3042 Originalarticle Chin Med J 2011;124(19):3042-3048 Increase of plasma IgE during treatment correlates with better outcome of patients with glioblastoma LIN Yi, JIN Qiang, ZHANG Guo-zhen, WANG Yun-jie, JIANG Tao, WU An-hua, WANG Jiang-fei and QIU Xiao-guang Keywords: immunoglobulin E; glioblastoma; plasma; prognosis G Background Previous studies have shown that glioma patients have lower blood IgE levels than controls. To evaluate its potential as a surrogate biomarker for glioma, we measured plasma IgE levels in glioma patients and healthy controls, and correlated them with clinicopathological factors and the patients’ outcome. Methods We used enzyme-linked immunosorbant assay (ELISA) to determine the plasma IgE levels of 25 normal subjects and 252 glioma patients (85 patients with grade II glioma, 46 patients with grade III glioma, and 121 patients with glioblastoma). We also collected longitudinal plasma samples from glioblastoma patients and compared the plasma IgE levels before operation, one week after operation, in the middle of radiotherapy, after two cycles of chemotherapy, and after recurrence. The correlations between plasma IgE levels and the outcomes of the patients were determined. Results Plasma IgE levels were significantly lower in glioma patients (P=0.004); patients with low-grade glioma have lower IgE levels than patients with high-grade glioma do (P=0.029). In 24 patients with both preoperative plasma and two-cycle chemotherapy plasma samples, IgE levels increased after successful removal of the tumor (P=0.021), and the increase correlated with the patients’ survival (increase >100 ng/ml vs. ≤100 ng/ml, 127.5 weeks vs. 62.3 weeks. P=0.012, log-rank). Plasma IgE level increase of >100 ng/ml has a specificity of 80% and a sensitivity of 78% to predict the patients’ long survival (>18 months). Conclusions Our results suggest that plasma IgE level correlates with clinical and pathological factors in glioma patients. It has the potential to be a biomarker for glioma patients. Chin Med J 2011;124(19):3042-3048 lioma accounts for about 50% of primary brain tumors. Despite surgical treatment, radiation, alkylating agent treatment and numerous recent therapeutic interventions, such as bevacizumab and targeted therapies, it remains one of the most lethal diseases. 1 According to the data from Health Ministry of China in 2004–2005, brain tumor is the seventh leading cause of cancer-related death in China. 2 As the most common and malignant form of brain tumor, glioblastoma has a median survival time of 12–15 months and a two-year survival rate of 5%–10%. 1 Currently, glioma management is limited by tumor diagnosis, prognosis and treatment assessment on imaging and tissue biopsy availability. Commonly used standard clinicopathologic prognostic factors such as age, tumor grade, Karnofsky Performance Status (KPS), and extent of tumor resection are often inaccurate for individual patients. Molecular markers such as combined chromosome 1p and 19q loss 3,4 or promoter methylation of the DNA repair gene O 6 -methylguanine-DNA methltransferase (MGMT) 5,6 rely on tumor tissues that are often unavailable. On the other hand, blood markers have the advantage of easy access, minimal invasiveness and can dynamically reflect the disease status, offer significant potential for neoplasm clinical management. Many such blood markers, such as prostate-specific antigen (PSA) in prostate cancer, 7 CA129 in ovarian cancer, 8 and alpha-fetoprotein in hapatic cancer, 9 have been widely used. However, in glioma, only a few studies have reported that factors in blood such as insulin-like growth factor binding protein 2 (IGFBP-2), 10 YKL-40, 11 glial fibrillar acidic protein (GFAP), 12 cathepsin D, 13 have been implicated for diagnosis and/or prognosis in glioma patients. The etiology and biology of glioma is probably multi-factorial. Ionizing radiation and dietary factors have been shown to correlate with higher risk of glioma. 14,15 Others have suggested recently that people with allergic conditions had a decreased risk of gliomas 16 and other DOI: 10.3760/cma.j.issn.0366-6999.2011.19.016 Department of Neurosurgery, First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China (Lin Y, Wang YJ and Wu AH) Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China (Jin Q, Zhang GZ, Jiang T, Wang JF and Qiu XG) Correspondence to: Dr. WANG Yun-jie, Department of Neurosurgery, First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China (Tel: 86-24-83283333. Fax: 86-24-83283306. Email: Wangyunjie024@vip.sina.com) LIN Yi and JIN Qiang contributed equally to this work. This study was supported by grants from the National High Technology Research and Development Program of China (No. 2007BAI05B08), the National Basic Research Program of China (No. 2010CB529406), and the National Natural Science Foundation of China (No. 81001124).