Prognostic Value of Choline and Other Metabolites Measured Using (1)H-Magnetic Resonance Spectroscopy in Gliomas: A Meta-Analysis and Systemic Review

Glioma is the most prevalent primary central nervous system malignant tumor, with high heterogeneity observed among different grades; therefore, non-invasive prediction of prognosis could improve the clinical management of patients with glioma. (1)H-magnetic resonance spectroscopy (MRS) can estimate metabolite levels non-invasively. Multiple studies have investigated its prognostic value in gliomas; however, no consensus has been reached. PubMed and Embase databases were searched up to 20 October 2022 to identify studies investigating the prognostic value of metabolites using (1)H-MRS in patients with glioma. Heterogeneity across studies was evaluated using the Q and I(2) tests, and a fixed- or random-effects model was used to estimate the combined overall hazard ratio (HR). Funnel plots and Begg tests were used to assess publication bias. Higher choline levels were associated with shorter overall survival (HR = 2.69, 95% CI, 1.92–2.99; p < 0.001) and progression-free survival (HR = 2.20, 95% CI, 1.16–4.17; p = 0.02) in all patients; however, in pediatric gliomas, it showed no significant correlation with overall survival (HR = 1.60, 95% CI, 0.97–2.64; p = 0.06). The estimated choline level by (1)H-MRS could be used to non-invasively predict the prognosis of patients with adult gliomas, and more studies are needed to evaluate the prognostic value of other metabolites.