Changes of laboratory indices in serum and cerebrospinal fluid for children retinoblastoma before and after chemotherapy

Abstract

Objective To analyze the changes of laboratory indices in serum and cerebrospinal fluid(CSF)for children retinoblastoma(RB)before and after chemotherapy between central nervous system (CNS) metastasis group and extraocular stage group, and to conclude the clinical significance. Methods From September 2005 to December 2013, 11 cases were collected in Beijing Tongren Hospital who were diagnosed as CNS metastasis and were assorted into CNS metastasis group.According to age, gender and eye difference, 11 cases were chosen for the extraocular stage group.Twenty-two cases were given 6 cycles of chemotherapy.The chemotherapy protocol was Carboplatin + Teniposide + Vincristine(CTV) or Carboplatin + Etoposide + Vincristine(CEV). In each chemotherapy cycle all patients underwent lumbar puncture and intrathecal injection therapy.Serum levels of neuron specific enolase (NSE), serum lactate dehydrogenase (LDH) and CSF levels of NSE, quantitative protein and white blood cell count of the two groups were monitored before initiating chemotherapy and after the third and sixth cycles of chemotherapy.Multi factor variance analysis of the data was compared between the two groups in the dynamic changes of laboratory indices before and after chemotherapy using repeated measurements. Results The serum NSE levels of CNS metastasis group before initiating chemotherapy and after the 6th cycle of chemotherapy were (120.19±105.19) μg/L and (39.07±24.10) μg/L, respectively.The serum NSE levels of extraocular stage group before initiating chemotherapy and after the 6th cycle of chemotherapy were (29.03±11.94) μg/L and (21.03±5.01) μg/L, respectively.Serum NSE levels of the two groups showed significant changes before and after chemotherapy (F=7.115, P=0.000). Serum NSE level of CNS metastasis group was significantly higher than that of the extraocular stage group(F=41.500, P=0.007). Serum LDH levels of the two groups showed no statistically significant changes before and after chemotherapy (F=0.892, P=0.525). The CSF-NSE level of CNS metastasis group was significantly higher than that of extraocular stage group(F=15.706, P=0.001). CSF quantitative protein level of the CNS metastasis group was significantly higher than that of extraocular stage group(F=15.228, P=0.001). CSF white blood cell count of the CNS metastasis group were significantly higher than that of extraocular stage group(F=5.514, P=0.003). Conclusions Serum NSE level can be used as a laboratory indicator for monitoring CNS metastasis stage and extraocular stage of RB.The CSF-NSE values can be used as a diagnostic tool for CNS metastasis and monitoring of disease progression.CSF quantitative protein and white blood cell count can be used as auxiliary laboratory index for CNS metastasis diagnosis.Serum LDH cannot be used as a valuable laboratory index for diagnosis of CNS metastasis cases and extraocular cases. Key words: Retinoblastoma; Neuron specific enolase; Lactate dehydrogenase; Cerebrospinal fluid