Cui Yong, Zeng Wei, Jiang Haihui, Ren Xiaohui, Lin Song, Fan Yanzhu, Liu Yapeng, Zhao Jizong
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China.
Front Neurol. 2020 Dec 4;11:592155. doi: 10.3389/fneur.2020.592155. eCollection 2020.
To explore the prognostic significance of metabolic parameters in postoperative peritumoral edema zone (PEZ) of patients with glioblastoma (GBM) based on proton magnetic resonance spectroscopy (MRS). The postoperative MRS data of 67 patients with GBM from Beijing Tiantan Hospital were retrospectively reviewed. Metabolite ratios including Cho/NAA, Cho/Cr, and NAA/Cr in both postoperative PEZ and contralateral normal brain region were recorded. Log-rank analysis and Cox regression model were used to identify parameters correlated with progression-free survival (PFS) and overall survival (OS). Compared with the contralateral normal brain region, postoperative PEZ showed a lower ratio of NAA/Cr (1.20 ± 0.42 vs. 1.81 ± 0.48, < 0.001), and higher ratios of Cho/Cr and Cho/NAA (1.36 ± 0.44 vs. 1.02 ± 0.27, < 0.001 and 1.32 ± 0.59 vs. 0.57 ± 0.14, < 0.001). Both the ratios of Cho/NAA and NAA/Cr were identified as prognostic factors in univariate analysis ( < 0.05), while only Cho/NAA ≥ 1.31 was further confirmed as an independent risk factor for early recurrence in the Cox regression model ( < 0.01). According to the factors of MGMT promoter unmethylation, without radiotherapy and Cho/NAA ≥ 1.31, a prognostic scoring scale for GBM was established, which could divide patients into low-risk, moderate-risk, and high-risk groups. There was a significant difference of survival rate between the three groups ( < 0.001). Higher Cho/NAA ratio in the postoperative PEZ of GBM predicts earlier recurrence and is associated with poor prognosis. The prognostic scoring scale based on clinical, molecular and metabolic parameters of patients with GBM can help doctors to make more precise prediction of survival time and to adjust therapeutic regimens.
基于质子磁共振波谱（MRS）探讨胶质母细胞瘤（GBM）患者术后瘤周水肿区（PEZ）代谢参数的预后意义。回顾性分析北京天坛医院67例GBM患者的术后MRS数据。记录术后PEZ及对侧正常脑区的代谢物比率，包括胆碱/ N-乙酰天门冬氨酸（Cho/NAA）、胆碱/肌酸（Cho/Cr）和N-乙酰天门冬氨酸/肌酸（NAA/Cr）。采用对数秩分析和Cox回归模型确定与无进展生存期（PFS）和总生存期（OS）相关的参数。与对侧正常脑区相比，术后PEZ的NAA/Cr比率较低（1.20±0.42 vs. 1.81±0.48，<0.001），Cho/Cr和Cho/NAA比率较高（1.36±0.44 vs. 1.02±0.27，<0.001；1.32±0.59 vs. 0.57±0.14，<0.001）。单因素分析中，Cho/NAA和NAA/Cr比率均被确定为预后因素（<0.05），而在Cox回归模型中，只有Cho/NAA≥1.31被进一步确认为早期复发的独立危险因素（<0.01）。根据O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）启动子未甲基化、未接受放疗和Cho/NAA≥1.31等因素，建立了GBM预后评分量表，可将患者分为低风险、中风险和高风险组。三组间生存率有显著差异（<0.001）。GBM术后PEZ中较高的Cho/NAA比率预示着更早复发，并与预后不良相关。基于GBM患者临床、分子和代谢参数的预后评分量表有助于医生更精确地预测生存时间并调整治疗方案。
