Glycine: a non-invasive imaging biomarker to aid magnetic resonance spectroscopy in the prediction of survival in paediatric brain tumours
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Ben Babourina-Brooks1,2, Sarah Kohe1,2, Simrandip K. Gill1,2, Lesley MacPherson2, Martin Wilson3, Nigel P. Davies4 and Andrew C. Peet1,2
1School of Cancer and Genomic Sciences, University of Birmingham, Birmingham UK
2Birmingham Children’s Hospital NHS foundation Trust, Birmingham, UK
3Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
4Medical Physics and Imaging, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Andrew C. Peet, email: [email protected]
Keywords: childhood brain tumours; glycine; survival; MRS; metabolism
Received: December 05, 2017 Accepted: February 25, 2018 Published: April 10, 2018
Paediatric brain tumours have a high mortality rate and are the most common solid tumour of childhood. Identification of high risk patients may allow for better treatment stratification. Magnetic Resonance Spectroscopy (MRS) provides a non-invasive measure of brain tumour metabolism and quantifies metabolite survival markers to aid in the clinical management of patients. Glycine can be identified using MRS and has been recently found to be important for cancer cell proliferation in tumours making it a valuable prognostic marker. The aims of this study were to investigate glycine and its added value to MRS as a prognostic marker for paediatric brain tumours in a clinical setting.
116 children with newly diagnosed brain tumours were examined with short echo-time MRS at the Birmingham Children’s Hospital and followed up for five years. Survival analysis was performed using Cox regression on the entire metabolite basis set with focus on glycine and three other established survival markers for comparison: n-acetylaspartate, scyllo-inositol and lipids at 1.3 ppm. Multivariate Cox regression was used in conjunction with risk values to establish if glycine added prognostic power when combined to the established survival markers.
Glycine was found to be a marker of poor prognosis in the cohort (p < 0.05) and correlated with tumour grade (p < 0.01). The addition of glycine improved the prognostic power of MRS compared to using the combination of established survival markers alone.
Tumour glycine was found to improve the MRS prediction of reduced survival in paediatric brain tumours aiding the non-invasive assessment of these children.
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