Pretreatment serum lactate level as a prognostic biomarker in patients undergoing supratentorial primary brain tumor resection
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Chung-Chih Shih1, Tzong-Shiun Lee1, Fon-Yih Tsuang2, Pei-Lin Lin1, Ya-Jung Cheng1, Hsiao-Liang Cheng1,* and Chun-Yu Wu1,*
1Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
2Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
*These authors have contributed equally to this work
Chun-Yu Wu, email: [email protected]
Hsiao-Liang Cheng, email: [email protected]
Keywords: lactate, brain tumor, tumor marker, prognostic factor, glioma
Received: March 09, 2017 Accepted: June 05, 2017 Published: June 29, 2017
Introduction: Malignant primary brain tumors are one of the most aggressive cancers. Pretreatment serum nonneuronal biomarkers closely associated with postoperative outcomes are of high clinical relevance. The present study aimed to identify potential pretreatment serum biomarkers that may influence oncological outcomes in patients with primary brain tumors.
Methods: A total of 74 patients undergoing supratentorial primary brain tumor resection were enrolled. Before tumor resection, serum neuronal biomarkers, namely neuron-specific enolase (NSE), S100β, and glial fibrillary acidic protein (GFAP), and serum nonneuronal biomarkers, namely neutrophil gelatinase-associated lipocalin (NGAL), lactate dehydrogenase (LDH), and lactate, were measured and associated postoperative oncological outcomes, including brain tumor grading, progression-free survival (PFS), and overall survival (OS), were compared.
Results: Patients with high-grade brain tumors had significantly higher pretreatment serum lactate levels (p = 0.011). By contrast, other biomarkers were comparable between patients with high-grade and low-grade brain tumors. Receiver operating characteristic curve analysis of serum lactate levels yielded an area under the curve of 0.71 for differentiating between high-grade and low-grade brain tumors. Kaplan–Meier survival analysis revealed patients with high serum lactate levels (≧2.0 mmol/L) had shorter PFS and OS (p = 0.021 and p = 0.093, respectively). In a multiple regression model, only elevated serum lactate levels were associated with poor PFS and OS (p = 0.021 and p = 0.048, respectively).
Conclusions: An elevated pretreatment serum lactate level is a prognostic biomarker of high-grade primary brain tumors and is significantly associated with poor PFS in patients with supratentorial brain tumors undergoing tumor resection. By contrast, other serum biomarkers are not significantly associated with oncological outcomes.
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