Cystatin C - A Fast and Reliable Biomarker for Glomerular Filtration Rate in Head and Neck Cancer Patients

Edwin Boelke*, Gisela Schieren, Stephan Gripp, Gerald Steinbach, Matthias Peiper, Klaus Orth, Christiane Matuschek, Maximilian Pelzer, Guido Lammering, Ruud Houben, Christina Antke, Lars Christian Rump, Rodrigo Mota, Peter Arne Gerber, Patrick Schuler, Thomas K. Hoffmann, Ethelyn Rusnak, Derik Hermsen, Wilfried Budach

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Determination of renal function is a prerequisite for planning therapy in cancer patients. Limitations of creatinine as marker for the glomerular filtration rate (GFR) led to the proposal of cystatin C as a more accurate biomarker especially in mild renal insufficiency or in patients with low muscle mass. We compared the accuracy of cystatin C- and creatinine-based equations to estimate GFR in head and neck cancer (HNC) patients receiving platinum-based radiochemotherapy.The study population consisted of 52 HNC patients (GFR range, 37-105 mL/min/1.73 m(2) complemented by 17 patients with known renal insufficiency (GFR range, 10-60 mL/min/1.73 m(2)). Intraclass correlation coefficients were calculated between the reference method (51)Cr-EDTA clearance and estimated GFR by creatinine clearance and equations based on creatinine (Cockroft-Gault, modification of diet in renal disease (MDRD), Wright) or cystatin C (Larsson, Dade-Behring, Hoek). In addition, sensitivity and specificity to discriminate GFR > 60 mL/min/1.73 m(2) were evaluated by receiver operating characteristic curve (ROC).The highest correlation coefficients were found for the cystatin C-based estimates in comparison with creatinine-based estimates or creatinine clearance, even though Bland-Altman plots revealed GFR overestimation for all equations tested. The cystatin C-based Hoek formula exhibited the highest overall precision and accuracy. GFR of <60 mL/min/1.73 m(2) was assumed as a cut-off for chemotherapy. ROC analyses revealed the highest AUC to predict a GFR > 60 mL/min/1.73 m(2) for the creatinine-based Wright formula, closely followed by the MDRD formula and cystatin C-based equations of Larsson, Dade-Behring, and Hoek.Cystatin C-based GFR estimates showed the overall strongest correlation to the reference method. Thus, we recommend cystatin C for GFR estimation in HNC patients as an alternative method to the estimated creatinine clearance in clinical practice.
Original languageEnglish
Pages (from-to)191-201
JournalStrahlentherapie Und onkologie
Issue number3
Publication statusPublished - Mar 2011


  • Glomerular filtration rate
  • Cystatin C
  • Estimated creatinine clearance

Cite this