Choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios together with age assemble a significant Cox's proportional-hazards regression model for prediction of survival in high-grade gliomas.
OBJECTIVE
A long-lasting concern has prevailed for the identification of predictive biomarkers for high-grade gliomas (HGGs) using MRI. However, a consensus of which imaging parameters assemble a significant survival model is still missing in the literature; we investigated the significant positive or negative contribution of several MR biomarkers in this tumour prognosis.


METHODS
A retrospective cohort of supratentorial HGGs [11 glioblastoma multiforme (GBM) and 17 anaplastic astrocytomas] included 28 patients (9 females and 19 males, respectively, with a mean age of 50.4 years, standard deviation: 16.28 years; range: 13-85 years). Oedema and viable tumour measurements were acquired using regions of interest in T1weighted, T2weighted, fluid-attenuated inversion recovery, apparent diffusion coefficient (ADC) and MR spectroscopy (MRS). We calculated Kaplan-Meier curves and obtained Cox's proportional hazards.


RESULTS
During the follow-up period (3-98 months), 17 deaths were recorded. The median survival time was 1.73 years (range, 0.287-8.947 years). Only 3 out of 20 covariates (choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios and age) showed significance in explaining the variability in the survival hazards model; score test: χ2(3) = 9.098, p = 0.028.


CONCLUSIONS
MRS metabolites overcome volumetric parameters of peritumoral oedema and viable tumour, as well as tumour region ADC measurements. Specific MRS ratios (Cho/Naa, L-L/Cr) might be considered in a regular follow-up for these tumours. Advances in knowledge: Cho/Naa ratio is the strongest survival predictor with a log-hazard function of 2.672 in GBM. Low levels of lipids-lactate/Cr ratio represent up to a 41.6% reduction in the risk of death in GBM.
1 Direccion de Investigacion, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico.
Ernesto
http://orcid.org/0000-0002-7116-5289
E
Roldan-Valadez
2 Department of Neurochemistry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Camilo
C
Rios
3 Oncology Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico.
Daniel
D
Motola-Kuba
3 Oncology Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico.
Juan
J
Matus-Santos
4 Division de Investigacion, Facultad de Medicina, UNAM, Mexico City, Mexico.
Antonio R
AR
Villa
5 Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Sergio
S
Moreno-Jimenez
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D015415:Biomarkers / Q000032:analysis*; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology*; D002794:Choline / Q000032:analysis; D003401:Creatine / Q000032:analysis; D005260:Female; D005910:Glioma / Q000401:mortality / Q000473:pathology*; D006801:Humans; D019344:Lactic Acid / Q000032:analysis; D008055:Lipids / Q000032:analysis; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate
D015415:Biomarkers; D008055:Lipids; D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline