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Hurvitz SA, McAndrew NP, Bardia A, Press MF, Pegram M, Crown JP, Fasching PA, Ejlertsen B, Yang EH, Glaspy JA, Slamon DJ. A careful reassessment of anthracycline use in curable breast cancer. NPJ Breast Cancer 2021; 7:134. [PMID: 34625570 PMCID: PMC8501074 DOI: 10.1038/s41523-021-00342-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022] Open
Abstract
It has been over three decades since anthracyclines took their place as the standard chemotherapy backbone for breast cancer in the curative setting. Though the efficacy of anthracycline chemotherapy is not debatable, potentially life-threatening and long-term risks accompany this class of agents, leading some to question their widespread use, especially when newer agents with improved therapeutic indices have become available. Critically assessing when to incorporate an anthracycline is made more relevant in an era where molecular classification is enabling not only the development of biologically targeted therapeutics but also is improving the ability to better select those who would benefit from cytotoxic agents. This comprehensive analysis will present the problem of overtreatment in early-stage breast cancer, review evidence supporting the use of anthracyclines in the pre-taxane era, analyze comparative trials evaluating taxanes with or without anthracyclines in biologically unselected and selected patient populations, and explore published work aimed at defining anthracycline-sensitive tumor types.
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Affiliation(s)
- Sara Alsterlind Hurvitz
- grid.19006.3e0000 0000 9632 6718Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA USA
| | - Nicholas P. McAndrew
- grid.19006.3e0000 0000 9632 6718Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA USA
| | - Aditya Bardia
- grid.38142.3c000000041936754XMassachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Michael F. Press
- grid.42505.360000 0001 2156 6853University of Southern California, Los Angeles, CA USA
| | - Mark Pegram
- Stanford Comprehensive Cancer Institute, Palo Alto, CA USA
| | - John P. Crown
- grid.412751.40000 0001 0315 8143Department of Medical Oncology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Peter A. Fasching
- grid.411668.c0000 0000 9935 6525Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Bent Ejlertsen
- grid.4973.90000 0004 0646 7373Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eric H. Yang
- grid.19006.3e0000 0000 9632 6718Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA USA
| | - John A. Glaspy
- grid.19006.3e0000 0000 9632 6718Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA USA
| | - Dennis J. Slamon
- grid.19006.3e0000 0000 9632 6718Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA USA
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Ali Y, Abd Hamid S. Human topoisomerase II alpha as a prognostic biomarker in cancer chemotherapy. Tumour Biol 2015; 37:47-55. [DOI: 10.1007/s13277-015-4270-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/15/2015] [Indexed: 12/12/2022] Open
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3
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de Poot SAH, Lai KW, van der Wal L, Plasman K, Van Damme P, Porter AC, Gevaert K, Bovenschen N. Granzyme M targets topoisomerase II alpha to trigger cell cycle arrest and caspase-dependent apoptosis. Cell Death Differ 2013; 21:416-26. [PMID: 24185622 DOI: 10.1038/cdd.2013.155] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 12/31/2022] Open
Abstract
Cytotoxic lymphocyte protease granzyme M (GrM) is a potent inducer of tumor cell death. The apoptotic phenotype and mechanism by which it induces cell death, however, remain poorly understood and controversial. Here, we show that GrM-induced cell death was largely caspase-dependent with various hallmarks of classical apoptosis, coinciding with caspase-independent G2/M cell cycle arrest. Using positional proteomics in human tumor cells, we identified the nuclear enzyme topoisomerase II alpha (topoIIα) as a physiological substrate of GrM. Cleavage of topoIIα by GrM at Leu(1280) separated topoIIα functional domains from the nuclear localization signals, leading to nuclear exit of topoIIα catalytic activity, thereby rendering it nonfunctional. Similar to the apoptotic phenotype of GrM, topoIIα depletion in tumor cells led to cell cycle arrest in G2/M, mitochondrial perturbations, caspase activation, and apoptosis. We conclude that cytotoxic lymphocyte protease GrM targets topoIIα to trigger cell cycle arrest and caspase-dependent apoptosis.
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Affiliation(s)
- S A H de Poot
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K W Lai
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L van der Wal
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K Plasman
- 1] Department of Medical Protein Research,VIB, Ghent, B-9000, Belgium [2] Department of Biochemistry, Ghent University, Ghent B-9000, Belgium
| | - P Van Damme
- 1] Department of Medical Protein Research,VIB, Ghent, B-9000, Belgium [2] Department of Biochemistry, Ghent University, Ghent B-9000, Belgium
| | - A C Porter
- Centre for Haematology, Faculty of Medicine, Imperial College London, London, UK
| | - K Gevaert
- 1] Department of Medical Protein Research,VIB, Ghent, B-9000, Belgium [2] Department of Biochemistry, Ghent University, Ghent B-9000, Belgium
| | - N Bovenschen
- 1] Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands [2] Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Concurrent inhibition of enzymatic activity and NF-Y-mediated transcription of Topoisomerase-IIα by bis-DemethoxyCurcumin in cancer cells. Cell Death Dis 2013; 4:e756. [PMID: 23928695 PMCID: PMC3763449 DOI: 10.1038/cddis.2013.287] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/03/2013] [Accepted: 07/04/2013] [Indexed: 01/23/2023]
Abstract
Topoisomerases-IIα (TOP2A) enzyme is essential for cell viability due to its fundamental role in DNA metabolism and in chromatin organization during interphase and mitosis. TOP2A expression is finely regulated at the transcriptional level through the binding of the CCAAT-transcription factor NF-Y to its promoter. Overexpression and/or amplification of TOP2A have been observed in many types of cancers. For this reason, TOP2A is the target of the most widely successful drugs in cancer chemotherapy, such as TOP2A poisons, which stabilize TOP2A-DNA cleavage complexes and create DSBs, leading to chromosome damage and cell death. We previously reported that the Curcumin-derivative bis-DemethoxyCurcumin (bDMC) is an anti-proliferative agent that inhibits cell growth by concomitant G1/S and G2/M arrest. Here we showed that bDMC irreversibly induces DSBs in cancer cells, but not in normal cells, by targeting TOP2A activity and expression. TOP2A ablation by siRNA corroborates its contribution to apoptosis induced by bDMC. Short-term exposure to bDMC induces retention of TOP2A-DNA intermediates, while longer exposure inhibits TOP2A transcription by affecting expression and sub-cellular localization of NF-Y subunits. ChIP analysis highlighted reduced recruitment of NF-Y to TOP2A regulatory regions, concomitantly to histone deacetylation and decreased gene transcription. Our findings suggest that the dual activity of bDMC on TOP2A represents a novel therapeutic strategy to induce persistent apoptosis in cancer cells and identify NF-Y regulation as a promising approach in anti-cancer therapy.
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Nordfors K, Haapasalo J, Korja M, Niemelä A, Laine J, Parkkila AK, Pastorekova S, Pastorek J, Waheed A, Sly WS, Parkkila S, Haapasalo H. The tumour-associated carbonic anhydrases CA II, CA IX and CA XII in a group of medulloblastomas and supratentorial primitive neuroectodermal tumours: an association of CA IX with poor prognosis. BMC Cancer 2010; 10:148. [PMID: 20398423 PMCID: PMC2874782 DOI: 10.1186/1471-2407-10-148] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 04/18/2010] [Indexed: 01/13/2023] Open
Abstract
Background Medulloblastomas (MBs) and supratentorial primitive neuroectodermal tumours (PNETs) are the most common highly aggressive paediatric brain tumours. In spite of extensive research on these tumours, there are only few known biomarkers or therapeutic target proteins, and the prognosis of patients with these tumours remains poor. Our aim was to investigate whether carbonic anhydrases (CAs), enzymes commonly overexpressed in various tumours including glioblastomas and oligodendrogliomas, are present in MBs and PNETs, and whether their expression can be correlated with patient prognosis. Methods We determined the expression of the tumour-associated carbonic anhydrases CA II, CA IX and CA XII in a series of MB/PNET specimens (n = 39) using immunohistochemistry. Results Endothelial CA II, cytoplasmic CA II, CA IX and CA XII were expressed in 49%, 73%, 23% and 11% of the tumours, respectively. CA II was detected in the neovessel endothelium and the tumour cell cytoplasm. CA IX was mainly expressed in the tumour cells located in perinecrotic areas. CA XII showed the most homogenous distribution within the tumours. Importantly, CA IX expression predicted poor prognosis in both univariate (p = 0.041) and multivariate analyses (p = 0.016). Conclusions We suggest that CA IX should be considered a potential prognostic and therapeutic target in MBs and PNETs.
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Abstract
Tissue microarrays (TMAs) have become a standard tool for tissue-based research during the last decade. In cancer research, depending on the available data attached to the arrayed tissue, three main types of arrays are commonly manufactured. Prevalence TMAs have no further data available and are suited to estimate the frequency of the occurrence of a particular alteration. Progression arrays include tissues of different stages of disease, and are instrumental to study the role of a marker protein for tumor initiation, progression, or metastatic growth. Prognosis TMAs contain tissues with patient follow-up data. These TMAs are the key to uncover the clinical impact of molecular markers. In combination with normal tissue arrays representing healthy tissues, prevalence, progression, and prognosis TMAs allow for a rapid and comprehensive analysis of molecular markers in human cancers. TMAs are also successfully used for many noncancer applications, such as Alzheimer's or inflammatory disease research.
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Brosh R, Rotter V. Transcriptional control of the proliferation cluster by the tumor suppressor p53. ACTA ACUST UNITED AC 2010; 6:17-29. [DOI: 10.1039/b911416e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Holmlund C, Haapasalo H, Yi W, Raheem O, Brännström T, Bragge H, Henriksson R, Hedman H. Cytoplasmic LRIG2 expression is associated with poor oligodendroglioma patient survival. Neuropathology 2009; 29:242-7. [PMID: 18992012 DOI: 10.1111/j.1440-1789.2008.00970.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The three leucine-rich repeats and immunoglobulin-like domains (LRIG) genes encode integral membrane proteins. Of these, LRIG1 negatively regulates growth factor signaling and is implicated as a tumor suppressor in certain malignancies. In astrocytic tumors, the subcellular distribution of LRIG proteins is associated with specific clinicopathological features and patient survival. The role of LRIG proteins in oligodendroglioma has not previously been studied. Here we used immunohistochemistry to analyze the expression of the LRIG proteins in 63 oligodendroglial tumors, and evaluated possible associations between LRIG protein expression and clinicopathological parameters. Notably, cytoplasmic LRIG2 expression was found to be an independent prognostic factor associated with poor oligodendroglioma patient survival. This is the first report of an LRIG protein showing a negative effect on survival, suggesting that LRIG2 might have a function different from that of LRIG1, and possibly contributing to the etiology of oligodendroglioma.
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Affiliation(s)
- Camilla Holmlund
- Departments of Radiation Sciences, Oncology, Umeå University, Sweden
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9
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Contribution of DNA repair mechanisms to determining chemotherapy response in high-grade glioma. J Clin Neurosci 2008; 15:1-8. [DOI: 10.1016/j.jocn.2007.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 05/23/2007] [Indexed: 01/07/2023]
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10
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Wang H, Wang H, Zhang W, Fuller GN. Tissue microarrays: applications in neuropathology research, diagnosis, and education. Brain Pathol 2006; 12:95-107. [PMID: 11770905 PMCID: PMC8095954 DOI: 10.1111/j.1750-3639.2002.tb00426.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Tissue microarrays (TMAs) are composite paraffin blocks constructed by extracting cylindrical tissue core "biopsies" from different paraffin donor blocks and re-embedding these into a single recipient (microarray) block at defined array coordinates. Using this technique, up to 1000 or more tissue samples can be composited into a single paraffin block. Tissue microarrays permit high-volume simultaneous analysis of molecular targets at the DNA, mRNA, and protein levels under identical, standardized conditions on a single glass slide, and also provide maximal preservation and utilization of limited and irreplaceable archival tissue samples. This versatile technique facilitates retrospective and prospective human tissue studies, animal tissue studies, and cell line cytospin cell block studies. In this review, we present the technical aspects of TMA construction and sectioning, validation aspects of the technique, TMA advantages and limitations, and a sampling of the broad range of TMA uses in modern neuropathologic clinical diagnosis, research, and education. A specific illustration of the most widely employed and increasingly important TMA application is also presented: confirmation via TMA-based immunohistochemistry of the differential expression of a marker (IGFBP2) initially identified by gene expression profiling to be overexpressed in glioblastoma.
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Affiliation(s)
- Huamin Wang
- Department of Pathology and Laboratory Medicine, The University of Texas Medical School at Houston
| | - Hua Wang
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Wei Zhang
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Gregory N. Fuller
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston
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Chacko G, Chacko AG, Rajshekhar V, Muliyil JP. Intracranial hemangiopericytomas: correlation of topoisomerase IIalpha expression with biologic behavior. ACTA ACUST UNITED AC 2006; 65:11-7. [PMID: 16378841 DOI: 10.1016/j.surneu.2005.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 07/05/2005] [Accepted: 08/03/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Meningeal hemangiopericytomas are aggressive tumors that have a high rate of recurrence despite gross total resection and radiation therapy. Topoisomerase, a cell proliferation marker, is also a target of certain chemotherapeutic agents, and its nuclear levels are speculated to predict efficacy of targeted therapy. The aim of this study was to correlate the topoisomerase IIalpha proliferation index (TPI) with biologic behavior in intracranial hemangiopericytomas. METHODS Clinical, radiological, and management data in 27 patients with intracranial hemangiopericytoma admitted between 1990 and 2003 were reviewed. Immunohistochemistry was performed on all the tumors using a monoclonal antibody to topoisomerase IIalpha, and the proliferation index was calculated. The effect of TPI on outcome was sought. RESULTS The male/female ratio was 15:12. The mean age at presentation was 31.33 years. A radical excision of tumor was done in 18, subtotal excision in 2, partial excision in 4, and a biopsy in 3 patients. Tumor recurrence was noted in 15 (55.6%) of the 27 patients (mean follow-up duration, 51.5 months). The time to recurrence ranged from 7 months to 8 years (mean, 49 months). The 5-year recurrence-free survival was 33.8% in patients with a TPI of 5% or greater, and 72% in patients with a TPI of less than 5%. The relative risk of recurrence was 2.9 times greater in patients with a TPI 5% or greater as compared with those a TPI of less than 5%. CONCLUSION Our study suggests that cases with a radical excision, radiation therapy, or a TPI index of less than 5% have a longer recurrence-free survival. A TPI of 5% or greater is a reliable predictor of recurrence.
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Affiliation(s)
- Geeta Chacko
- Division of Neuropathology, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore 632004, India.
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12
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Oda M, Arakawa Y, Kano H, Kawabata Y, Katsuki T, Shirahata M, Ono M, Yamana N, Hashimoto N, Takahashi JA. Quantitative analysis of topoisomerase IIα to rapidly evaluate cell proliferation in brain tumors. Biochem Biophys Res Commun 2005; 331:971-6. [PMID: 15882973 DOI: 10.1016/j.bbrc.2005.03.224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2005] [Indexed: 11/24/2022]
Abstract
Immunohistochemical cell proliferation analyses have come into wide use for evaluation of tumor malignancy. Topoisomerase IIalpha (topo IIalpha), an essential nuclear enzyme, has been known to have cell cycle coupled expression. We here show the usefulness of quantitative analysis of topo IIalpha mRNA to rapidly evaluate cell proliferation in brain tumors. A protocol to quantify topo IIalpha mRNA was developed with a real-time RT-PCR. It took only 3 h to quantify from a specimen. A total of 28 brain tumors were analyzed, and the level of topo IIalpha mRNA was significantly correlated with its immuno-staining index (p<0.0001, r=0.9077). Furthermore, it sharply detected that topo IIalpha mRNA decreased in growth-inhibited glioma cell. These results support that topo IIalpha mRNA may be a good and rapid indicator to evaluate cell proliferate potential in brain tumors.
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Affiliation(s)
- Masashi Oda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8315, Japan
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Abstract
The identification of disease-related genes is a major focus of modern biomedical research. Recent techniques, including array-based platforms for molecular profiling of disease tissues such as DNA arrays for expression profiling or matrix comparative genomic hybridization, allow for the comprehensive screening of the whole genome in a single experiment. Consequently, thousands of candidate genes have already been identified that may be linked to disease development and progression, and the process of lead discovery continues unimpeded. The evaluation of the clinical value of such leads is challenging because thousands of well-characterized tissue specimens must be analyzed. Tissue microarray (TMA) technology enables high-throughput tissue analyses to keep pace with the rapid process of lead discovery. With this technique, up to 1000 minute tissue samples are brought into an array format and analyzed simultaneously. The TMA technology is a fast, cost-effective, and statistically powerful method that will substantially facilitate translational research.
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Affiliation(s)
- Ronald Simon
- University of Basel, Institut für Pathologie, Schönbeinstrasse 40, Basel, Switzerland.
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Mueller RE, Parkes RK, Andrulis I, O'Malley FP. Amplification of the TOP2A gene does not predict high levels of topoisomerase II alpha protein in human breast tumor samples. Genes Chromosomes Cancer 2004; 39:288-97. [PMID: 14978790 DOI: 10.1002/gcc.20008] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Recent clinical trials have suggested that patients whose breast tumors overexpress HER2 may derive particular benefit from anthracycline-containing chemotherapy compared to that without anthracycline. It has been proposed that the HER2 gene amplification reported in these tumors might mask an underlying TOP2A gene amplification that occurs frequently and concurrently with HER2 amplification. Topoisomerase II alpha, encoded by TOP2A, is a direct molecular target of anthracycline drug action and is potentially useful as a predictive marker of response to anthracycline therapy for breast cancer. In this study, we examined whether TOP2A gene amplification is an appropriate marker for identifying breast tumors expressing high levels of topoisomerase II alpha. We determined topoisomerase II alpha protein expression by immunohistochemistry in 81 human breast tumors in relation to HER2 and TOP2A gene copy numbers analyzed by fluorescence in situ hybridization, histologic grade, cell proliferation fraction measured by MIB-1 expression, and HER2 protein expression determined by immunohistochemistry. The results showed no correlation between TOP2A gene copy number and topoisomerase II alpha protein expression levels in breast tumors, in contrast to the analogous situation for HER2 gene amplification and HER2 immunohistochemistry. Our results suggest that TOP2A gene amplification in breast tumors does not predict high expression of topoisomerase II alpha protein.
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MESH Headings
- Antigens, Neoplasm
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Chromosomes, Human, Pair 17/genetics
- DNA Topoisomerases, Type II/genetics
- DNA Topoisomerases, Type II/immunology
- DNA-Binding Proteins
- Data Interpretation, Statistical
- Formaldehyde/metabolism
- Gene Amplification/genetics
- Gene Dosage
- Gene Expression Regulation, Neoplastic
- Humans
- Immunohistochemistry/methods
- Immunohistochemistry/statistics & numerical data
- In Situ Hybridization, Fluorescence/methods
- Ki-67 Antigen/immunology
- Paraffin Embedding/methods
- Ploidies
- Poly-ADP-Ribose Binding Proteins
- Predictive Value of Tests
- Receptor, ErbB-2/biosynthesis
- Receptor, ErbB-2/immunology
- Tissue Fixation/methods
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Affiliation(s)
- Rosemary E Mueller
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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15
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Abstract
Modern research technologies, including DNA, protein, and antibody microarrays identify a steadily growing number of clues that are useful in molecular disease classification, drug development, and the prediction of response to treatment. Subsequent validation of the clinical importance of such candidate genes or proteins requires large-scale analysis of human tissues. To date, this analysis constitutes an important bottleneck in the process of discovery because tissue analysis by the conventional slide-by-slide strategy is slow and expensive. To overcome these limitations, tissue microarray (TMA) technology has been developed. TMA allows for the simultaneous analysis of up to 1,000 tissue samples in a single experiment, using all types of in-situ analyses including immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and RNA in situ hybridization (RNA-ISH). TMA technology has the potential to greatly facilitate the translation of basic research into clinical practice. Potential applications include the establishment of associations between molecular changes and clinical endpoints, testing of potential therapeutic targets using tissue samples from specific cancer patients, standardization of molecular detection of targets, and rapid translation of results from cell lines and animal models to human cancer. Because of its beneficial economic aspects and ability to differentiate ethnic differences in tumor biology, TMA applications may become particularly important in developing countries.
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16
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Abstract
Recent advances in the molecular classification of lung carcinomas and the identification of causative genetic alterations will likely lead to improvements in the diagnosis and treatment of patients with lung cancer. It is now possible to identify gene expression profiles that associate with patient outcome in lung carcinomas, in particular adenocarcinoma. Furthermore, patient survival has been shown to correlate with lung cancer oligonucleotide microarray expression profiles. Large-scale microarray technology may allow for the identification of useful biomarkers for early cancer detection. Oligonucleotide microarray data can be optimized by relating them to protein expression levels in tissue microarrays, by annotation with mutational data, and with results of testing for post-translational modification of cellular proteins. These data may be useful in tailoring chemotherapeutic protocols to individual tumors and identifying new targets for therapeutic intervention.
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Affiliation(s)
- Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Insitute, Boston, MA 02115, USA
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17
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Affiliation(s)
- Guido Sauter
- Institut of Pathology, University of Basel, Schoenbeinstrasse 40, CH-4031 Basel, Switzerland.
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18
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Vrolijk H, Sloos W, Mesker W, Franken P, Fodde R, Morreau H, Tanke H. Automated acquisition of stained tissue microarrays for high-throughput evaluation of molecular targets. J Mol Diagn 2003; 5:160-7. [PMID: 12876206 PMCID: PMC1907332 DOI: 10.1016/s1525-1578(10)60468-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
At present, limiting factors in the use of tissue microarrays (TMAs) for high-throughput analysis relate to the visual evaluation of the staining patterns of each of the individual cores in the array and to the subsequent input of the results into a database. Such a database is essential to correlate the data with tumor type and outcome, and to evaluate the performance against other markers achieved in separate experiments. So far, these steps are mostly performed by hand, and consequently are time-consuming and potentially prone to bias and errors, respectively. This paper describes the use of a high-resolution flat-bed scanner for digitization of TMAs with a resolution of about 5 x 5 micro m(2). The arrays are acquired, the positions of the tissue cores are automatically determined, and measurement data including the images of the individual cores are archived. The program provides digital zooming of arrays for interactive verification of the results and rapid linkage of individual core images to data sets of other markers derived from the same array. Performance of the system was compared to manual classification for a representative set of arrays containing colorectal tumors stained with different markers.
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Affiliation(s)
- Hans Vrolijk
- Laboratory for Cytochemistry and Cytometry, Leiden University Medical Center, Leiden, The Netherlands.
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19
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Park SH, Suh YL. Expression of cyclin A and topoisomerase IIalpha of oligodendrogliomas is correlated with tumour grade, MIB-1 labelling index and survival. Histopathology 2003; 42:395-402. [PMID: 12653952 DOI: 10.1046/j.1365-2559.2003.01597.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS This study was designed to investigate immunoexpression of cyclin A and D1, and topoisomerase IIalpha in oligodendrogliomas and to evaluate the correlation with MIB-1 (Ki67), tumour grade, and survival of the patients. METHODS AND RESULTS Forty cases of oligodendrogliomas (20 high- and 20 low-grade) were studied immunohistochemically with the above-mentioned monoclonal antibodies. RESULTS Normal brain tissues included in tumour sections did not express any of cyclin A, MIB-1 and topoisomerase IIalpha except cyclin D1, which was shown in perineuronal and interfascicular normal oligodendroglial cells. In low-grade and high-grade oligodendrogliomas, the mean cyclin A labelling index (LI) was 1.18 +/- 0.98% versus 4.65 +/- 1.99%, respectively; the mean topoisomerase IIalpha LI was 1.32 +/- 1.04% versus 6.63 +/- 4.31%, respectively; and the mean MIB-1 LI was 1.69 +/- 1.55% versus 9.46 +/- 4.66%, respectively. Interestingly, cyclin D1 was not expressed in any oligodendrogliomas. Both cyclin A and topoisomerase IIalpha LI showed a significant positive correlation with MIB-1 LI and histological grade of oligodendrogliomas (P < 0.01) and an inverse correlation with overall survival (P < 0.01). Univariate analysis showed that cyclin A and topoisomerase IIalpha LIs with a cut-off point at 3% were a significant prognostic factor (P: cyclin A = 0.0040, topoisomerase IIalpha = 0.0033). CONCLUSION Cyclin A and topoisomerase IIalpha expression are closely correlated with anaplastic oligodendrogliomas and worse clinical outcomes. Cyclin D1 seems not to be involved in the tumorigenesis of oligodendrogliomas.
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Affiliation(s)
- S-H Park
- Department of Pathology, Ilsanpaik Hospital, Inje University College of Medicine, Seoul, Korea
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20
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Abstract
Despite a number of basic and clinical studies, it is still very difficult to improve the prognosis of patients with high-grade astrocytoma. However, the recent success of procarbazine, N-(2-chloroethyl)-N'-cyclohexyl-N-nitrosourea and vincristine (PCV) chemotherapy for oligodendrogliomas that have lost chromosomes 1p and 19q has encouraged the authors to evaluate the biological behavior of brain tumors by means of genetic analysis. Both the disorders of the p53/MDM2/p14(ARF) and the p16(INK4a)/RB signaling pathways have been found to play an essential role in tumorigenesis of various brain tumors. Herein, the authors summarize the genetic alterations of brain tumors by mainly focusing on two pathways that appear to affect significantly the patient prognosis.
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21
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Fuller CE, Wang H, Zhang W, Fuller GN, Perry A. High-throughput molecular profiling of high-grade astrocytomas: the utility of fluorescence in situ hybridization on tissue microarrays (TMA-FISH). J Neuropathol Exp Neurol 2002; 61:1078-84. [PMID: 12484570 DOI: 10.1093/jnen/61.12.1078] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Due to recent biological and technical advances, the list of potentially useful candidate genes is rapidly expanding in the study of brain tumors. However, traditional methods of screening individual genes in individual samples are slow and tedious, often with consumption of precious resources after only a few experiments. This study evaluates the feasibility of high-throughput molecular analysis using fluorescence in situ hybridization (FISH) on glioma tissue microarrays (TMA). A single microarray paraffin block was constructed using 65 WHO grade III and IV astrocytomas, sampled in duplicate with 0.6-mm-diameter punch cores. FISH was used to detect common alterations, such as EGFR amplification, chromosome 7, 9, and 10 aneusomies and deletions of 1p, 19q, PTEN, DMBT1, and p16. Of 585 hybridization sets, 508 (87%) yielded interpretable data, with hybridization failure in 33 (5.5%) and dislodged tissue in 44 sets (7.5%), respectively. Glioblastomas harbored significantly more alterations than anaplastic astrocytomas, with the overall frequencies of alterations similar to those reported using other techniques. The overall concordance rate between paired tumor core samples was 93%. We conclude that TMA-FISH is an efficient and reliable method for detecting molecular alterations in high-grade astrocytomas.
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Affiliation(s)
- Christine E Fuller
- Division of Neuropathology, Barnes-Jewish Hospital, Washington University Medical Center, St. Louis, Missouri 63110, USA
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22
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Korshunov A, Shishkina L, Golanov A. DNA topoisomerase II-alpha and cyclin A immunoexpression in meningiomas and its prognostic significance: an analysis of 263 cases. Arch Pathol Lab Med 2002; 126:1079-86. [PMID: 12204057 DOI: 10.5858/2002-126-1079-dtiaca] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Routine pathologic examination cannot distinctively predict the clinical course of meningiomas because even histologically benign tumors may recur after gross total resection. Therefore, numerous efforts have been made to evaluate the meningioma growth fraction and its prognostic value. However, a universally applicable proliferative marker for meningioma outcome is not yet a reality. OBJECTIVE To investigate the prognostic utility of 3 proliferative markers, namely, Ki-67, DNA topoisomerase II-alpha (topoII), and cyclin A in a representative series of intracranial meningiomas. DESIGN Two hundred sixty-three adult patients with intracranial meningiomas (208 benign, 42 atypical, and 13 anaplastic) were studied retrospectively. Tumor specimens were immunohistochemically examined with antibodies to Ki-67 (MM-1), topoII, and cyclin A. A computerized color image analyzer was used to count immunostained nuclei. RESULTS The topoII and cyclin A scores exhibited a close correlation with Ki-67 immunostaining. Significant differences between the indices for all 3 markers were noted among the 3 grades of meningiomas. The scores for all 3 markers were significantly different between recurrent and nonrecurrent meningiomas, including benign tumors that were treated with gross total resection. Recurrence-free survival was significantly reduced for cases with a Ki-67 labeling index (LI) of 4.4% or greater, a topoII LI of 3.2% or greater, and a cyclin A LI of 3.1% or greater. Multivariate analysis revealed that the risk of recurrence for the entire meningioma cohort was significantly associated with tumor grade (hazard ratio = 2.7; P =.004), topoII LI of 3.2% or greater (hazard ratio = 5.5; P <.001), and a cyclin A LI of 3.1% or greater (hazard ratio = 2.4; P =.01). CONCLUSIONS There is a close correlation in the expression of these 3 proliferative markers in meningiomas, and all of the markers showed a significant association with tumor grade, recurrence rate, and recurrence-free survival. Consequently, in addition to Ki-67, immunoexpression of topoII and cyclin A is available for predicting meningioma recurrence. Moreover, the topoII and cyclin A staining scores were found to be more sensitive predictors for meningioma progression than Ki-67 and, therefore, either of these 2 markers may prove to be clinically informative and useful.
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Affiliation(s)
- Andrey Korshunov
- Department of Neuropathology, Burdenko Neurosurgical Institute, Moscow, Russia.
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23
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Engelhard HH, Stelea A, Cochran EJ. Oligodendroglioma: pathology and molecular biology. SURGICAL NEUROLOGY 2002; 58:111-7; discussion 117. [PMID: 12453646 DOI: 10.1016/s0090-3019(02)00751-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recently, important new information has become available concerning the histologic recognition and molecular biology of oligodendrogliomas. This information, in turn, impacts the way neurosurgeons diagnose and treat patients with these tumors. The purpose of this paper is to review the pathology and basic science of oligodendroglioma, highlighting these developments. METHODS Information for this review was obtained by a Medline search using the term "oligodendroglioma," and limiting the results to articles dealing with pathology. Chapters from standard textbooks were also used, and bibliographies were checked for additional key articles contributing to the understanding of the pathobiology of this disease. RESULTS On histologic examination, oligodendrogliomas must be differentiated from tumors including the fibrillary astrocytoma, clear cell ependymoma, central neurocytoma, and dysembryoplastic neuroepithelial tumor (DNT). There is no specific immunocytochemical marker allowing for the recognition of human oligodendroglial tumor cells. A current simplified grading scheme separates these tumors into low grade (WHO grade II) and anaplastic (WHO grade III) oligodendrogliomas. New molecular and genetic markers may aid in grading oligodendrogliomas and identifying patients with a better prognosis or response to chemotherapy. Markers studied include Ki-67, PCNA, EGFr, VEGF, platelet-derived growth factor, p16, p18, p53, bcl-2, COX-1, and chromosomal deletions. The combination of allelic losses on chromosomes 1p and 19q has been statistically associated with a longer recurrence-free survival after chemotherapy. CONCLUSIONS A patient with an oligodendroglioma may at times still present a diagnostic challenge for the neuropathologist. Yet making an accurate diagnosis is essential, since the clinical course and optimal therapeutic approach differs from that of other gliomas. In the near future, molecular characterization of oligodendrogliomas is expected to play an even greater clinical role.
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Affiliation(s)
- Herbert H Engelhard
- Department of Neurosurgery, The University of Illinois at Chicago, 912 South Wood Street, Chicago, IL 60612, USA
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24
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Abstract
Malignant transformation results from accumulation of genetic and epigenetic events. Functional studies of cancer will be crucial to our understanding of its complexity and polymorphism. There is no doubt that emerging genomic and proteomic technologies will facilitate such investigations. Microarray technology is a new and efficient approach to extract data of biomedical relevance for a wide range of applications. In cancer research, it will provide high-throughput and valuable insights into differences in an individual's tumor as compared with constitutional DNA, mRNA expression, and protein expression and activity. Across individuals, comparisons could provide tissue-specific disease signatures that provide diagnosis based on hundreds of informative genes. The resulting product should be a wealth of tumor-associated and tumor-specific biomarkers, which may help in cancer etiology, diagnosis, and therapy and ultimately lead to "molecular nosology" of cancers. This review highlights the recent developments in microarray technologies in cancer research, focuses on the results obtained so far, and describes the eventual use of microarray technology for clinical applications.
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Affiliation(s)
- Steve Mohr
- Institut National de Recherche et de Sécurité, Vandoeuvre-Lès-Nancy, France
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25
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Korshunov A, Golanov A, Sycheva R. Immunohistochemical markers for prognosis of oligodendroglial neoplasms. J Neurooncol 2002; 58:237-53. [PMID: 12187958 DOI: 10.1023/a:1016270101321] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Despite numerous previous studies, oligodendrogliomas continue to generate considerable controversy in the identification of prognostic factors, including single histopathological patterns, and grade of tumor malignancy. The prognostic significance of various pathological and immunohistochemical factors has been intensively examined but numerous studies have yielded conflicting results. In the present study, biopsy samples of 123 oligodendrogliomas were examined immunohistochemically to evaluate a possible association between expression of various tumor-associated antigens and clinical outcome. Both the progression-free and overall survival times were significantly reduced for high-grade tumors, for Ki-S1 labeling index (LI) > 10%, for p27 LI < 20% and for p18, p53, and vascular endothelial growth factor (VEGF)-positive tumors. For low-grade tumors survival rates were significantly reduced for p27 LI less than 20%, whereas high-grade oligodendrogliomas with Ki-S1 LI greater than 10%, and with p18 positivity revealed significantly shortened survival times. We found no differences in survival times in patients with or without p 14ARF, p21, mdm2, and pRb immunoreactivity. Multivariate analysis revealed that risk of oligodendroglioma progression is associated with high-grade tumors, with Ki-S1 LI > 10%, and with p27 LI < 20%; whereas risk of death is associated with high-grade tumors, with Ki-S1 LI > 10%, and with p18 positivity. CART modeling process identified four final groups of oligodendroglioma patients: (1) thirty-nine patients with low-grade tumors and p27 LI > 20%; (2) twenty patients with low-grade tumors and p27 LI < 20%; (3) thirty-four patients with high-grade tumors and Ki-S1 LI < 10%; and (4) thirty patients with high-grade tumors and Ki-S1 LI >10%. In summary, both the p27 and Ki-S1 scores were found to be the strong predictors of oligodendroglioma outcome together with the WHO tumor grade and they seem to be useful for assessing individual prognosis in routinely processed specimens.
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Affiliation(s)
- Andrey Korshunov
- Department of Neuropathology, Neurosurgical NN Burdenko Institute, Moscow, Russia.
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Abstract
Chemotherapy lacks efficacy in most histological types of primary human brain tumours and has, for most types, failed to improve outcome for patients. The unsatisfactory results with chemotherapeutic intervention in these cancers have been chiefly attributed to tumour-cell resistance. This review summarises some of the major molecular markers that, although neither exclusive for nor specific to brain tumours, have been associated with the formation of a chemoresistant phenotype. Elucidation of the cellular mechanisms involved in resistance regulation is needed for future progress in efficient approaches to selective modulation of drug resistance in these lesions.
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Affiliation(s)
- Markus Bredel
- Department of General Neurosurgery, Neurocenter, University of Freiburg, Freiburg, Germany.
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27
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Abstract
Object
The strategies used to diagnose and treat oligodendroglial tumors have changed significantly over the past decade. The purpose of this paper is to review the topic of oligodendroglioma, emphasizing the new developments.
Methods
Information was obtained by conducting a Medline search in which the term oligodendroglioma was used. Recent editions of standard textbooks were also studied.
Because of tools such as magnetic resonance imaging, oligodendrogliomas are being diagnosed earlier, and they are being recognized more frequently histologically than in the past. Seizures are common in these patients. Functional mapping and image-guided surgery may now allow for a safer and more complete resection, especially when tumors are located in difficult areas. Genetic analysis and positron emission tomography may provide data that supplement the standard diagnostic tools. Unlike other low-grade gliomas, patients in whom residual or recurrent oligodendroglioma (World Health Organization Grade II) is present may respond to chemotherapy. Although postoperative radiotherapy prolongs survival of the patient, increasingly this therapeutic modality is being delayed until tumor recurrence, especially if a gross-total tumor resection has been achieved. Oligodendrogliomas are the first type of brain tumor for which “molecular” characterization gives important information. The most significant finding is that allelic losses on chromosomes 1p and 19q indicate a favorable response to chemotherapy.
Conclusions
Whereas surgery continues to be the primary treatment for oligodendroglioma, the scheme for postoperative therapy has shifted, primarily because of the lesion's relative chemosensitivity. Molecular characterization of oligodendrogliomas may become a standard practice in the near future.
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Affiliation(s)
- Herbert H Engelhard
- Department of Neurosurgery, The University of Illinois at Chicago, Illinois 60612, USA.
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Korshunov A, Golanov A. Immunohistochemical analysis of p18INK4C and p14ARF protein expression in 117 oligodendrogliomas: correlation with tumor grade and clinical outcome. Arch Pathol Lab Med 2002; 126:42-8. [PMID: 11800646 DOI: 10.5858/2002-126-0042-iaopap] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate immunoexpression of 2 cyclin-dependent kinase inhibitors, p18INK4C (p18) and p14ARF (p14), in oligodendrogliomas and to evaluate the possible association with tumor grade and clinical outcome. DESIGN One hundred seventeen specially selected cases of cerebral oligodendrogliomas were studied retrospectively. Tumor specimens were immunohistochemically examined with antibodies to p18INK4C (118.2) and p14ARF (FL-132) proteins. A computerized color image analyzer was used to count immunostained nuclei. RESULTS p18 nuclear immunoexpression was found in 57 (49%) of the oligodendrogliomas we studied. p18 immunoreactivity exhibited a clear tendency to elevate with increasing tumor grade, and the mean p18 labeling index was 9.7% for low-grade (World Health Organization [WHO] grade II) and 19.2% for high-grade (WHO III) tumors. p14-immunopositive nuclei were found in 87 (74%) tumors, and p14 immunoreactivity showed no correlation with oligodendroglioma histological malignancy. Survival times were significantly reduced for p18-positive tumors, and risk of death was independently associated with p18 expression (hazard ratio = 2.48; P =.01). There was no difference in survival times in patients with or without p14 immunoreactivity. CONCLUSIONS p18 protein expression is closely associated with malignant oligodendrogliomas and worse clinical outcome. It seems unlikely that p14 immunohistochemistry will be of value in assessing individual prognosis for these tumors.
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Affiliation(s)
- Andrey Korshunov
- Department of Neuropathology, Burdenko Neurosurgical Institute, Moscow, Russia.
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Paunu N, Syrjäkoski K, Sankila R, Simola KO, Helén P, Niemelä M, Matikainen M, Isola J, Haapasalo H. Analysis of p53 tumor suppressor gene in families with multiple glioma patients. J Neurooncol 2001; 55:159-65. [PMID: 11859970 DOI: 10.1023/a:1013890022041] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The high incidence of gliomas in Li-Fraumeni families and the high frequency of somatic p53 mutations in sporadic glial tumors have raised the possibility that germline p53 mutations could play an important role in familial aggregation of gliomas. In the present study, 18 families with two or more gliomas were screened for germline p53 mutation. The families were identified through questionnaires sent to 369 consecutive glioma patients operated at Tampere University Hospital during 1983-1994. In these families, a family history of cancer was verified through the Finnish Cancer Registry. Interestingly, the questionnaires reveled only 15 of 57 cancers (index gliomas excluded) retrieved through the Cancer Registry. None of the 18 families fufilled the criteria for classic Li-Fraumeni syndrome. Immunostaining analysis of p53 protein accumulation suggested that alterations of the p53 gene are as common in familial as in sporadic gliomas. Sequencing analysis of exons 4-10 of the p53 gene revealed no germline mutations in any of the 18 families. Thus, although occasional glioma families carrying germline p53 mutations have been identified in earlier studies, systematic evaluation of familial glioma patients suggests that the p53 gene is not a common susceptibility gene in case of familial gliomas. The p53 tumor suppressor gene seems to have a similar role in the tumorigenesis of most familial and sporadic gliomas.
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Affiliation(s)
- N Paunu
- Department of Pathology, Tampere University Hospital and University of Tampere, Finland.
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