Relationship between DLK-1 levels in blood serum and survival of patients with glioblastoma

Several studies have shown that the increased expression of delta–like noncanonical Notch ligand 1 (DLK-1) is associated with more aggressive tumor characteristics in patients with glioblastoma. The aim of the study was to estimate the diagnostic and prognostic values of DLK-1 serum levels in glioblastoma patients. Material and Methods. The study included 39 patients with newly diagnosed glioblastoma. The DLK-1 level was evaluated in paired serum and cerebrospinal fluid samples in glioblastoma patients before starting chemoradiotherapy (CRT). All patients with glioblastoma received combined modality treatment. The DLK-1 level in blood serum was additionally assessed during follow-up visits. Results. The median levels of DLK-1 in paired CSF and serum samples before CRT were 1.17 ng/ml (95 % CI 0.78; 2.89) and 0.27 ng/ml (95 % CI 0.26; 0.29), respectively (p=0.006). The assessment of the DLK-1 serum level in glioblastoma patients didn’t show any significant differences related to the response to therapy. In patients with tumor progression after CRT, the median serum DLK-1 level before CRT was 0.43 ng/ml, and in patients with stable disease, the median serum level was 1.7 ng/ml (p=0.012). The DLK-1 serum levels were 1.60 ng/ml and 0.32 ng/ml in patients with favorable prognosis for progression–free survival and in patients with unfavorable prognosis, respectively (p=0.005). The median concentrations of DLK-1 in serum before starting CRT were 1.01 ng/ml and 0.32 ng/ml in patients with favorable prognosis of overall survival and in patients with unfavorable prognosis, respectively (p=0.04). The DLK-1 levels in 4 weeks after CRT were 1.53 ng/ml and 0.23 ng/ml in patients with favorable prognosis of overall survival and in patients with the unfavorable prognosis, respectively (p=0.04). Conclusion. The DLK-1 serum level in patients with glioblastoma cannot be used to diagnose disease progression. However, this marker is a prognostic factor for overall and progression-free survival, and allows identification of patients with favorable and unfavorable prognosis.

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