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Diagnostic utility and correlation of tumor markers in the serum and cerebrospinal fluid of children with intracranial germ cell tumors

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Abstract

Purpose

In order to predict whether tumor markers assist in the histopathologic diagnosis of germ cell tumors (GCTs), we analyzed the correlation of beta human chorionic gonadotropin (βhCG) and alpha-fetoprotein (AFP) in serum and cerebrospinal fluid (CSF) samples at baseline and subsequent follow-up examinations.

Method

A retrospective study of patients diagnosed with intracranial GCTs between July 1985 and February 2011 at our institution was conducted to review clinical, surgical, radiological, laboratory, and histopathologic data.

Results

Of the 67 patients eligible for the study, 42 had germinomas and 25 non-germinomatous GCTs. At baseline, serum and CSF AFP agreed in 97.9 % of patients (Cohen’s Kappa 0.93). Baseline βhCG samples agreed in only 72.5 % of patients (Cohen’s Kappa 0.46). In most cases, values were higher in serum for AFP and in CSF for βhCG. ROC curves estimated from logistic regression model indicated that CSF and serum samples had almost equal diagnostic utility, and the DeLong test showed that the difference in area under curves was not statistically significant. During follow-up (185 paired CSF and serum values from 43 patients), 90.3 % of AFP values correlated between CSF and serum (Cohen’s Kappa 0.22, showing fair agreement). For βhCG, 96.2 % of values agreed in serum and CSF (Cohen’s Kappa 0.61).

Conclusions

In some patients, intracranial GCTs can be diagnosed based solely upon positive serum AFP values. In addition, marker values from serum only may be sufficient to predict tumor relapse at interval follow-up examinations.

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Acknowledgments

This work was supported in part by Cancer Center Support Grant CA21765 from the National Cancer Institute, The Noyes Brain Tumor Foundation, Musicians Against Childhood Cancer, and the American Lebanese Syrian Associated Charities. The authors would like to acknowledge Vani Shanker for the scientific editing of the manuscript and Julie Groff for support of the artwork.

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Authors and Affiliations

  1. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Ibrahim Qaddoumi, Karen Wright, Alberto Broniscer & Amar Gajjar

  2. Department of Pediatric Oncology Education Program, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Miheer Sane

  3. Cornell University, New York, NY, 10065, USA

    Miheer Sane

  4. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Shaoyu Li & Mehmet Kocak

  5. Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Atmaram Pai-Panandiker & Julie Harreld

  6. Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Paul Klimo

  7. St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA

    Ibrahim Qaddoumi

Authors
  1. Ibrahim Qaddoumi
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  2. Miheer Sane
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  3. Shaoyu Li
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  4. Mehmet Kocak
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  5. Atmaram Pai-Panandiker
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  6. Julie Harreld
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  7. Paul Klimo
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  8. Karen Wright
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  9. Alberto Broniscer
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  10. Amar Gajjar
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Corresponding author

Correspondence to Ibrahim Qaddoumi.

Additional information

Ibrahim Qaddoumi and Miheer Sane contributed equally to the study.

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Qaddoumi, I., Sane, M., Li, S. et al. Diagnostic utility and correlation of tumor markers in the serum and cerebrospinal fluid of children with intracranial germ cell tumors. Childs Nerv Syst 28, 1017–1024 (2012). https://doi.org/10.1007/s00381-012-1762-4

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  • DOI: https://doi.org/10.1007/s00381-012-1762-4

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