1
|
Quantitative Analysis of the MGMT Methylation Status of Glioblastomas in Light of the 2021 WHO Classification. Cancers (Basel) 2022; 14:cancers14133149. [PMID: 35804921 PMCID: PMC9264886 DOI: 10.3390/cancers14133149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Glioblastomas with methylation of the promoter region of the O(6)-methylguanine-DNA methyltransferase (MGMT) gene exhibit increased sensitivity to alkylating chemotherapy. Quantitative assessment of the MGMT promoter methylation status might provide additional prognostic information. The aim of our study was to determine a quantitative methylation threshold for better survival among patients with glioblastomas. Methods: We included consecutive patients ≥18 years treated at our department between 11/2010 and 08/2018 for a glioblastoma, IDH wildtype, undergoing quantitative MGMT promoter methylation analysis. The primary endpoint was overall survival. Results: A total of 321 patients were included. Median overall survival was 12.6 months. Kaplan−Meier and adjusted Cox regression analysis showed better survival for the groups with 16−30%, 31−60%, and 61−100% methylation. In contrast, survival in the group with 1−15% methylation was similar to those with unmethylated promoter regions. A secondary analysis confirmed this threshold. Conclusions: Better survival is observed in patients with glioblastomas with ≥16% methylation of the MGMT promoter region than with <16% methylation. Survival with tumors with 1−15% methylation is similar to with unmethylated tumors. Above 16% methylation, we found no additional benefit with increasing methylation.
Collapse
|
2
|
EGFR Amplification Is a Phenomenon of IDH Wildtype and TERT Mutated High-Grade Glioma: An Integrated Analysis Using Fluorescence In Situ Hybridization and DNA Methylome Profiling. Biomedicines 2022; 10:biomedicines10040794. [PMID: 35453544 PMCID: PMC9033057 DOI: 10.3390/biomedicines10040794] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/04/2023] Open
Abstract
Gliomas are the most common intrinsic brain tumors in adults, and in accordance with their clinical behavior and patients’ outcome, they are graded by the World Health Organization (WHO) classification of brain tumors. One very interesting candidate for targeted tumor therapy may be epidermal growth factor receptor (EGFR) amplification. Here, we performed an integrated comparative analysis of EGFR amplification in 34 glioma samples using standard fluorescence in situ hybridization (FISH) and Illumina EPIC Infinium Methylation Bead Chip and correlated results with molecular glioma hallmarks. We found that the EPIC analysis showed the same power of detecting EGFR amplification compared with FISH. EGFR amplification was detectable in high-grade gliomas (25%). Moreover, EGFR amplification was found to be present solely in IDH wildtype gliomas (26%) and TERT mutated gliomas (27%), occurring independently of MGMT promoter methylation status and being mutually exclusive with 1p/19q codeletion (LOH). In summary, EPIC Bead Chip analysis is a reliable tool for detecting EGFR amplification and is comparable with the standard method FISH. EGFR amplification is a phenomenon of IDH wildtype TERT mutated high-grade gliomas.
Collapse
|
3
|
Tesileanu CMS, Sanson M, Wick W, Brandes AA, Clement PM, Erridge SC, Vogelbaum MA, Nowak AK, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Rogers L, Taal W, Rudà R, Weller M, McBain C, van Linde ME, Aldape K, Jenkins RB, Kros JM, Wesseling P, von Deimling A, Hoogstrate Y, de Heer I, Atmodimedjo PN, Dubbink HJ, Brouwer RWW, van IJcken WFJ, Cheung KJ, Golfinopoulos V, Baumert BG, Gorlia T, French PJ, van den Bent MJ. Temozolomide and radiotherapy versus radiotherapy alone in patients with glioblastoma, IDH-wildtype: post-hoc analysis of the EORTC randomized phase 3 CATNON trial. Clin Cancer Res 2022; 28:2527-2535. [PMID: 35275197 DOI: 10.1158/1078-0432.ccr-21-4283] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/10/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE In a post-hoc analysis of the CATNON trial (NCT00626990), we explored whether adding temozolomide to radiotherapy improves outcome in patients with IDH1/2wt anaplastic astrocytomas with molecular features of glioblastoma (redesignated as glioblastoma, IDH-wildtype in the 2021 WHO classification of CNS tumors). EXPERIMENTAL DESIGN From the randomized phase 3 CATNON study examining the addition of adjuvant and concurrent temozolomide to radiotherapy in anaplastic astrocytomas, we selected a subgroup of IDH1/2wt and H3F3Awt tumors with presence of TERT promoter mutations and/or EGFR amplifications and/or combined gain of chromosome 7 and loss of chromosome 10. Molecular abnormalities including MGMT promoter methylation status were determined by next-generation sequencing, DNA methylation profiling, and SNaPshot analysis. RESULTS Of the 751 patients entered in the CATNON study, 670 had fully molecularly characterized tumors. 159 of these tumors met the WHO 2021 molecular criteria for glioblastoma, IDH-wildtype. Of these patients, 47 received radiotherapy only and 112 received a combination of radiotherapy and temozolomide. There was no added effect of temozolomide on either overall survival (HR 1.19, 95%CI 0.82-1.71) or progression-free survival (HR 0.87, 95%CI 0.61-1.24). MGMT promoter methylation was prognostic for overall survival, but was not predictive for outcome to temozolomide treatment either with respect to overall survival or progression-free survival. CONCLUSIONS In this cohort of patients with glioblastoma, IDH-wildtype temozolomide treatment did not add benefit beyond that observed from radiotherapy, regardless of MGMT promoter status. These findings require a new well-powered prospective clinical study to explore the efficacy of temozolomide treatment in this patient population.
Collapse
Affiliation(s)
- C Mircea S Tesileanu
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marc Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Paris Brain Institute - Institut du Cerveau (ICM), AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Wolfgang Wick
- Neurology Department, University of Heidelberg, and Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alba A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Paul M Clement
- Oncology Department, KU Leuven and General Medical Oncology Department, UZ Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Anna K Nowak
- Medical School, University of Western Australia, Crawley, Western Australia
- Medical Oncology Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia
- CoOperative Group for NeuroOncology, University of Sydney, New South Wales, Australia
| | - Jean-Francois Baurain
- Medical Oncology Department, King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Warren P Mason
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Helen Wheeler
- Northern Sydney Cancer Centre, University of Sydney, St Leonards, New South Wales, Australia
| | - Olivier L Chinot
- Aix-Marseille University, AP-HM, Neuro-Oncology division, Marseille, France
| | - Sanjeev Gill
- Medical Oncology Department, Alfred Hospital, Melbourne, Australia
| | - Matthew Griffin
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Leland Rogers
- Radiation Oncology Department, Gammawest Cancer Services, Salt Lake City, Utah
| | - Walter Taal
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Roberta Rudà
- Neuro-Oncology Department, City of Health and Science Hospital and University of Turin, Turin, Italy
| | - Michael Weller
- Neurology Department, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Catherine McBain
- Clinical Oncology Department, The Christie NHS FT, Manchester, United Kingdom
| | - Myra E van Linde
- Medical Oncology Department, Brain Tumor Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Kenneth Aldape
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Johan M Kros
- Pathology Department, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Pieter Wesseling
- Pathology Department, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Andreas von Deimling
- Neuropathology Department, Ruprecht-Karls-University, and CCU Neuropathology German Cancer Institute and Consortium, DKFZ, and DKTK, Heidelberg, Germany
| | - Youri Hoogstrate
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Iris de Heer
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Peggy N Atmodimedjo
- Pathology Department, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Hendrikus J Dubbink
- Pathology Department, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | | | | | - Brigitta G Baumert
- Radiation-Oncology Department (MAASTRO), Maastricht University Medical Center (MUMC) and GROW (School for Oncology), Maastricht, the Netherlands
- Institute of Radiation-Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - Pim J French
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martin J van den Bent
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| |
Collapse
|
4
|
Hölzl D, Hutarew G, Zellinger B, Schlicker HU, Schwartz C, Winkler PA, Sotlar K, Kraus TFJ. Integrated analysis of programmed cell death ligand 1 expression reveals increased levels in high-grade glioma. J Cancer Res Clin Oncol 2021; 147:2271-2280. [PMID: 33963441 PMCID: PMC8236471 DOI: 10.1007/s00432-021-03656-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 12/21/2022]
Abstract
Purpose Gliomas are the most frequent primary brain tumors of adults. Despite intensive research, there are still no targeted therapies available. Here, we performed an integrated analysis of glioma and programmed cell death ligand 1 (PD-L1) in 90 samples including 58 glioma and 32 control brain tissues. Methods To identify PD-L1 expression in glioma, we performed immunohistochemical analysis of PD-L1 tumor proportion score (TPS) using the clinically valid PD-L1 22C3 antibody on 90 samples including controls and WHO grade I–IV gliomas. Results We found that PD-L1 is highly expressed in a subfraction of glioma cells. Analysis of PD-L1 levels in different glioma subtypes revealed a strong intertumoral variation of PD-L1 protein. Furthermore, we correlated PD-L1 expression with molecular glioma hallmarks such as MGMT-promoter methylation, IDH1/2 mutations, TERT promoter mutations and LOH1p/19q. Conclusion In summary, we found that PD-L1 is highly expressed in a subfraction of glioma, indicating PD-L1 as a potential new marker in glioma assessment opening up novel therapeutic approaches.
Collapse
Affiliation(s)
- Dorothee Hölzl
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Georg Hutarew
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Barbara Zellinger
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Hans U Schlicker
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignatz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Peter A Winkler
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignatz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Theo F J Kraus
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| |
Collapse
|
5
|
Mikkelsen VE, Dai HY, Stensjøen AL, Berntsen EM, Salvesen Ø, Solheim O, Torp SH. MGMT Promoter Methylation Status Is Not Related to Histological or Radiological Features in IDH Wild-type Glioblastomas. J Neuropathol Exp Neurol 2021; 79:855-862. [PMID: 32688383 DOI: 10.1093/jnen/nlaa060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/25/2020] [Accepted: 06/03/2020] [Indexed: 11/15/2022] Open
Abstract
O6-methylguanine DNA methyltransferase (MGMT) promoter methylation is an important favorable predictive marker in patients with glioblastoma (GBM). We hypothesized that MGMT status could be a surrogate marker of pretreatment tumor biology observed as histopathological and radiological features. Apart from some radiological studies aiming to noninvasively predict the MGMT status, few studies have investigated relationships between MGMT status and phenotypical tumor biology. We have therefore aimed to investigate such relationships in 85 isocitrate dehydrogenase (IDH) wild-type GBMs. MGMT status was determined by methylation-specific PCR and was assessed for associations with 22 histopathological features, immunohistochemical proliferative index and microvessel density measurements, conventional magnetic resonance imaging characteristics, preoperative speed of tumor growth, and overall survival. None of the investigated histological or radiological features were significantly associated with MGMT status. Methylated MGMT status was a significant independent predictor of improved overall survival. In conclusion, our results suggest that MGMT status is not related to the pretreatment phenotypical biology in IDH wild-type GBMs. Furthermore, our findings suggest the survival benefit of MGMT methylated GBMs is not due to an inherently less aggressive tumor biology, and that conventional magnetic resonance imaging features cannot be used to noninvasively predict the MGMT status.
Collapse
Affiliation(s)
- Vilde Elisabeth Mikkelsen
- From the Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology
| | - Hong Yan Dai
- Department of Pathology, St Olav's University Hospital
| | - Anne Line Stensjøen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology
| | - Erik Magnus Berntsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology.,Department of Radiology and Nuclear Medicine, St. Olav's University Hospital
| | | | - Ole Solheim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology.,Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
| | - Sverre Helge Torp
- From the Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology.,Department of Pathology, St Olav's University Hospital
| |
Collapse
|
6
|
Xu W, Hu J, Liu W, Zhu Q, Gong X, Zhu P, Yang X, Xia R, Xue R. Remimazolan inhibits glioma cell growth and induces apoptosis through down-regulation of NF-κB pathway. IUBMB Life 2020; 73:341-348. [PMID: 33368968 DOI: 10.1002/iub.2433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022]
Abstract
Glioma alone accounts for 30% of various kinds of primary brain tumors and is the highest cause of mortality associated with intracranial malignant cancers. In the present study, Suzuki-coupling products of remimazolan were synthesized and investigated for anti-neoplastic property against glioma cells. RFMSP treatment for 48 hr suppressed viabilities of U-118MG and U87MG cells in dose dependent manner. Exposure of primary astrocytes to RFMSP at 2-20 μM concentration range minimally affected viabilities. RFMSP treatment at 5 μM doses raised apoptotic cell count to 53.8 ± 2.3% and 48.2 ± 1.8%, respectively in U-118MG and U87MG cells. Treatment of the cells with RFMSP induced nuclear condensation and subsequent fragmentation. In RFMSP treated U-118MG and U87MG cells, NF-κB p65 expression was markedly suppressed compared to the control cells. Additionally, RFMSP treatment decreased the ratio of nuclear to total NF-κB p65 level in both the cell lines. Treatment of U-118MG and U87MG cells with 5 μM RFMSP for 48 hr caused a marked down-regulation in survivin and XIAP levels. Treatment with RFMSP promoted Bax expression and suppressed Bcl-2 level. The caspase-9 and -3 activation was markedly induced by RFMSP treatment in U-118MG and U87MG cells compared to the control cells. In summary, the RFMSP synthesized by Suzuki-coupling of RFMSP inhibited glioma cell survival via DNA damage mediated apoptosis. The anti-glioma potential of RFMSP involved down-regulation of NF-κB expression, targeted survivin & XIAP levels and induced caspase activation in glioma cells. Therefore, RFMSP may be studied further as therapeutic agent for the treatment of glioma.
Collapse
Affiliation(s)
- Wei Xu
- Department of Anesthesiology, The First People's Hospital of Jingzhou, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Jiamei Hu
- Department of Obstetrics, The Third People's Hospital of Jingzhou, Jingzhou, Hubei, China
| | - Weiwei Liu
- Department of Anesthesiology, The First People's Hospital of Jingzhou, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Qiong Zhu
- Department of Anesthesiology, The First People's Hospital of Jingzhou, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Xuan Gong
- Department of Anesthesiology, The First People's Hospital of Jingzhou, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Pengpeng Zhu
- Department of Anesthesiology, The First People's Hospital of Jingzhou, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Xiao Yang
- Department of Anesthesiology, The First People's Hospital of Jingzhou, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Rui Xia
- Department of Anesthesiology, The First People's Hospital of Jingzhou, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Rui Xue
- Department of Anesthesiology, People's Hospital of Shiyan, People's Hospital affiliated to Hubei University of Medicine, Shiyan, Hubei, China
| |
Collapse
|
7
|
Mansouri A, Hachem LD, Mansouri S, Nassiri F, Laperriere NJ, Xia D, Lindeman NI, Wen PY, Chakravarti A, Mehta MP, Hegi ME, Stupp R, Aldape KD, Zadeh G. MGMT promoter methylation status testing to guide therapy for glioblastoma: refining the approach based on emerging evidence and current challenges. Neuro Oncol 2020; 21:167-178. [PMID: 30189035 DOI: 10.1093/neuonc/noy132] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/11/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor, with a universally poor prognosis. The emergence of molecular biomarkers has had a significant impact on histological typing and diagnosis, as well as predicting patient survival and response to treatment. The methylation status of the O6-methylguanine-DNA methyl-transferase (MGMT) gene promoter is one such molecular biomarker. Despite the strong evidence supporting the role of MGMT methylation status in prognostication, its routine implementation in clinical practice has been challenging. The methods and optimal cutoff definitions for MGMT status determination remain controversial. Variation in detection methods between laboratories presents a major challenge for consensus. Moreover, consideration of other clinical and genetic/epigenetic factors must also be incorporated into treatment decision making. In this review, we distill the available evidence to summarize our position on the optimal use of available assays, and propose strategies for resolving cases with equivocal methylation status and a framework for incorporating this important assay into research and clinical practice.
Collapse
Affiliation(s)
- Alireza Mansouri
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Laureen D Hachem
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sheila Mansouri
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Farshad Nassiri
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Normand J Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Daniel Xia
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Arnab Chakravarti
- Radiation Oncology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - Monika E Hegi
- Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Roger Stupp
- Malnati Brain Tumor Institute of the Lurie Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kenneth D Aldape
- Department of Laboratory Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Barsoum I, Tawedrous E, Faragalla H, Yousef GM. Histo-genomics: digital pathology at the forefront of precision medicine. ACTA ACUST UNITED AC 2020; 6:203-212. [PMID: 30827078 DOI: 10.1515/dx-2018-0064] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/28/2018] [Indexed: 12/26/2022]
Abstract
The toughest challenge OMICs face is that they provide extremely high molecular resolution but poor spatial information. Understanding the cellular/histological context of the overwhelming genetic data is critical for a full understanding of the clinical behavior of a malignant tumor. Digital pathology can add an extra layer of information to help visualize in a spatial and microenvironmental context the molecular information of cancer. Thus, histo-genomics provide a unique chance for data integration. In the era of a precision medicine, a four-dimensional (4D) (temporal/spatial) analysis of cancer aided by digital pathology can be a critical step to understand the evolution/progression of different cancers and consequently tailor individual treatment plans. For instance, the integration of molecular biomarkers expression into a three-dimensional (3D) image of a digitally scanned tumor can offer a better understanding of its subtype, behavior, host immune response and prognosis. Using advanced digital image analysis, a larger spectrum of parameters can be analyzed as potential predictors of clinical behavior. Correlation between morphological features and host immune response can be also performed with therapeutic implications. Radio-histomics, or the interface of radiological images and histology is another emerging exciting field which encompasses the integration of radiological imaging with digital pathological images, genomics, and clinical data to portray a more holistic approach to understating and treating disease. These advances in digital slide scanning are not without technical challenges, which will be addressed carefully in this review with quick peek at its future.
Collapse
Affiliation(s)
- Ivraym Barsoum
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Eriny Tawedrous
- Department of Laboratory Medicine, and the Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Hala Faragalla
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - George M Yousef
- Department of Laboratory Medicine, and the Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| |
Collapse
|
9
|
Glioblastoma with Both Oligodendroglioma and Primitive Neuroectodermal Tumor-Like Components in a Case with 9-Year Survival. Case Rep Surg 2018; 2018:1382680. [PMID: 29992076 PMCID: PMC6016224 DOI: 10.1155/2018/1382680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/23/2018] [Indexed: 01/25/2023] Open
Abstract
Introduction Glioblastoma multiforme (GBM), the most common primary malignant brain tumor in adults, is characterized by extensive heterogeneity in its clinicopathological presentation. A primary brain tumor with both astrocytic differentiation and neuronal immunophenotype features is rare. Here, we report a long-term survival patient who presented this rare form of GBM in the disease course. Presentation of Case A 23-year-old woman, presenting with rapidly progressive headache and right-side weakness, was diagnosed with brain tumor over the left basal ganglion. She underwent the first craniectomy for tumor removal, and histopathology revealed classic GBM. Tumor recurrence occurred 8 years later. Another gross total resection was performed and pathology revealed GBM with the oligodendroglioma component (GBM-O). Due to disease progression, she received debulking surgery the following year. The third pathology revealed glioblastoma with primitive neuroectodermal tumor-like component (GBM-PNET). Discussion GBM-PNETs are collision tumors with both neuronal and glial components. They are rare, and a few case reports have suggested that these tumors are associated with favorable outcomes but a higher risk of cerebrospinal fluid dissemination. Conclusion We report a patient who developed the distinct pathologic variants of classic GBM, GBM-O, and GBM-PNET, throughout the disease course. Young age, aggressive surgical resection, and pathologic and genetic features may have contributed to the long-term survival of the patient.
Collapse
|
10
|
Stupp R, Taillibert S, Kanner A, Read W, Steinberg DM, Lhermitte B, Toms S, Idbaih A, Ahluwalia MS, Fink K, Di Meco F, Lieberman F, Zhu JJ, Stragliotto G, Tran DD, Brem S, Hottinger AF, Kirson ED, Lavy-Shahaf G, Weinberg U, Kim CY, Paek SH, Nicholas G, Burna J, Hirte H, Weller M, Palti Y, Hegi ME, Ram Z. Effect of Tumor-Treating Fields Plus Maintenance Temozolomide vs Maintenance Temozolomide Alone on Survival in Patients With Glioblastoma: A Randomized Clinical Trial. JAMA 2017; 318:2306-2316. [PMID: 29260225 PMCID: PMC5820703 DOI: 10.1001/jama.2017.18718] [Citation(s) in RCA: 1485] [Impact Index Per Article: 212.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Tumor-treating fields (TTFields) is an antimitotic treatment modality that interferes with glioblastoma cell division and organelle assembly by delivering low-intensity alternating electric fields to the tumor. OBJECTIVE To investigate whether TTFields improves progression-free and overall survival of patients with glioblastoma, a fatal disease that commonly recurs at the initial tumor site or in the central nervous system. DESIGN, SETTING, AND PARTICIPANTS In this randomized, open-label trial, 695 patients with glioblastoma whose tumor was resected or biopsied and had completed concomitant radiochemotherapy (median time from diagnosis to randomization, 3.8 months) were enrolled at 83 centers (July 2009-2014) and followed up through December 2016. A preliminary report from this trial was published in 2015; this report describes the final analysis. INTERVENTIONS Patients were randomized 2:1 to TTFields plus maintenance temozolomide chemotherapy (n = 466) or temozolomide alone (n = 229). The TTFields, consisting of low-intensity, 200 kHz frequency, alternating electric fields, was delivered (≥ 18 hours/d) via 4 transducer arrays on the shaved scalp and connected to a portable device. Temozolomide was administered to both groups (150-200 mg/m2) for 5 days per 28-day cycle (6-12 cycles). MAIN OUTCOMES AND MEASURES Progression-free survival (tested at α = .046). The secondary end point was overall survival (tested hierarchically at α = .048). Analyses were performed for the intent-to-treat population. Adverse events were compared by group. RESULTS Of the 695 randomized patients (median age, 56 years; IQR, 48-63; 473 men [68%]), 637 (92%) completed the trial. Median progression-free survival from randomization was 6.7 months in the TTFields-temozolomide group and 4.0 months in the temozolomide-alone group (HR, 0.63; 95% CI, 0.52-0.76; P < .001). Median overall survival was 20.9 months in the TTFields-temozolomide group vs 16.0 months in the temozolomide-alone group (HR, 0.63; 95% CI, 0.53-0.76; P < .001). Systemic adverse event frequency was 48% in the TTFields-temozolomide group and 44% in the temozolomide-alone group. Mild to moderate skin toxicity underneath the transducer arrays occurred in 52% of patients who received TTFields-temozolomide vs no patients who received temozolomide alone. CONCLUSIONS AND RELEVANCE In the final analysis of this randomized clinical trial of patients with glioblastoma who had received standard radiochemotherapy, the addition of TTFields to maintenance temozolomide chemotherapy vs maintenance temozolomide alone, resulted in statistically significant improvement in progression-free survival and overall survival. These results are consistent with the previous interim analysis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00916409.
Collapse
Affiliation(s)
- Roger Stupp
- Lou and Jean MalnatiBrain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sophie Taillibert
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | | | - William Read
- University of California, San Diego
- Emory University, Atlanta, Georgia
| | | | - Benoit Lhermitte
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Steven Toms
- Geisinger Health System, Danville, Pennsylvania
| | - Ahmed Idbaih
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | | | - Karen Fink
- Baylor University Medical Center, Houston, Texas
| | | | - Frank Lieberman
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jay-Jiguang Zhu
- University of Texas Health Sciences Center at Houston
- Tufts Medical Center, Boston, Massachusetts
| | | | - David D. Tran
- Washington University Barnes-Jewish Hospital, St Louis, Missouri
| | - Steven Brem
- Moffitt Cancer Center, Tampa, Florida
- University of Pennsylvania, Philadelphia
| | - Andreas F. Hottinger
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Chae-Yong Kim
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, Korea
| | | | - Garth Nicholas
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jordi Burna
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Hal Hirte
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Michael Weller
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Monika E. Hegi
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Zvi Ram
- Tel Aviv Medical Center, Tel Aviv, Israel
| |
Collapse
|
11
|
Roh TH, Park HH, Kang SG, Moon JH, Kim EH, Hong CK, Ahn SS, Choi HJ, Cho J, Kim SH, Lee SK, Kim DS, Kim SH, Suh CO, Lee KS, Chang JH. Long-term outcomes of concomitant chemoradiotherapy with temozolomide for newly diagnosed glioblastoma patients: A single-center analysis. Medicine (Baltimore) 2017; 96:e7422. [PMID: 28682902 PMCID: PMC5502175 DOI: 10.1097/md.0000000000007422] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present study analyzed outcomes of surgery followed by concomitant chemoradiotherapy (CCRT) with temozolomide (TMZ) in patients with newly diagnosed glioblastoma (GBM) at a single institution. Outcomes were retrospectively reviewed in 252 consecutive patients with newly diagnosed GBM who underwent surgery followed by CCRT with TMZ at the authors' institution between 2005 and 2013. At initial operation, 126 (50.0%), 55 (21.8%), 45 (17.9%), and 26 (10.3%) patients underwent gross total resection (GTR), subtotal resection, partial resection (PR), and biopsy, respectively. Their median overall survival (OS) was 20.8 months (95% confidence interval [CI] 17.7-23.9 months) and their median progression-free survival was 12.7 months (95% CI 11.2-14.2 months). The O-methylguanine-DNA methyltransferase (MGMT) promoter was methylated in 78 (34.1%) of the 229 patients assayed, and an isocitrate dehydrogenase 1 mutation was detected in 7 (6.6%) of the 106 patients analyzed. Univariate analyses showed that patient age, involvement of eloquent areas, involvement of the subventricular zone, presence of leptomeningeal seeding, Karnofsky Performance Status, extent of resection (EOR), MGMT promoter methylation, and presence of an oligodendroglioma component were prognostic of OS. Multivariate analysis showed that age, involvement of eloquent areas, presence of leptomeningeal seeding, EOR, and MGMT promoter methylation were significantly predictive of survival. OS in patients with GBM who undergo surgery followed by CCRT with TMZ is enhanced by complete resection. Other factors significantly prognostic of OS include that age, involvement of eloquent areas, presence of leptomeningeal seeding, and MGMT promoter methylation.
Collapse
Affiliation(s)
- Tae Hoon Roh
- Yonsei University Graduate School, Seoul
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Hun Ho Park
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Seok-Gu Kang
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Eui Hyun Kim
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Sung Soo Ahn
- Department of Radiology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Hye Jin Choi
- Department of Medical Oncology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Jaeho Cho
- Department of Radiation Oncology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Seung Koo Lee
- Department of Radiology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Dong Seok Kim
- Department of Neurosurgery
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Ho Kim
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Kyu Sung Lee
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| |
Collapse
|
12
|
Contribution of the Microenvironmental Niche to Glioblastoma Heterogeneity. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28630875 PMCID: PMC5467280 DOI: 10.1155/2017/9634172] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Glioblastoma is the most aggressive cancer of the brain. The dismal prognosis is largely attributed to the heterogeneous nature of the tumor, which in addition to intrinsic molecular and genetic changes is also influenced by the microenvironmental niche in which the glioma cells reside. The cancer stem cells (CSCs) hypothesis suggests that all cancers arise from CSCs that possess the ability to self-renew and initiate tumor formation. CSCs reside in specialized niches where interaction with the microenvironment regulates their stem cell behavior. The reciprocal interaction between glioma stem cells (GSCs) and cells from the microenvironment, such as endothelial cells, immune cells, and other parenchymal cells, may also promote angiogenesis, invasion, proliferation, and stemness of the GSCs and be likely to have an underappreciated role in their responsiveness to therapy. This crosstalk may also promote molecular transition of GSCs. Hence the inherent plasticity of GSCs can be seen as an adaptive response, changing according to the signaling cue from the niche. Given the association of GSCs with tumor recurrence and treatment sensitivity, understanding this bidirectional crosstalk between GSCs and its niche may provide a framework to identify more effective therapeutic targets and improve treatment outcome.
Collapse
|
13
|
Banan R, Hartmann C. The new WHO 2016 classification of brain tumors-what neurosurgeons need to know. Acta Neurochir (Wien) 2017; 159:403-418. [PMID: 28093610 DOI: 10.1007/s00701-016-3062-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The understanding of molecular alterations of tumors has severely changed the concept of classification in all fields of pathology. The availability of high-throughput technologies such as next-generation sequencing allows for a much more precise definition of tumor entities. Also in the field of brain tumors a dramatic increase of knowledge has occurred over the last years partially calling into question the purely morphologically based concepts that were used as exclusive defining criteria in the WHO 2007 classification. METHODS Review of the WHO 2016 classification of brain tumors as well as a search and review of publications in the literature relevant for brain tumor classification from 2007 up to now. RESULTS The idea of incorporating the molecular features in classifying tumors of the central nervous system led the authors of the new WHO 2016 classification to encounter inevitable conceptual problems, particularly with respect to linking morphology to molecular alterations. As a solution they introduced the concept of a "layered diagnosis" to the classification of brain tumors that still allows at a lower level a purely morphologically based diagnosis while partially forcing the incorporation of molecular characteristics for an "integrated diagnosis" at the highest diagnostic level. In this context the broad availability of molecular assays was debated. On the one hand molecular antibodies specifically targeting mutated proteins should be available in nearly all neuropathological laboratories. On the other hand, different high-throughput assays are accessible only in few first-world neuropathological institutions. As examples oligodendrogliomas are now primarily defined by molecular characteristics since the required assays are generally established, whereas molecular grouping of ependymomas, found to clearly outperform morphologically based tumor interpretation, was rejected from inclusion in the WHO 2016 classification because the required assays are currently only established in a small number of institutions. CONCLUSION In summary, while neuropathologists have now encountered various challenges in the transitional phase from the previous WHO 2007 version to the new WHO 2016 classification of brain tumors, clinical neurooncologists now face many new diagnoses allowing a clearly improved understanding that could offer them more effective therapeutic opportunities in neurooncological treatment. The new WHO 2016 classification presumably presents the highest number of modifications since the initial WHO classification of 1979 and thereby forces all professionals in the field of neurooncology to intensively understand the new concepts. This review article aims to present the basic concepts of the new WHO 2016 brain tumor classification for neurosurgeons with a focus on neurooncology.
Collapse
|
14
|
|
15
|
Wefel JS, Noll KR, Rao G, Cahill DP. Neurocognitive function varies by IDH1 genetic mutation status in patients with malignant glioma prior to surgical resection. Neuro Oncol 2016; 18:1656-1663. [PMID: 27576872 DOI: 10.1093/neuonc/now165] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/12/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with malignant gliomas present with variation in neurocognitive function (NCF) not attributable to lesion size or location alone. A potential contributor is the rate at which tumors grow, or "lesion momentum." Isocitrate dehydrogenase 1 wild type (IDH1-WT) are more proliferative and aggressive than IDH1-mutant (IDH1-M) tumors. We hypothesized that patients with IDH1-WT would exhibit worse NCF than patients with IDH1-M tumors. METHODS Comprehensive NCF testing was completed in 119 patients with malignant glioma prior to surgical resection. IDH1 status was determined with immunohistochemistry and sequencing. Rates of impairment and mean test performances were compared by IDH1. RESULTS NCF impairment was significantly more frequent in patients with IDH1-WT tumors in memory, processing speed, visuoconstruction, language, executive functioning, and manual dexterity. Mean performances of patients with IDH1-WT were also significantly lower than those with IDH1-M tumors on measures of learning and memory, processing speed, language, executive functioning, and dexterity. Lesion volume was not statistically different between IDH1-WT and IDH1-M tumors. Tumor and lesion volume on T1-weighted and fluid attenuated inversion recovery MRI were significantly associated with most NCF tests in patients with IDH1-WT, but only significantly associated with a single measure in patients with IDH1-M tumors. CONCLUSION Patients with IDH1-WT show reduced NCF compared with those with IDH1-M malignant gliomas. Lesion volume is inversely associated with NCF for patients with IDH1-WT, but not IDH1-M tumors. These findings are consistent with the hypothesis that patients with IDH1-WT tumors present with more severe NCF impairment due to greater lesion momentum, which may impede compensatory neuroplasticity and cerebral reorganization.
Collapse
Affiliation(s)
- Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S.W., K.R.N); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (G.R.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (D.P.C.)
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S.W., K.R.N); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (G.R.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (D.P.C.)
| | - Ganesh Rao
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S.W., K.R.N); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (G.R.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (D.P.C.)
| | - Daniel P Cahill
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.S.W., K.R.N); Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (G.R.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (D.P.C.)
| |
Collapse
|
16
|
White A, Fabian V, McDonald K, Nowak AK. Compliance with reporting guidelines by Australian pathologists: an audit of the quality of histopathology reporting in high-grade glioma. Neurooncol Pract 2016; 3:97-104. [PMID: 31386085 PMCID: PMC6668263 DOI: 10.1093/nop/npv033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diagnostic pathology reports inform management plans for patients with glioma, and there is an increasing clinical need for molecular testing. We assessed the quality of histopathology reports of grade III/IV gliomas. METHODS Reports were obtained as part of a tumor biobank. From 720 pathology reports, 594 eligible reports were assessed for 28 elements derived from published checklists. A summary quality score incorporated 9 critical parameters for clinical decision making: diagnosis using World Health Organization 2007 criteria; cell type; grade; narrative supporting cell type and grade; absence of equivocal language; conclusion reporting cell type and grade; and conclusion aligned with report narrative. RESULTS Of 594 eligible reports, the final conclusion was not supported by the report narrative in 122 (21%). Tumor classification and grade were not supported by the narrative in 105 (18%) and 36 (6%) reports, respectively. Only 145 (24%) reports fulfilled all 9 quality criteria, while 25% contained 6 or fewer key quality indices. Report quality was higher when pathologists had neuropathology subspecialization, when a grade IV tumor was reported, and when the specimen was from an initial resection or grade-progressed tumor rather than recurrent high-grade glioma. Use of molecular testing increased over time, from 29% to 48% over four quartiles of the study. Molecular testing was more frequently done where oligodendroglial elements were reported. CONCLUSION A significant proportion of reports failed to meet key indicators of report quality. Pathology reporting is critical in communicating between pathologists and treating clinicians. Clinicians should be aware of reporting quality and seek clarification when required.
Collapse
Affiliation(s)
- Alison White
- Sir Charles Gairdner Hospital, Department of Medical Oncology,
Hospital Avenue, Nedlands,
Perth, WA 6009, Australia (A.W., A.K.N.);
Neuropathology Section, Department of Anatomical Pathology,
Pathwest, Royal Perth Hospital,
GPO Box X2213, Perth, WA 6001, Australia (V.F.);
Cure Brain Cancer Neuro-oncology Laboratory, Prince of Wales Clinical School, Lowy Cancer Research
Institute,2052UNSW Australia
(K.M., T.A.N); School of Medicine and
Pharmacology, University of Western Australia, 35 Stirling
Highway Nedlands WA 6009, Australia (A.K.N., T.A.N.)
| | - Vicki Fabian
- Sir Charles Gairdner Hospital, Department of Medical Oncology,
Hospital Avenue, Nedlands,
Perth, WA 6009, Australia (A.W., A.K.N.);
Neuropathology Section, Department of Anatomical Pathology,
Pathwest, Royal Perth Hospital,
GPO Box X2213, Perth, WA 6001, Australia (V.F.);
Cure Brain Cancer Neuro-oncology Laboratory, Prince of Wales Clinical School, Lowy Cancer Research
Institute,2052UNSW Australia
(K.M., T.A.N); School of Medicine and
Pharmacology, University of Western Australia, 35 Stirling
Highway Nedlands WA 6009, Australia (A.K.N., T.A.N.)
| | - Kerrie McDonald
- Sir Charles Gairdner Hospital, Department of Medical Oncology,
Hospital Avenue, Nedlands,
Perth, WA 6009, Australia (A.W., A.K.N.);
Neuropathology Section, Department of Anatomical Pathology,
Pathwest, Royal Perth Hospital,
GPO Box X2213, Perth, WA 6001, Australia (V.F.);
Cure Brain Cancer Neuro-oncology Laboratory, Prince of Wales Clinical School, Lowy Cancer Research
Institute,2052UNSW Australia
(K.M., T.A.N); School of Medicine and
Pharmacology, University of Western Australia, 35 Stirling
Highway Nedlands WA 6009, Australia (A.K.N., T.A.N.)
| | - Anna K. Nowak
- Sir Charles Gairdner Hospital, Department of Medical Oncology,
Hospital Avenue, Nedlands,
Perth, WA 6009, Australia (A.W., A.K.N.);
Neuropathology Section, Department of Anatomical Pathology,
Pathwest, Royal Perth Hospital,
GPO Box X2213, Perth, WA 6001, Australia (V.F.);
Cure Brain Cancer Neuro-oncology Laboratory, Prince of Wales Clinical School, Lowy Cancer Research
Institute,2052UNSW Australia
(K.M., T.A.N); School of Medicine and
Pharmacology, University of Western Australia, 35 Stirling
Highway Nedlands WA 6009, Australia (A.K.N., T.A.N.)
| |
Collapse
|
17
|
Farewell to GBM-O: Genomic and transcriptomic profiling of glioblastoma with oligodendroglioma component reveals distinct molecular subgroups. Acta Neuropathol Commun 2016; 4:4. [PMID: 26757882 PMCID: PMC4711079 DOI: 10.1186/s40478-015-0270-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/24/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Glioblastoma with oligodendroglioma component (GBM-O) was recognized as a histologic pattern of glioblastoma (GBM) by the World Health Organization (WHO) in 2007 and is distinguished by the presence of oligodendroglioma-like differentiation. To better understand the genetic underpinnings of this morphologic entity, we performed a genome-wide, integrated copy number, mutational and transcriptomic analysis of eight (seven primary, primary secondary) cases. RESULTS Three GBM-O samples had IDH1 (p.R132H) mutations; two of these also demonstrated 1p/19q co-deletion and had a proneural transcriptional profile, a molecular signature characteristic of oligodendroglioma. The additional IDH1 mutant tumor lacked 1p/19q co-deletion, harbored a TP53 mutation, and overall, demonstrated features most consistent with IDH mutant (secondary) GBM. Finally, five tumors were IDH wild-type (IDHwt) and had chromosome seven gains, chromosome 10 losses, and homozygous 9p deletions (CDKN2A), alterations typical of IDHwt (primary) GBM. IDHwt GBM-Os also demonstrated EGFR and PDGFRA amplifications, which correlated with classical and proneural expression subtypes, respectively. CONCLUSIONS Our findings demonstrate that GBM-O is composed of three discrete molecular subgroups with characteristic mutations, copy number alterations and gene expression patterns. Despite displaying areas that morphologically resemble oligodendroglioma, the current results indicate that morphologically defined GBM-O does not correspond to a particular genetic signature, but rather represents a collection of genetically dissimilar entities. Ancillary testing, especially for IDH and 1p/19q, should be used for determining these molecular subtypes.
Collapse
|
18
|
Van Den Bent MJ, Bromberg JEC, Buckner J. Low-grade and anaplastic oligodendroglioma. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:361-80. [PMID: 26948366 DOI: 10.1016/b978-0-12-802997-8.00022-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Anaplastic oligodendrogliomas have long attracted interest because of their sensitivity to chemotherapy, in particular in the subset of 1p/19q co-deleted tumors. Recent molecular studies have shown that all 1p/19q co-deleted tumors have IDH mutations and most of them also have TERT mutations. Because of the presence of similar typical genetic alterations in astrocytoma and glioblastoma, the current trend is to diagnose these tumors on the basis of their molecular profile. Further long-term follow-up analysis of both EORTC and RTOG randomized studies on (neo)adjuvant procarbazine, lomustine, vincristine (PCV) chemotherapy have shown that adjuvant chemotherapy indeed improves outcome, and this is now standard of care. It is also equally clear that benefit to PCV chemotherapy is not limited to the 1p/19q co-deleted cases; potential other predictive factors are IDH mutations and MGMT promoter methylation. Moreover, a recent RTOG study on low-grade glioma also noted an improved outcome after adjuvant PCV chemotherapy, thus making (PCV) chemotherapy now standard of care for all 1p/19q co-deleted tumors regardless of grade. It remains unclear whether temozolomide provides the same survival benefit, as no data from well-designed clinical trials on adjuvant temozolomide in this tumor type are available. Another question that remains is whether one can safely leave out radiotherapy as part of initial treatment to avoid cognitive side-effects of radiotherapy. The current data suggest that delaying radiotherapy and treatment with chemotherapy only may be detrimental for overall survival.
Collapse
Affiliation(s)
- Martin J Van Den Bent
- Neuro-Oncology Unit, The Brain Tumor Center at Erasmus MC Cancer Center, Rotterdam, The Netherlands.
| | - Jacolien E C Bromberg
- Neuro-Oncology Unit, The Brain Tumor Center at Erasmus MC Cancer Center, Rotterdam, The Netherlands
| | - Jan Buckner
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
19
|
Dubbink HJ, Atmodimedjo PN, Kros JM, French PJ, Sanson M, Idbaih A, Wesseling P, Enting R, Spliet W, Tijssen C, Dinjens WNM, Gorlia T, van den Bent MJ. Molecular classification of anaplastic oligodendroglioma using next-generation sequencing: a report of the prospective randomized EORTC Brain Tumor Group 26951 phase III trial. Neuro Oncol 2015; 18:388-400. [PMID: 26354927 DOI: 10.1093/neuonc/nov182] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/04/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Histopathological diagnosis of diffuse gliomas is subject to interobserver variation and correlates modestly with major prognostic and predictive molecular abnormalities. We investigated a series of patients with locally diagnosed anaplastic oligodendroglial tumors included in the EORTC phase III trial 26951 on procarbazine/lomustine/vincristine (PCV) chemotherapy to explore the diagnostic, prognostic, and predictive value of targeted next-generation sequencing (NGS) in diffuse glioma and to assess the prognostic impact of FUBP1 and CIC mutations. METHODS Mostly formalin-fixed paraffin-embedded samples were tested with targeted NGS for mutations in ATRX, TP53, IDH1, IDH2, CIC, FUBP1, PI3KC, TERT, EGFR, H3F3A, BRAF, PTEN, and NOTCH and for copy number alterations of chromosomes 1p, 19q, 10q, and 7. TERT mutations were also assessed, with PCR. RESULTS Material was available from 139 cases, in 6 of which results were uninformative. One hundred twenty-six tumors could be classified: 20 as type II (IDH mutation [mut], "astrocytoma"), 49 as type I (1p/19q codeletion, "oligodendroglioma"), 55 as type III (7+/10q- or TERTmut and 1p/19q intact, "glioblastoma"), and 2 as childhood glioblastoma (H3F3Amut), leaving 7 unclassified (total 91% classified). Molecular classification was of clear prognostic significance and correlated better with outcome than did classical histopathology. In 1p/19q codeleted tumors, outcome was not affected by CIC and FUBP1 mutations. MGMT promoter methylation remained the most predictive factor for survival benefit of PCV chemotherapy. CONCLUSION Targeted NGS allows a clinically relevant classification of diffuse glioma into groups with very different outcomes. The diagnosis of diffuse glioma should be primarily based on a molecular classification, with the histopathological grade added to it. Future discussion should primarily aim at establishing the minimum requirements for molecular classification of diffuse glioma.
Collapse
Affiliation(s)
- Hendrikus J Dubbink
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Peggy N Atmodimedjo
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Johan M Kros
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Pim J French
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Marc Sanson
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Ahmed Idbaih
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Pieter Wesseling
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Roelien Enting
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Wim Spliet
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Cees Tijssen
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Winand N M Dinjens
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Thierry Gorlia
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Martin J van den Bent
- Department of Pathology, Rotterdam, the Netherlands (H.J.D., P.N.A., J.M.K., W.N.M.D.); Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands (P.J.F.); Groupe Hospitalier Pitie Salpetriere, Service de Neurologie Mazarin, Paris, France (M.S., A.I.); Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (P.W.); Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands (P.W.); Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (R.E.); Department of Pathology, UMCU, Utrecht, the Netherlands (W.S.); Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands (C.T.); European Organisation for Research and Treatment of Cancer Data Center, Brussels, Belgium (T.G.); Department of Neurology/Neuro-oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| |
Collapse
|
20
|
Zhen L, Yun-Hui L, Hong-Yu D, Jun M, Yi-Long Y. Long noncoding RNA NEAT1 promotes glioma pathogenesis by regulating miR-449b-5p/c-Met axis. Tumour Biol 2015; 37:673-83. [PMID: 26242266 DOI: 10.1007/s13277-015-3843-y] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/24/2015] [Indexed: 02/06/2023] Open
Abstract
Growing evidence demonstrates that long noncoding RNAs (lncRNAs) are involved in the progression of various cancers including glioma. Nuclear enriched abundant transcript 1 (NEAT1), an essential lncRNA for the formation of nuclear body paraspeckles, was not fully explored in glioma. We aimed to determine the expression, roles, and functional mechanisms of NEAT1 in the progression of glioma. By real-time PCR, we suggested that NEAT1 was upregulated in glioma tissues than noncancerous brain tissues. Knockdown of NEAT1 reduced glioma cell proliferation, invasion, and migration. RNA immunoprecipitation assay combined with luciferase reporter assay confirmed miR-449b-5p-specific binding to NEAT1. Furthermore, we verified that c-Met was a directly target of miR-449b-5p. Rescue assays demonstrated NEAT1 functions a molecular sponge for miR-449b-5p and leads to the upregulation of c-Met. This regulation menchaism promotes glioma pathogenesis and may provide a potential target for the prognosis and treatment of glioma.
Collapse
Affiliation(s)
- Li Zhen
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Sanhao Street, Shenyang, Liaoning province, 110004, People's Republic of China.
| | - Liu Yun-Hui
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Sanhao Street, Shenyang, Liaoning province, 110004, People's Republic of China
| | - Diao Hong-Yu
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Sanhao Street, Shenyang, Liaoning province, 110004, People's Republic of China
| | - Ma Jun
- Department of Neurobiology, College of Basic Medicine, China Medical University, Shenyang, Liaoning province, 110001, People's Republic of China
| | - Yao Yi-Long
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Sanhao Street, Shenyang, Liaoning province, 110004, People's Republic of China
| |
Collapse
|
21
|
Molecularly based management of gliomas in clinical practice. Neurol Sci 2015; 36:1551-7. [PMID: 26194534 DOI: 10.1007/s10072-015-2332-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
Abstract
Histological subtyping and grading of malignancy are the cornerstone of the present World Health Organization (WHO) Classification of CNS tumors. However, among diffuse gliomas of the adult, patients with histologically identical tumors may have different outcomes. As the genomic analysis of these tumors has progressed, it has become clear that specific molecular features transcend histologically defined variants, and may become markers of prognostic and/or predictive value. At the present time, the number of molecular biomarkers with confirmed clinical relevance (MGMT promoter methylation, 1p/19q codeletion, IDH1/2 mutations) remains limited, but new technologies will hopefully provide new candidates requiring rigorous validation in well-designed clinical trials.
Collapse
|
22
|
Figarella‐Branger D, Mokhtari K, Colin C, Uro‐Coste E, Jouvet A, Dehais C, Carpentier C, Villa C, Maurage C, Eimer S, Polivka M, Vignaud J, Laquerriere A, Sevestre H, Lechapt‐Zalcman E, Quintin‐Roué I, Aubriot‐Lorton M, Diebold M, Viennet G, Adam C, Loussouarn D, Michalak S, Rigau V, Heitzmann A, Vandenbos F, Forest F, Chiforeanu D, Tortel M, Labrousse F, Chenard M, Nguyen AT, Varlet P, Kemeny JL, Levillain P, Cazals‐Hatem D, Richard P, Delattre J. Prognostic Relevance of Histomolecular Classification of Diffuse Adult High-Grade Gliomas with Necrosis. Brain Pathol 2015; 25:418-28. [PMID: 25407774 PMCID: PMC8029113 DOI: 10.1111/bpa.12227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/07/2014] [Indexed: 12/26/2022] Open
Abstract
Diffuse adult high-grade gliomas (HGGs) with necrosis encompass anaplastic oligodendrogliomas (AOs) with necrosis (grade III), glioblastomas (GBM, grade IV) and glioblastomas with an oligodendroglial component (GBMO, grade IV). Here, we aimed to search for prognostic relevance of histological classification and molecular alterations of these tumors. About 210 patients were included (63 AO, 56 GBM and 91 GBMO). GBMO group was split into "anaplastic oligoastrocytoma (AOA) with necrosis grade IV/GBMO," restricted to tumors showing intermingled astrocytic and oligodendroglial component, and "GBM/GBMO" based on tumors presenting oligodendroglial foci and features of GBM. Genomic arrays, IDH1 R132H expression analyses and IDH direct sequencing were performed. 1p/19q co-deletion characterized AO, whereas no IDH1 R132H expression and intact 1p/19q characterized both GBM and GBM/GBMO. AOA with necrosis/GBMO mainly demonstrated IDH1 R132H expression and intact 1p/19q. Other IDH1 or IDH2 mutations were extremely rare. Both histological and molecular classifications were predictive of progression free survival (PFS) and overall survival (OS) (P < 10(-4) ). Diffuse adult HGGs with necrosis can be split into three histomolecular groups of prognostic relevance: 1p/19q co-deleted AO, IDH1 R132H-GBM and 1p/19q intact IDH1 R132H+ gliomas that might be classified as IDH1 R132H+ GBM. Because of histomolecular heterogeneity, we suggest to remove the name GBMO.
Collapse
Affiliation(s)
- Dominique Figarella‐Branger
- Service d'Anatomie Pathologique et de NeuropathologieHôpital de la TimoneAPHMMarseilleFrance
- INSERMCRO2 UMR_S 911Aix‐Marseille UniversitéMarseilleFrance
| | - Karima Mokhtari
- Département de Neuropathologie Raymond EscourolleGroupe Hospitalier Pitié‐SalpêtrièreAP‐HPParisFrance
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière (CRICM)UMR 7225Université Pierre et Marie Curie—Paris 6ParisFrance
- INSERM U1127ParisFrance
| | - Carole Colin
- INSERMCRO2 UMR_S 911Aix‐Marseille UniversitéMarseilleFrance
| | - Emmanuelle Uro‐Coste
- Service d'Anatomie Pathologique et Histologie‐CytologieHôpital RangueilCHU ToulouseToulouseFrance
- INSERM U1037Centre de Recherche en Cancérologie de ToulouseUniversité de ToulouseToulouseFrance
| | - Anne Jouvet
- Centre de Pathologie et de Neuropathologie EstHospices Civils de LyonBronFrance
| | - Caroline Dehais
- Service de Neurologie 2—MazarinGroupe Hospitalier Pitié‐SalpêtrièreAP‐HPParisFrance
| | - Catherine Carpentier
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière (CRICM)UMR 7225Université Pierre et Marie Curie—Paris 6ParisFrance
- INSERM U1127ParisFrance
| | - Chiara Villa
- Département de Neuropathologie Raymond EscourolleGroupe Hospitalier Pitié‐SalpêtrièreAP‐HPParisFrance
- Service d'Anatomie PathologiqueHôpital FochSuresnesFrance
| | | | - Sandrine Eimer
- Service de Pathologie—NeuropathologieHôpital PellegrinCHU BordeauxBordeauxFrance
- EA2406Histologie et Pathologie Moléculaire des TumeursUniversité Bordeaux SegalenBordeauxFrance
| | - Marc Polivka
- Service d'Anatomie et Cytologie PathologiqueHôpital LariboisièreAP‐HPParisFrance
| | | | - Annie Laquerriere
- Laboratoire de PathologieHôpital Charles NicolleCHU RouenRouenFrance
| | - Henri Sevestre
- Service d'Anatomie et Cytologie PathologiquesCHU AmiensAmiensFrance
| | - Emmanuelle Lechapt‐Zalcman
- Service d'Anatomie PathologiqueHôpital de la Côte de NacreCHU CaenCaenFrance
- GIP CYCERONCERVOxyUMR 6301 ISTCTCNRSCaenFrance
| | | | | | - Marie‐Danièle Diebold
- Laboratoire d'Anatomie et Cytologie PathologiquesHôpital Robert DebréCHU ReimsReimsFrance
| | - Gabriel Viennet
- Service Anatomie et Cytologie PathologiquesHôpital Jean MinjozCHU BesançonBesançonFrance
| | - Clovis Adam
- Service Anatomie et Cytologie PathologiquesHôpital BicêtreAP‐HPKremlin‐BicêtreFrance
| | | | - Sophie Michalak
- Département Pathologie Cellulaire et TissulaireCHU AngersAngersFrance
| | - Valérie Rigau
- Laboratoire d'Anatomie et Cytologie PathologiquesHôpital Gui de ChaulliacCHU MontpellierMontpellierFrance
| | - Anne Heitzmann
- Service d'Anatomie PathologiqueHôpital la SourceCHR OrléansOrléansFrance
| | - Fanny Vandenbos
- Laboratoire d'Anatomie et Cytologie PathologiquesHôpital PasteurCHU NiceNiceFrance
| | - Fabien Forest
- Service d'Anatomie et Cytologie PathologiquesHôpital NordCHU Saint‐EtienneSaint‐EtienneFrance
| | | | | | | | - Marie‐Pierre Chenard
- Service d'Anatomie PathologiqueHôpital HautepierreCHU StrasbourgStrasbourgFrance
| | | | | | - Jean Louis Kemeny
- Service d'Anatomie et Cytologie PathologiquesHôpital Gabriel MontpiedCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Pierre‐Marie Levillain
- Laboratoire d'Anatomie et Cytologie PathologiquesHôpital la MilétrieCHU PoitiersPoitiersFrance
| | | | - Pomone Richard
- Laboratoire d'Anatomie et Cytologie Pathologiques des FeuillantsToulouseFrance
| | - Jean‐Yves Delattre
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière (CRICM)UMR 7225Université Pierre et Marie Curie—Paris 6ParisFrance
- INSERM U1127ParisFrance
- Service de Neurologie 2—MazarinGroupe Hospitalier Pitié‐SalpêtrièreAP‐HPParisFrance
| | | |
Collapse
|
23
|
Oligodendroglioma: pathology, molecular mechanisms and markers. Acta Neuropathol 2015; 129:809-27. [PMID: 25943885 PMCID: PMC4436696 DOI: 10.1007/s00401-015-1424-1] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 02/07/2023]
Abstract
For nearly a century, the diagnosis and grading of oligodendrogliomas and oligoastrocytomas has been based on histopathology alone. Roughly 20 years ago, the first glioma-associated molecular signature was found with complete chromosome 1p and 19q codeletion being particularly common in histologically classic oligodendrogliomas. Subsequently, this codeletion appeared to not only carry diagnostic, but also prognostic and predictive information, the latter aspect only recently resolved after carefully constructed clinical trials with very long follow-up times. More recently described biomarkers, including the non-balanced translocation leading to 1p/19q codeletion, promoter hypermethylation of the MGMT gene, mutations of the IDH1 or IDH2 gene, and mutations of FUBP1 (on 1p) or CIC (on 19q), have greatly enhanced our understanding of oligodendroglioma biology, although their diagnostic, prognostic, and predictive roles are less clear. It has therefore been suggested that complete 1p/19q codeletion be required for the diagnosis of 'canonical oligodendroglioma'. This transition to an integrated morphological and molecular diagnosis may result in the disappearance of oligoastrocytoma as an entity, but brings new challenges as well. For instance it needs to be sorted out how (histopathological) criteria for grading of 'canonical oligodendrogliomas' should be adapted, how pediatric oligodendrogliomas (known to lack codeletions) should be defined, which platforms and cut-off levels should ideally be used for demonstration of particular molecular aberrations, and how the diagnosis of oligodendroglioma should be made in centers/countries where molecular diagnostics is not available. Meanwhile, smart integration of morphological and molecular information will lead to recognition of biologically much more uniform groups within the spectrum of diffuse gliomas and thereby facilitate tailored treatments for individual patients.
Collapse
|
24
|
Appin CL, Brat DJ. Biomarker-driven diagnosis of diffuse gliomas. Mol Aspects Med 2015; 45:87-96. [PMID: 26004297 DOI: 10.1016/j.mam.2015.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/20/2015] [Indexed: 11/26/2022]
Abstract
The diffuse gliomas are primary central nervous system tumors that arise most frequently in the cerebral hemispheres of adults. They are currently classified as astrocytomas, oligodendrogliomas or oligoastrocytomas and range in grade from II to IV. Glioblastoma (GBM), grade IV, is the highest grade and most common form. The diagnosis of diffuse gliomas has historically been based primarily on histopathologic features, yet these tumors have a wide range of biological behaviors that are only partially explained by morphology. Biomarkers have now become an established component of the neuropathologic diagnosis of gliomas, since molecular alterations aid in classification, prognostication and prediction of therapeutic response. Isocitrate dehydrogenase (IDH) mutations are frequent in grades II and III infiltrating gliomas of adults, as well as secondary GBMs, and are a major discriminate of biologic class. IDH mutant infiltrating astrocytomas (grades II and III), as well as secondary GBMs, are characterized by TP53 and ATRX mutations. Oligodendrogliomas are also IDH mutant, but instead are characterized by 1p/19q co-deletion and mutations of CIC, FUBP1, Notch1 and the TERT promoter. Primary GBMs typically lack IDH mutations and demonstrate EGFR, PTEN, TP53, PDGFRA, NF1 and CDKN2A/B alterations and TERT promoter mutations. Pediatric gliomas differ in their spectrum of disease from those in adults; high grade gliomas occurring in children frequently have mutations in H3F3A, ATRX and DAXX, but not IDH. Circumscribed, low grade gliomas, such as pilocytic astrocytoma, pleomorphic xanthoastrocytoma and ganglioglioma, need to be distinguished from diffuse gliomas in the pediatric population. These gliomas often harbor mutations or activating gene rearrangements in BRAF.
Collapse
Affiliation(s)
- Christina L Appin
- Department of Pathology and Laboratory Medicine, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel J Brat
- Department of Pathology and Laboratory Medicine, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
25
|
Goda JS, Lewis S, Agarwal A, Epari S, Churi S, Padmavati A, Gupta T, Shetty P, Moiyadi A, Jalali R. Impact of oligodendroglial component in glioblastoma (GBM-O): Is the outcome favourable than glioblastoma? Clin Neurol Neurosurg 2015; 135:46-53. [PMID: 26038275 DOI: 10.1016/j.clineuro.2015.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/25/2015] [Accepted: 05/07/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prognosis of patients with glioblastoma with oligodendroglial component (GBM-O) is not well defined. We report our experience of patients of GBM-O treated at our center. METHODS Between January 2007 and August 2013, out of 817 consecutive patients with glioblastoma (GBM), 74 patients with GBM-O were identified in our prospectively maintained database. An experienced neuropathologist revaluated the histopathology of all these 74 patients and the diagnosis of GBM-O was eventually confirmed in 57 patients. Patients were uniformly treated with maximal safe resection followed by focal radiotherapy with concurrent and adjuvant temozolamide (TMZ). RESULTS At a median follow up of 16 months, median overall survival (OS) and progression free survival (PFS) of the entire cohort was 23 months and 13 months respectively. Near total excision was performed in 30/57 (52.6%). On univariate analysis, age < 50 years was a significant favourable prognostic factor for OS (p = 0.009) and PFS (p = 0.017), while patients with near total resection had a significantly better PFS (p = 0.017), patients who completed a minimum of 6 cycles of adjuvant TMZ had significantly better OS (p = 0.000) and PFS (p = 0.003). On multivariate analysis, none of the above factors were significant except for patient who had completed a minimum of 6 cycles of TMZ (OS; p = 0.000 & PFS; p = 0.015). A comparative analysis of GBM-O patients with a similarly treated cohort of 105 GBM patients during the same period revealed significantly better median OS in favour of GBM-O (p = 0.01). CONCLUSIONS Our experience suggests patients with GBM-O have a more favourable clinical outcome as compared to GBM.
Collapse
Affiliation(s)
- Jayant S Goda
- Neuro Oncology disease management group, Tata Memorial Centre, Parel, Mumbai 400012, India
| | - Shirley Lewis
- Neuro Oncology disease management group, Tata Memorial Centre, Parel, Mumbai 400012, India
| | - Aditi Agarwal
- Neuro Oncology disease management group, Tata Memorial Centre, Parel, Mumbai 400012, India
| | - Sridhar Epari
- Neuro Oncology disease management group, Tata Memorial Centre, Parel, Mumbai 400012, India
| | - Shraddha Churi
- Neuro Oncology disease management group, Tata Memorial Centre, Parel, Mumbai 400012, India
| | - A Padmavati
- Clinical Research Secretariat, ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India
| | - Tejpal Gupta
- Neuro Oncology disease management group, Tata Memorial Centre, Parel, Mumbai 400012, India
| | - Prakash Shetty
- Neuro Oncology disease management group, Tata Memorial Centre, Parel, Mumbai 400012, India
| | - Aliasgar Moiyadi
- Neuro Oncology disease management group, Tata Memorial Centre, Parel, Mumbai 400012, India
| | - Rakesh Jalali
- Neuro Oncology disease management group, Tata Memorial Centre, Parel, Mumbai 400012, India.
| |
Collapse
|
26
|
Kros JM, Huizer K, Hernández-Laín A, Marucci G, Michotte A, Pollo B, Rushing EJ, Ribalta T, French P, Jaminé D, Bekka N, Lacombe D, van den Bent MJ, Gorlia T. Evidence-Based Diagnostic Algorithm for Glioma: Analysis of the Results of Pathology Panel Review and Molecular Parameters of EORTC 26951 and 26882 Trials. J Clin Oncol 2015; 33:1943-50. [PMID: 25918297 DOI: 10.1200/jco.2014.59.0166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE With the rapid discovery of prognostic and predictive molecular parameters for glioma, the status of histopathology in the diagnostic process should be scrutinized. Our project aimed to construct a diagnostic algorithm for gliomas based on molecular and histologic parameters with independent prognostic values. METHODS The pathology slides of 636 patients with gliomas who had been included in EORTC 26951 and 26882 trials were reviewed using virtual microscopy by a panel of six neuropathologists who independently scored 18 histologic features and provided an overall diagnosis. The molecular data for IDH1, 1p/19q loss, EGFR amplification, loss of chromosome 10 and chromosome arm 10q, gain of chromosome 7, and hypermethylation of the promoter of MGMT were available for some of the cases. The slides were divided in discovery (n = 426) and validation sets (n = 210). The diagnostic algorithm resulting from analysis of the discovery set was validated in the latter. RESULTS In 66% of cases, consensus of overall diagnosis was present. A diagnostic algorithm consisting of two molecular markers and one consensus histologic feature was created by conditional inference tree analysis. The order of prognostic significance was: 1p/19q loss, EGFR amplification, and astrocytic morphology, which resulted in the identification of four diagnostic nodes. Validation of the nodes in the validation set confirmed the prognostic value (P < .001). CONCLUSION We succeeded in the creation of a timely diagnostic algorithm for anaplastic glioma based on multivariable analysis of consensus histopathology and molecular parameters.
Collapse
Affiliation(s)
- Johan M Kros
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland.
| | - Karin Huizer
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Aurelio Hernández-Laín
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Gianluca Marucci
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Alex Michotte
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Bianca Pollo
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Elisabeth J Rushing
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Teresa Ribalta
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Pim French
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - David Jaminé
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Nawal Bekka
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Denis Lacombe
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Martin J van den Bent
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| | - Thierry Gorlia
- Johan M. Kros and Karin Huizer, Erasmus Medical Center; Pim French and Martin J. van den Bent, Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Aurelio Hernández-Laín, Hospital Universitario 12 de Octubre Reseach Institute, Madrid; Teresa Ribalta, Hospital Clínic, University of Barcelona, Barcelona, Spain; Gianluca Marucci, Bellaria Hospital, University of Bologna, Bologna; Bianca Pollo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico "C. Besta," Milano, Italy; Alex Michotte, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; David Jaminé, Nawal Bekka, Denis Lacombe, and Thierry Gorlia, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; and Elisabeth J. Rushing, Institute for Neuropathology, University Hospital of Zurich, Zurich, Switzerland
| |
Collapse
|
27
|
Cooper LA, Kong J, Gutman DA, Dunn WD, Nalisnik M, Brat DJ. Novel genotype-phenotype associations in human cancers enabled by advanced molecular platforms and computational analysis of whole slide images. J Transl Med 2015; 95:366-76. [PMID: 25599536 PMCID: PMC4465352 DOI: 10.1038/labinvest.2014.153] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/20/2014] [Accepted: 09/22/2014] [Indexed: 11/09/2022] Open
Abstract
Technological advances in computing, imaging, and genomics have created new opportunities for exploring relationships between histology, molecular events, and clinical outcomes using quantitative methods. Slide scanning devices are now capable of rapidly producing massive digital image archives that capture histological details in high resolution. Commensurate advances in computing and image analysis algorithms enable mining of archives to extract descriptions of histology, ranging from basic human annotations to automatic and precisely quantitative morphometric characterization of hundreds of millions of cells. These imaging capabilities represent a new dimension in tissue-based studies, and when combined with genomic and clinical endpoints, can be used to explore biologic characteristics of the tumor microenvironment and to discover new morphologic biomarkers of genetic alterations and patient outcomes. In this paper, we review developments in quantitative imaging technology and illustrate how image features can be integrated with clinical and genomic data to investigate fundamental problems in cancer. Using motivating examples from the study of glioblastomas (GBMs), we demonstrate how public data from The Cancer Genome Atlas (TCGA) can serve as an open platform to conduct in silico tissue-based studies that integrate existing data resources. We show how these approaches can be used to explore the relation of the tumor microenvironment to genomic alterations and gene expression patterns and to define nuclear morphometric features that are predictive of genetic alterations and clinical outcomes. Challenges, limitations, and emerging opportunities in the area of quantitative imaging and integrative analyses are also discussed.
Collapse
|
28
|
Grant R, Kolb L, Moliterno J. Molecular and genetic pathways in gliomas: the future of personalized therapeutics. CNS Oncol 2015; 3:123-36. [PMID: 25055018 DOI: 10.2217/cns.14.7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In the last few decades, we have seen significant advances in brain imaging, which have resulted in more detailed anatomic and functional localization of gliomas in relation to the eloquent cortex, as well as improvements in microsurgical techniques and enhanced delivery of adjuvant stereotactic radiation. While these advancements have led to a relatively modest improvement in clinical outcomes for patients with malignant gliomas, much more work remains to be done. As with other types of cancer, we are now rapidly moving past the era of histopathology dictating treatment for brain tumors and into the realm of molecular diagnostics and associated targeted therapies, specifically based on the genomic architecture of individual gliomas. In this review, we discuss the current era of molecular glioma characterization and how these profiles will allow for individualized, patient-specific targeted treatments.
Collapse
Affiliation(s)
- Ryan Grant
- Department of Neurosurgery, Yale University School of Medicine, Yale-New Haven Hospital, 333 Cedar Street, TMP4, New Haven, CT 06510, USA
| | | | | |
Collapse
|
29
|
Dynamic study of methionine positron emission tomography in patients with glioblastoma with oligodendroglial components. Brain Tumor Pathol 2015; 32:253-60. [DOI: 10.1007/s10014-015-0218-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/17/2015] [Indexed: 11/26/2022]
|
30
|
Myung JK, Cho HJ, Kim H, Park CK, Lee SH, Choi SH, Park P, Yoon JM, Park SH. Prognosis of Glioblastoma With Oligodendroglioma Component is Associated With the IDH1 Mutation and MGMT Methylation Status. Transl Oncol 2014; 7:712-9. [PMID: 25500080 PMCID: PMC4311043 DOI: 10.1016/j.tranon.2014.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 11/15/2022] Open
Abstract
Glioblastoma (GBM) with oligodendroglioma component (GBMO) is a newly described GBM subtype in the 2007 World Health Organization classification. However, its biological and genetic characteristics are largely unknown. We investigated the clinicopathological and molecular features of 34 GBMOs and compared the survival rate of these patients with those of patients with astrocytoma, oligodendroglioma, anaplastic oligoastrocytoma (AOA), and conventional GBMs in our hospital. GBMO could be divided into two groups based on the presence of an IDH1 mutation. The IDH1 mutation was more frequently found in secondary GBMO, which had lower frequencies of EGFR amplification but higher MGMT methylation than the wild type IDH1 group, and patients with mutant IDH1 GBMO were on average younger than those with wild-type IDH1. Therefore, GBMO is a clinically and molecularly heterogeneous subtype, largely belonging to a proneural and classical subtype of GBM. The survival rate of GBMO patients itself was worse than that of AOA patients but not significantly better than that of conventional GBM patients. GBMO survival was independent of the dominant histopathological subtype i.e., astrocyte-dominant or oligodendroglioma -dominant, but it was significantly associated with the IDH1 mutation and MGMT methylation status. Therefore, GBMO should be regarded as a separate entity from AOA and must be classified as a subtype of GBM. However, further study is needed to determine whether it is a pathologic variant or a pattern of GBM because GBMO has a similar prognosis to conventional GBMs.
Collapse
Affiliation(s)
- Jae Kyung Myung
- Department of Pathology, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea
| | - Hwa Jin Cho
- Department of Pathology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Hanna Kim
- Department of Pathology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Peom Park
- Department of Industrial Engineering, Ajou University, Suwon, Republic of Korea
| | - Jung Min Yoon
- Department of Industrial Engineering, Ajou University, Suwon, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, College of Medicine, Seoul, Republic of Korea; Neuroscience Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
31
|
Hata N, Suzuki SO, Murata H, Hatae R, Akagi Y, Sangatsuda Y, Amano T, Yoshimoto K, Tahira T, Mizoguchi M. Genetic Analysis of a Case of Glioblastoma with Oligodendroglial Component Arising During the Progression of Diffuse Astrocytoma. Pathol Oncol Res 2014; 21:839-43. [DOI: 10.1007/s12253-014-9850-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 10/14/2014] [Indexed: 11/29/2022]
|
32
|
1p/19q-driven prognostic molecular classification for high-grade oligodendroglial tumors. J Neurooncol 2014; 120:607-14. [DOI: 10.1007/s11060-014-1593-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022]
|
33
|
Thakkar JP, Dolecek TA, Horbinski C, Ostrom QT, Lightner DD, Barnholtz-Sloan JS, Villano JL. Epidemiologic and molecular prognostic review of glioblastoma. Cancer Epidemiol Biomarkers Prev 2014; 23:1985-96. [PMID: 25053711 DOI: 10.1158/1055-9965.epi-14-0275] [Citation(s) in RCA: 809] [Impact Index Per Article: 80.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common and aggressive primary central nervous system malignancy with a median survival of 15 months. The average incidence rate of GBM is 3.19/100,000 population, and the median age of diagnosis is 64 years. Incidence is higher in men and individuals of white race and non-Hispanic ethnicity. Many genetic and environmental factors have been studied in GBM, but the majority are sporadic, and no risk factor accounting for a large proportion of GBMs has been identified. However, several favorable clinical prognostic factors are identified, including younger age at diagnosis, cerebellar location, high performance status, and maximal tumor resection. GBMs comprise of primary and secondary subtypes, which evolve through different genetic pathways, affect patients at different ages, and have differences in outcomes. We report the current epidemiology of GBM with new data from the Central Brain Tumor Registry of the United States 2006 to 2010 as well as demonstrate and discuss trends in incidence and survival. We also provide a concise review on molecular markers in GBM that have helped distinguish biologically similar subtypes of GBM and have prognostic and predictive value.
Collapse
Affiliation(s)
- Jigisha P Thakkar
- Department of Medicine, University of Kentucky, Lexington, Kentucky. Department of Neurology, University of Kentucky, Lexington, Kentucky
| | - Therese A Dolecek
- Division of Epidemiology and Biostatistics and Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Craig Horbinski
- Department of Pathology, University of Kentucky, Lexington, Kentucky
| | - Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Donita D Lightner
- Department of Neurology and Pediatrics, University of Kentucky, Lexington, Kentucky
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John L Villano
- Department of Medicine, University of Kentucky, Lexington, Kentucky. Department of Neurology, University of Kentucky, Lexington, Kentucky.
| |
Collapse
|
34
|
Abstract
Oligodendroglial tumors are relatively rare, comprising approximately 5% of all glial neoplasms. Oligodendroglial tumor patients have a better prognosis than those with astrocytic neoplasms, and patients with tumors that contain 1p/19q co-deletions or IDH-1 mutations appear to be particularly sensitive to treatment. In the past decade, scientists have made significant progress in the unraveling the molecular events that relate to the pathogenesis of these neoplasms. There is considerable excitement resulting from the recent reports from two large phase III randomized trials (European Organization for Research and Treatment of Cancer [EORTC] 26951 and Radiation Therapy Oncology Group [RTOG] 9402), which disclosed that patients with newly diagnosed 1p/19q co-deleted anaplastic oligodendroglial tumors have a 7+year increase in median overall survival following chemoradiation, as compared to radiation alone. This has stimulated a renewed interest in the development of new therapeutic strategies for treatment and potential cure of oligodendroglial tumors, based on an improved scientific understanding of the molecular events involved in the pathogenesis of these neoplasms. The goal of this document is to summarize the key translational developments and recent clinical therapeutic trial data, with a correlative perspective on current and future directions.
Collapse
Affiliation(s)
- Kurt A Jaeckle
- Departments of Neurology and Oncology, Mayo Clinic Florida, Jacksonville, FL.
| |
Collapse
|
35
|
Kanamori M, Kikuchi A, Watanabe M, Shibahara I, Saito R, Yamashita Y, Sonoda Y, Kumabe T, Kure S, Tominaga T. Rapid and sensitive intraoperative detection of mutations in the isocitrate dehydrogenase 1 and 2 genes during surgery for glioma. J Neurosurg 2014; 120:1288-97. [DOI: 10.3171/2014.3.jns131505] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Intraoperative diagnosis is important in determining the strategies during surgery for glioma. Because the mutations in the isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) genes have diagnostic, prognostic, and predictive values, the authors assessed the feasibility and significance of a simplified method for the intraoperative detection of IDH1 and IDH2 gene mutations.
Methods
Rapid DNA extraction, amplification with conventional polymerase chain reaction (PCR) or co-amplification at lower denaturation temperature PCR (COLD-PCR), and fluorescence melting curve analysis with adjacent hybridization probes were performed for the intraoperative detection of IDH1 and IDH2 mutations in 18 cases of suspected nonneoplastic lesions and low- and high-grade gliomas and in 3 cases of radiation necrosis.
Results
DNA extraction for detection of the mutation took 60–65 minutes. The results of this assay showed complete correlation with that of Sanger sequencing. The sensitivity for detection of mutations in a background of wild-type genes was 12.5% and 2.5% in conventional PCR and COLD-PCR, respectively. The diagnosis of glioma was established in 3 of 5 cases in which definitive diagnosis was not obtained using frozen sections, and information was obtained for the discrimination of glioblastoma or glioblastoma with an oligodendroglioma component from anaplastic glioma or secondary glioblastoma. This assay also detected a small fraction of tumor cells with IDH1 mutation in radiation necrosis.
Conclusions
These methods provide important information for establishing the differential diagnosis between low-grade glioma and nonneoplastic lesions and the diagnosis for subtypes of high-grade glioma. Although tumor cells in radiation necrosis were detected with a high sensitivity, further investigation is necessary for clinical application in surgery for recurrent glioma.
Collapse
Affiliation(s)
| | - Atsuo Kikuchi
- 2Pediatrics, Tohoku University Graduate School of Medicine
| | - Mika Watanabe
- 3Department of Pathology, Tohoku University Hospital, Sendai
| | | | | | - Yoji Yamashita
- 4Department of Neurosurgery, Miyagi Cancer Center, Natori, Miyagi; and
| | | | - Toshihiro Kumabe
- 5Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shigeo Kure
- 2Pediatrics, Tohoku University Graduate School of Medicine
| | | |
Collapse
|
36
|
Stupp R, Brada M, van den Bent MJ, Tonn JC, Pentheroudakis G. High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3:iii93-101. [PMID: 24782454 DOI: 10.1093/annonc/mdu050] [Citation(s) in RCA: 458] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- R Stupp
- Department of Oncology and Cancer Centre, University Hospital Zurich, Zurich, Switzerland
| | - M Brada
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Clatterbridge Cancer Centre, Wirral, UK
| | - M J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Center, Rotterdam, Netherlands
| | - J-C Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
| | - G Pentheroudakis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | | |
Collapse
|
37
|
Hewer E, Beck J, Murek M, Kappeler A, Vassella E, Vajtai I. Polymorphous oligodendroglioma of Zülch revisited: a genetically heterogeneous group of anaplastic gliomas including tumors of bona fide oligodendroglial differentiation. Neuropathology 2014; 34:323-32. [PMID: 24444336 DOI: 10.1111/neup.12097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 12/01/2022]
Abstract
A polymorphous variant of oligodendroglioma was described by K.J. Zülch half a century ago, and is only very sporadically referred to in the subsequent literature. In particular, no comprehensive analysis with respect to clinical or genetic features of these tumors is available. From a current perspective, the term polymorphous oligodendroglioma (pO) may appear as contradictory in terms, as nuclear monotony is a histomorphological hallmark of oligodendrogliomas. For the purpose of this study, we defined pO as diffusely infiltrating gliomas felt to be of oligodendroglial rather than astrocytic differentiation and characterized by the presence of multinucleate tumor giant cells and/or nuclear pleomorphism. In a total of nine patients, we identified tumors consistent with this working definition. All tumors were high-grade. We characterized these with respect to clinical, histomorphological and genetic features. Despite clinical and genetic heterogeneity, we identified a subset of tumors of bona fide oligodendroglial differentiation as characterized by combined loss of heterozygosity of chromosome arms 1p and 19q (LOH 1p19q). Those tumors that lacked LOH 1p19q showed a high frequency of IDH1 mutations and loss of alpha thalassemia/mental retardation syndrome X-linked gene (ATRX) immunoreactivity, indicating a possible phenotypic convergence of true oligodendrogliomas and gliomas of the alternative lengthening of telomeres (ALT) pathway. p53 alterations were common irrespective of the 1p19q status. Histomorphologically, the tumors featured interspersed bizarre multinucleate giant tumor cells, while the background population varied from monotonous to significantly pleomorphic. Our findings indicate, that a rare polymorphous - or "giant cell" - variant of oligodendroglioma does indeed exist.
Collapse
Affiliation(s)
- Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | | | | | | | | |
Collapse
|
38
|
Olar A, Aldape KD. Using the molecular classification of glioblastoma to inform personalized treatment. J Pathol 2014; 232:165-77. [PMID: 24114756 PMCID: PMC4138801 DOI: 10.1002/path.4282] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 08/23/2013] [Accepted: 09/24/2013] [Indexed: 12/19/2022]
Abstract
Glioblastoma is the most common and most aggressive diffuse glioma, associated with short survival and uniformly fatal outcome, irrespective of treatment. It is characterized by morphological, genetic and gene-expression heterogeneity. The current standard of treatment is maximal surgical resection, followed by radiation, with concurrent and adjuvant chemotherapy. Due to the heterogeneity, most tumours develop resistance to treatment and shortly recur. Following recurrence, glioblastoma is quickly fatal in the majority of cases. Recent genetic molecular advances have contributed to a better understanding of glioblastoma pathophysiology and disease stratification. In this paper we review basic glioblastoma pathophysiology, with emphasis on clinically relevant genetic molecular alterations and potential targets for further drug development.
Collapse
Affiliation(s)
- Adriana Olar
- Department of Pathology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | | |
Collapse
|
39
|
Beiko J, Suki D, Hess KR, Fox BD, Cheung V, Cabral M, Shonka N, Gilbert MR, Sawaya R, Prabhu SS, Weinberg J, Lang FF, Aldape KD, Sulman EP, Rao G, McCutcheon IE, Cahill DP. IDH1 mutant malignant astrocytomas are more amenable to surgical resection and have a survival benefit associated with maximal surgical resection. Neuro Oncol 2013; 16:81-91. [PMID: 24305719 DOI: 10.1093/neuonc/not159] [Citation(s) in RCA: 324] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND IDH1 gene mutations identify gliomas with a distinct molecular evolutionary origin. We sought to determine the impact of surgical resection on survival after controlling for IDH1 status in malignant astrocytomas-World Health Organization grade III anaplastic astrocytomas and grade IV glioblastoma. METHODS Clinical parameters including volumetric assessment of preoperative and postoperative MRI were recorded prospectively on 335 malignant astrocytoma patients: n = 128 anaplastic astrocytomas and n = 207 glioblastoma. IDH1 status was assessed by sequencing and immunohistochemistry. RESULTS IDH1 mutation was independently associated with complete resection of enhancing disease (93% complete resections among mutants vs 67% among wild-type, P < .001), indicating IDH1 mutant gliomas were more amenable to resection. The impact of residual tumor on survival differed between IDH1 wild-type and mutant tumors. Complete resection of enhancing disease among IDH1 wild-type tumors was associated with a median survival of 19.6 months versus 10.7 months for incomplete resection; however, no survival benefit was observed in association with further resection of nonenhancing disease (minimization of total tumor volume). In contrast, IDH1 mutants displayed an additional survival benefit associated with maximal resection of total tumor volume (median survival 9.75 y for >5 cc residual vs not reached for <5 cc, P = .025). CONCLUSIONS The survival benefit associated with surgical resection differs based on IDH1 genotype in malignant astrocytic gliomas. Therapeutic benefit from maximal surgical resection, including both enhancing and nonenhancing tumor, may contribute to the better prognosis observed in the IDH1 mutant subgroup. Thus, individualized surgical strategies for malignant astrocytoma may be considered based on IDH1 status.
Collapse
Affiliation(s)
- Jason Beiko
- Corresponding author: Daniel P. Cahill, MD, PhD, Department of Neurosurgery, 32 Fruit Street - Yawkey 9E, Massachusetts General Hospital, Brain Tumor Center/Neuro-Oncology, Boston, MA 02114.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Jiang H, Ren X, Wang J, Zhang Z, Jia W, Lin S. Short-term survivors in glioblastomas with oligodendroglioma component: a clinical study of 186 Chinese patients from a single institution. J Neurooncol 2013; 116:395-404. [PMID: 24264532 PMCID: PMC3890040 DOI: 10.1007/s11060-013-1311-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/10/2013] [Indexed: 02/01/2023]
Abstract
This study was designed to display the molecular genetic features of short-term survivors in glioblastomas with oligodendroglioma component (GBMO). A total of 186 patients with histological diagnosis of primary gliomas, including 11 GBMO-STS (short-term survivors, survival ≤12 months), 29 GBMO-LTS (relatively long-term survivors, survival >12 months), 36 anaplastic oligoastrocytoma (AOA) and 110 glioblastoma multiforme (GBM), enrolled in the study. An evaluation form was developed and used to document molecular pathological, clinical and treatment-associated parameters between subgroups. Kaplan–Meier plots for survival showed that the median progression-free survival (PFS) and overall survival (OS) of GBMO-STS were 5.0 and 10.0 months, respectively. Intergroup comparison revealed that the GBMO-STS harbored the most dismal prognosis than those with AOA, GBMO-LTS or GBM (P < 0.001 for PFS, P < 0.001 for OS, respectively). Cox regression analyses revealed that 1p/19q co-deletion and 19p polysomy were independent prognostic factors (P < 0.05). Pearson’s Chi square test demonstrated GBMO-STS exhibited lower 1p/19q co-deletion, IDH1 mutation rates than AOA or GBMO-LTS (P = 0.032, P = 0.045 for 1p/19q co-deletion; P = 0.034, P = 0.005 for IDH1 mutation, respectively) but higher chromosome 1q, 19p polysomy rates compared with AOA or GBM (P = 0.037, P = 0.030 for 1q polysomy; P = 0.017, P = 0.011 for 19p polysomy, respectively). Patients with glioblastomas with oligodendroglioma component concurrent with polysomy for chromosomes 1 and 19 always confers an unfavorable prognosis which needs our extra attention in clinic.
Collapse
Affiliation(s)
- Haihui Jiang
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | - Xiaohui Ren
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | - Junmei Wang
- Pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100050 China
| | - Zhe Zhang
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | - Wenqing Jia
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | - Song Lin
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| |
Collapse
|
41
|
Saponin 1 induces apoptosis and suppresses NF-κB-mediated survival signaling in glioblastoma multiforme (GBM). PLoS One 2013; 8:e81258. [PMID: 24278406 PMCID: PMC3836797 DOI: 10.1371/journal.pone.0081258] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 10/10/2013] [Indexed: 01/08/2023] Open
Abstract
Saponin 1 is a triterpeniod saponin extracted from Anemone taipaiensis, a traditional Chinese medicine against rheumatism and phlebitis. It has also been shown to exhibit significant anti-tumor activity against human leukemia (HL-60 cells) and human hepatocellular carcinoma (Hep-G2 cells). Herein we investigated the effect of saponin 1 in human glioblastoma multiforme (GBM) U251MG and U87MG cells. Saponin 1 induced significant growth inhibition in both glioblastoma cell lines, with a 50% inhibitory concentration at 24 h of 7.4 µg/ml in U251MG cells and 8.6 µg/ml in U87MG cells, respectively. Nuclear fluorescent staining and electron microscopy showed that saponin 1 caused characteristic apoptotic morphological changes in the GBM cell lines. Saponin 1-induced apoptosis was also verified by DNA ladder electrophoresis and flow cytometry. Additionally, immunocytochemistry and western blotting analyses revealed a time-dependent decrease in the expression and nuclear location of NF-κB following saponin 1 treatment. Western blotting data indicated a significant decreased expression of inhibitors of apoptosis (IAP) family members,(e.g., survivin and XIAP) by saponin 1. Moreover, saponin 1 caused a decrease in the Bcl-2/Bax ratio and initiated apoptosis by activating caspase-9 and caspase-3 in the GBM cell lines. These findings indicate that saponin 1 inhibits cell growth of GBM cells at least partially by inducing apoptosis and inhibiting survival signaling mediated by NF-κB. In addition, in vivo study also demonstrated an obvious inhibition of saponin 1 treatment on the tumor growth of U251MG and U87MG cells-produced xenograft tumors in nude mice. Given the minimal toxicities of saponin 1 in non-neoplastic astrocytes, our results suggest that saponin 1 exhibits significant in vitro and in vivo anti-tumor efficacy and merits further investigation as a potential therapeutic agent for GBM.
Collapse
|
42
|
Kong J, Cooper LAD, Wang F, Gao J, Teodoro G, Scarpace L, Mikkelsen T, Schniederjan MJ, Moreno CS, Saltz JH, Brat DJ. Machine-based morphologic analysis of glioblastoma using whole-slide pathology images uncovers clinically relevant molecular correlates. PLoS One 2013; 8:e81049. [PMID: 24236209 PMCID: PMC3827469 DOI: 10.1371/journal.pone.0081049] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022] Open
Abstract
Pathologic review of tumor morphology in histologic sections is the traditional method for cancer classification and grading, yet human review has limitations that can result in low reproducibility and inter-observer agreement. Computerized image analysis can partially overcome these shortcomings due to its capacity to quantitatively and reproducibly measure histologic structures on a large-scale. In this paper, we present an end-to-end image analysis and data integration pipeline for large-scale morphologic analysis of pathology images and demonstrate the ability to correlate phenotypic groups with molecular data and clinical outcomes. We demonstrate our method in the context of glioblastoma (GBM), with specific focus on the degree of the oligodendroglioma component. Over 200 million nuclei in digitized pathology slides from 117 GBMs in the Cancer Genome Atlas were quantitatively analyzed, followed by multiplatform correlation of nuclear features with molecular and clinical data. For each nucleus, a Nuclear Score (NS) was calculated based on the degree of oligodendroglioma appearance, using a regression model trained from the optimal feature set. Using the frequencies of neoplastic nuclei in low and high NS intervals, we were able to cluster patients into three well-separated disease groups that contained low, medium, or high Oligodendroglioma Component (OC). We showed that machine-based classification of GBMs with high oligodendroglioma component uncovered a set of tumors with strong associations with PDGFRA amplification, proneural transcriptional class, and expression of the oligodendrocyte signature genes MBP, HOXD1, PLP1, MOBP and PDGFRA. Quantitative morphologic features within the GBMs that correlated most strongly with oligodendrocyte gene expression were high nuclear circularity and low eccentricity. These findings highlight the potential of high throughput morphologic analysis to complement and inform human-based pathologic review.
Collapse
Affiliation(s)
- Jun Kong
- Center for Comprehensive Informatics, Emory University, Atlanta, Georgia, United States of America
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, United States of America
| | - Lee A. D. Cooper
- Center for Comprehensive Informatics, Emory University, Atlanta, Georgia, United States of America
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, United States of America
| | - Fusheng Wang
- Center for Comprehensive Informatics, Emory University, Atlanta, Georgia, United States of America
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, United States of America
| | - Jingjing Gao
- Center for Comprehensive Informatics, Emory University, Atlanta, Georgia, United States of America
| | - George Teodoro
- Center for Comprehensive Informatics, Emory University, Atlanta, Georgia, United States of America
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, United States of America
- College of Computing, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Lisa Scarpace
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Tom Mikkelsen
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Matthew J. Schniederjan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Carlos S. Moreno
- Center for Comprehensive Informatics, Emory University, Atlanta, Georgia, United States of America
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, United States of America
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
- Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| | - Joel H. Saltz
- Center for Comprehensive Informatics, Emory University, Atlanta, Georgia, United States of America
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, United States of America
| | - Daniel J. Brat
- Center for Comprehensive Informatics, Emory University, Atlanta, Georgia, United States of America
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, United States of America
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
- Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| |
Collapse
|
43
|
Zhang JX, Han L, Bao ZS, Wang YY, Chen LY, Yan W, Yu SZ, Pu PY, Liu N, You YP, Jiang T, Kang CS. HOTAIR, a cell cycle-associated long noncoding RNA and a strong predictor of survival, is preferentially expressed in classical and mesenchymal glioma. Neuro Oncol 2013; 15:1595-603. [PMID: 24203894 DOI: 10.1093/neuonc/not131] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Long noncoding RNA Hox transcript antisense intergenic RNA (HOTAIR) has been characterized as a negative prognostic factor in breast and colon cancer patients. The clinical significance and function of HOTAIR in glioma remains unclear. METHODS We analyzed the clinical significance of HOTAIR in 3 different glioma cohorts with gene expression data, including correlation with tumor grade, prognosis, and molecular subtype. The function of HOTAIR in glioma was explored by performing gene set enrichment analysis and in vitro and in vivo experiments. RESULTS HOTAIR expression was closely associated with glioma grade and poor prognosis. Multivariate Cox regression analysis revealed that HOTAIR was an independent prognostic factor in glioblastoma multiforme patients. HOTAIR expression correlated with glioma molecular subtype, including those of The Cancer Genome Atlas. HOTAIR was preferentially expressed in the classical and mesenchymal subtypes compared with the neural and proneural subtypes. A gene set enrichment analysis designed to show gene set differences between patients with high and low HOTAIR expression indicated that HOTAIR expression was associated with gene sets involved in cell cycle progression. HOTAIR reduction induced colony formation suppression, cell cycle G0/G1 arrest, and orthotopic tumor growth inhibition. CONCLUSION Our data establish that HOTAIR is an important long noncoding RNA that primarily serves as a prognostic factor for glioma patient survival, as well as a biomarker for identifying glioma molecular subtypes, a critical regulator of cell cycle progression.
Collapse
Affiliation(s)
- Jun-Xia Zhang
- Corresponding Authors: Yong-Ping You, PhD, Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China. ); Tao Jiang, PhD, Beijing Neurosurgical Institute, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, ; Chun-Sheng Kang, PhD, Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China (
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Komori T, Hirose T, Shibuya M, Suzuki H, Tanaka S, Sasaki A. Controversies over the diagnosis of oligodendroglioma: a report from the satellite workshop at the 4th international symposium of brain tumor pathology, Nagoya Congress Center, May 23, 2012. Brain Tumor Pathol 2013; 30:253-61. [PMID: 24100794 DOI: 10.1007/s10014-013-0165-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
With the goal of discussing how the neuropathology community should resolve the controversy over the diagnosis of oligodendroglioma, this Satellite Workshop reflects the collaboration between two invited keynote speakers: Dr. Johan M. Kros of the Erasmus Medical Center and Dr. Kenneth D. Aldape of the University of Texas MD Anderson Cancer Center and the Organizing Committee of the Japanese Society of Brain Tumor Pathology. In the first half of the workshop, the keynote speakers reviewed the current status of the pathology and genetics of oligodendroglioma. In the second half, six debatable cases that exemplify the current controversies over the diagnosis of oligodendroglioma were presented. The consensus diagnoses in these six cases, which have been reviewed by members of the Society, were opened to discussion and comments by the speakers. These cases highlight unresolved issues in the WHO 2007 classification of oligodendrogliomas, particularly the discordance between morphology and genetics. To achieve synchronization between phenotypes and genotypes, the neuropathology diagnosis should focus on the classic features of oligodendrogliomas that are highly correlated with the genetic background.
Collapse
Affiliation(s)
- Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan,
| | | | | | | | | | | |
Collapse
|
45
|
Clark KH, Villano JL, Nikiforova MN, Hamilton RL, Horbinski C. 1p/19q testing has no significance in the workup of glioblastomas. Neuropathol Appl Neurobiol 2013; 39:706-17. [PMID: 23363074 PMCID: PMC4095883 DOI: 10.1111/nan.12031] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 01/28/2013] [Indexed: 01/09/2023]
Abstract
AIMS To determine whether testing for isolated 1p or 19q losses, or as a codeletion, has any significance in the workup of glioblastomas (GBMs). METHODS Upfront 1p/19q testing by fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR)-based loss of heterozygosity (LOH) was done in 491 gliomas that were histologically diagnosed as GBMs. Outcomes were determined and measured against 1p/19q results. RESULTS Twenty-eight showed apparent 1p/19q codeletion by either FISH and/or PCR-based LOH, but only 1/26 showed codeletion by both tests. Over 90% of tumours with apparent codeletion by either FISH or LOH also had 10q LOH and/or EGFR amplification, features inversely related to true whole-arm 1p/19q codeletion. Furthermore, only 1/28 tumours demonstrated an R132H IDH1 mutation. Neither 1p/19q codeletion by FISH nor LOH had an impact on GBM survival. Isolated losses of 1p or 19q also had no impact on survival. CONCLUSIONS These data suggest that (i) 1p/19q testing is not useful on gliomas that are histologically GBMs; (ii) codeletion testing should be reserved only for cases with compatible morphology; and (iii) EGFR, 10q, and IDH1 testing can help act as safeguards against a false-positive 1p/19q result.
Collapse
Affiliation(s)
- K H Clark
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | |
Collapse
|
46
|
Thon N, Kreth S, Kreth FW. Personalized treatment strategies in glioblastoma: MGMT promoter methylation status. Onco Targets Ther 2013; 6:1363-72. [PMID: 24109190 PMCID: PMC3792931 DOI: 10.2147/ott.s50208] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The identification of molecular genetic biomarkers considerably increased our current understanding of glioma genesis, prognostic evaluation, and treatment planning. In glioblastoma, the most malignant intrinsic brain tumor entity in adults, the promoter methylation status of the gene encoding for the repair enzyme O6-methylguanine-DNA methyltransferase (MGMT) indicates increased efficacy of current standard of care, which is concomitant and adjuvant chemoradiotherapy with the alkylating agent temozolomide. In the elderly, MGMT promoter methylation status has recently been introduced to be a predictive biomarker that can be used for stratification of treatment regimes. This review gives a short summery of epidemiological, clinical, diagnostic, and treatment aspects of patients who are currently diagnosed with glioblastoma. The most important molecular genetic markers and epigenetic alterations in glioblastoma are summarized. Special focus is given to the physiological function of DNA methylation-in particular, of the MGMT gene promoter, its clinical relevance, technical aspects of status assessment, its correlation with MGMT mRNA and protein expressions, and its place within the management cascade of glioblastoma patients.
Collapse
Affiliation(s)
- Niklas Thon
- Department of Neurosurgery, Hospital of the University of Munich, Campus Grosshadern, Munich, Germany
| | | | | |
Collapse
|
47
|
McNamara MG, Sahebjam S, Mason WP. Emerging biomarkers in glioblastoma. Cancers (Basel) 2013; 5:1103-19. [PMID: 24202336 PMCID: PMC3795381 DOI: 10.3390/cancers5031103] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 08/14/2013] [Accepted: 08/19/2013] [Indexed: 11/16/2022] Open
Abstract
Glioblastoma, the most common primary brain tumor, has few available therapies providing significant improvement in survival. Molecular signatures associated with tumor aggressiveness as well as with disease progression and their relation to differences in signaling pathways implicated in gliomagenesis have recently been described. A number of biomarkers which have potential in diagnosis, prognosis and prediction of response to therapy have been identified and along with imaging modalities could contribute to the clinical management of GBM. Molecular biomarkers including O(6)-methlyguanine-DNA-methyltransferase (MGMT) promoter and deoxyribonucleic acid (DNA) methylation, loss of heterozygosity (LOH) of chromosomes 1p and 19q, loss of heterozygosity 10q, isocitrate dehydrogenase (IDH) mutations, epidermal growth factor receptor (EGFR), epidermal growth factor, latrophilin, and 7 transmembrane domain-containing protein 1 on chromosome 1 (ELTD1), vascular endothelial growth factor (VEGF), tumor suppressor protein p53, phosphatase and tensin homolog (PTEN), p16INK4a gene, cytochrome c oxidase (CcO), phospholipid metabolites, telomerase messenger expression (hTERT messenger ribonucleic acid [mRNA]), microRNAs (miRNAs), cancer stem cell markers and imaging modalities as potential biomarkers are discussed. Inclusion of emerging biomarkers in prospective clinical trials is warranted in an effort for more effective personalized therapy in the future.
Collapse
Affiliation(s)
- Mairéad G McNamara
- Pencer Brain Tumor Centre, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
| | | | | |
Collapse
|
48
|
Abstract
Glioblastoma, the most common primary brain tumor, has few available therapies providing significant improvement in survival. Molecular signatures associated with tumor aggressiveness as well as with disease progression and their relation to differences in signaling pathways implicated in gliomagenesis have recently been described. A number of biomarkers which have potential in diagnosis, prognosis and prediction of response to therapy have been identified and along with imaging modalities could contribute to the clinical management of GBM. Molecular biomarkers including O(6)-methlyguanine-DNA-methyltransferase (MGMT) promoter and deoxyribonucleic acid (DNA) methylation, loss of heterozygosity (LOH) of chromosomes 1p and 19q, loss of heterozygosity 10q, isocitrate dehydrogenase (IDH) mutations, epidermal growth factor receptor (EGFR), epidermal growth factor, latrophilin, and 7 transmembrane domain-containing protein 1 on chromosome 1 (ELTD1), vascular endothelial growth factor (VEGF), tumor suppressor protein p53, phosphatase and tensin homolog (PTEN), p16INK4a gene, cytochrome c oxidase (CcO), phospholipid metabolites, telomerase messenger expression (hTERT messenger ribonucleic acid [mRNA]), microRNAs (miRNAs), cancer stem cell markers and imaging modalities as potential biomarkers are discussed. Inclusion of emerging biomarkers in prospective clinical trials is warranted in an effort for more effective personalized therapy in the future.
Collapse
|
49
|
Henriquez NV, Forshew T, Tatevossian R, Ellis M, Richard-Loendt A, Rogers H, Jacques TS, Reitboeck PG, Pearce K, Sheer D, Grundy RG, Brandner S. Comparative expression analysis reveals lineage relationships between human and murine gliomas and a dominance of glial signatures during tumor propagation in vitro. Cancer Res 2013; 73:5834-44. [PMID: 23887970 DOI: 10.1158/0008-5472.can-13-1299] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brain tumors are thought to originate from stem/progenitor cell populations that acquire specific genetic mutations. Although current preclinical models have relevance to human pathogenesis, most do not recapitulate the histogenesis of the human disease. Recently, a large series of human gliomas and medulloblastomas were analyzed for genetic signatures of prognosis and therapeutic response. Using a mouse model system that generates three distinct types of intrinsic brain tumors, we correlated RNA and protein expression levels with human brain tumors. A combination of genetic mutations and cellular environment during tumor propagation defined the incidence and phenotype of intrinsic murine tumors. Importantly, in vitro passage of cancer stem cells uniformly promoted a glial expression profile in culture and in brain tumors. Gene expression profiling revealed that experimental gliomas corresponded to distinct subclasses of human glioblastoma, whereas experimental supratentorial primitive neuroectodermal tumors (sPNET) correspond to atypical teratoid/rhabdoid tumor (AT/RT), a rare childhood tumor.
Collapse
Affiliation(s)
- Nico V Henriquez
- Authors' Affiliations: Division of Neuropathology, Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology; Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Department of Histopathology, Neural Development Unit, and UCL Genomics, UCL Institute of Child Health, Great Ormond Street Hospital, London; and Children's Brain Tumour Research Centre, Queen's Medical Centre, Nottingham, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Boots-Sprenger SHE, Sijben A, Rijntjes J, Tops BBJ, Idema AJ, Rivera AL, Bleeker FE, Gijtenbeek AM, Diefes K, Heathcock L, Aldape KD, Jeuken JWM, Wesseling P. Significance of complete 1p/19q co-deletion, IDH1 mutation and MGMT promoter methylation in gliomas: use with caution. Mod Pathol 2013; 26:922-9. [PMID: 23429602 DOI: 10.1038/modpathol.2012.166] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/23/2012] [Accepted: 08/23/2012] [Indexed: 01/25/2023]
Abstract
The histopathological diagnosis of diffuse gliomas often lacks the precision that is needed for tailored treatment of individual patients. Assessment of the molecular aberrations will probably allow more robust and prognostically relevant classification of these tumors. Markers that have gained a lot of interest in this respect are co-deletion of complete chromosome arms 1p and 19q, (hyper)methylation of the MGMT promoter and IDH1 mutations. The aim of this study was to assess the prognostic significance of complete 1p/19q co-deletion, MGMT promoter methylation and IDH1 mutations in patients suffering from diffuse gliomas. The presence of these molecular aberrations was investigated in a series of 561 diffuse astrocytic and oligodendroglial tumors (low grade n=110, anaplastic n=118 and glioblastoma n=333) and correlated with age at diagnosis and overall survival. Complete 1p/19q co-deletion, MGMT promoter methylation and/or IDH1 mutation generally signified a better prognosis for patients with a diffuse glioma including glioblastoma. However, in all 10 patients with a histopathological diagnosis of glioblastoma included in this study complete 1p/19q co-deletion was not associated with improved survival. Furthermore, in glioblastoma patients >50 years of age the favorable prognostic significance of IDH1 mutation and MGMT promoter methylation was absent. In conclusion, molecular diagnostics is a powerful tool to obtain prognostically relevant information for glioma patients. However, for individual patients the molecular information should be interpreted with caution and weighed in the context of parameters such as age and histopathological diagnosis.
Collapse
Affiliation(s)
- Sandra H E Boots-Sprenger
- Department of Pathology, Radboud University Nijmegen Medical Centre RUNMC, 6500 HB Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|