradually with the progress of targeted therapies. There are currently no standard guidelines for the therapy of LM. Intrathecal chemotherapy is the mainstay of treatment for NSCLC patients with LM, but the optimal drug, administration route and mode, and dosage remain unclear. We report a case of LM from NSCLC, who received the intrathecal chemotherapy with pemetrexed by Ommaya reservoir after prior targeted therapies. This local treatment improved the quality of life, and obtained the clearing of CSF cytology and stable lesions of LM without any notable side effects. After confirmation of LM, the patient has survived 17 months until now. Here we report the first case to demonstrate the potential effectiveness of intrathecal pemetrexed by Ommaya reservoir for the treatment of LM of NSCLC, summarize the safety and effectiveness of intrathecal chemotherapy in combination with related literatures, and provide a new strategy for local treatment of LM in clinical. .
RESUMO
Objective:To observe the clinical characteristics of elderly patients with liver failure complicated with fungal infection,and to analyze the factors influencing the prognosis.Method:117 cases of elderly patients with liver failure,who were treated in our hospital from May 2013 to May 2015,were selected as object,according to whether combined with fungal infection,the patients were divided into Fungal infection group (57 cases) and non fungal infection group (60 cases).The differences of liver function index,treatment effective rate and mortality were observed between the two groups;To compare the prognosis of patients with different clinicopathological features,and to explore the factors influencing the prognosis of patients.Results:The scores of ALT,AST and DBIL in patients with fungal infection were significantly higher than those without fungal infection,and the difference was statistically significant (P＜0.05);The effective rate of the treatment group was significantly lower than that of the non fungal infection group,the mortality rate was higher than that of the non fungal infection group,the difference was statistically significant (P＜0.05);The death rate of patients with age was more than or equal to 70 years of age,with diabetes,with fungal infection were higher (P＜0.05);Logistic regression analysis showed that combined with diabetes mellitus,combined with fungal infection was an independent prognostic factor for elderly patients with liver failure (OR=2.982,4.817,P＜0.05).Conclusion:Liver function injury is severe in elderly patients with liver failure,the mortality rate is high,and fungal infection is more serious,and diabetes and fungal infection are risk factors for mortality.
