Pretreatment serum lactate level as a prognostic biomarker in patients undergoing supratentorial primary brain tumor resection

Abstract

IntroductionMalignant 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.MethodsA 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.ResultsPatients 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).ConclusionsAn 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.

Factors affecting serum lactate in patients with intracranial tumors – A report of our series and review of the literature

“…[5] Nonetheless, other authors found a significant higher baseline serum lactate in high-grade gliomas compared with low-grade gliomas. [1,9,14] Moreover, patients with intracranial metastases showed higher preoperative serum lactate compared with meningioma and pituitary tumors in another series. [1] Our results confirm the findings of the literature that GBM malignant phenotype contributes to higher serum lactate levels regardless the possible influence of other factors.…”

“…e research was conducted up to April 2019 and yielded 215 studies. e articles [1][2][3]5,9,14] in which the correlation between the level of serum lactate and intracranial tumors was studied are reported in Table 4. In an initial series of 18 patients submitted to craniotomy for intracranial tumor, the authors found an increase of serum lactate during surgery regardless to the diagnosis.…”

“…is is an important topic to address in future although the previous studies failed to demonstrate a correlation between increased serum lactate and patient's prognosis. [2,3,14]…”

“…28-meningioma 37-pituitary 17-metastasis 39-other (non-glial cell tumors) Shih et al, 2017 [14] 74 20-HGG 54-LGG Cata et al, 2017 [2] 275 275-GBM de Smalen et al, 2019 [3] 496…”

The immunological Warburg effect: Can a metabolic‐tumor‐stroma score (MeTS) guide cancer immunotherapy?

“…13,14 Accordingly, lactate levels have been suggested as a prognostic biomarker in high-grade primary brain tumors and metastatic lung cancer where elevated pretreatment serum lactate levels were associated with worse progression free survival. 15,16 Bringing an additional layer of complexity, in the "Reverse Warburg…”