1
|
Buckley DN, Tew BY, Gooden C, Salhia B. A comprehensive analysis of minimally differentially methylated regions common to pediatric and adult solid tumors. NPJ Precis Oncol 2024; 8:125. [PMID: 38824198 PMCID: PMC11144230 DOI: 10.1038/s41698-024-00590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/14/2024] [Indexed: 06/03/2024] Open
Abstract
Cancer is the second most common cause of death in children aged 1-14 years in the United States, with 11,000 new cases and 1200 deaths annually. Pediatric cancers typically have lower mutational burden compared to adult-onset cancers, however, the epigenomes in pediatric cancer are highly altered, with widespread DNA methylation changes. The rarity of pediatric cancers poses a significant challenge to developing cancer-type specific biomarkers for diagnosis, prognosis, or treatment monitoring. In the current study, we explored the potential of a DNA methylation profile common across various pediatric cancers. To do this, we conducted whole genome bisulfite sequencing (WGBS) on 31 recurrent pediatric tumor tissues, 13 normal tissues, and 20 plasma cell-free (cf)DNA samples, representing 11 different pediatric cancer types. We defined minimal focal regions that were differentially methylated across samples in the multiple cancer types which we termed minimally differentially methylated regions (mDMRs). These methylation changes were also observed in 506 pediatric and 5691 adult cancer samples accessed from publicly available databases, and in 44 pediatric cancer samples we analyzed using a targeted hybridization probe capture assay. Finally, we found that these methylation changes were detectable in cfDNA and could serve as potential cfDNA methylation biomarkers for early detection or minimal residual disease.
Collapse
Affiliation(s)
- David N Buckley
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ben Yi Tew
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chris Gooden
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bodour Salhia
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
2
|
Yin HT, Hui-Lu, Yang JH, Li Q, Li M, Zhao QQ, Wen ZP. Daurisoline suppress glioma progression by inhibiting autophagy through PI3K/AKT/mTOR pathway and increases TMZ sensitivity. Biochem Pharmacol 2024; 223:116113. [PMID: 38460907 DOI: 10.1016/j.bcp.2024.116113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/26/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
Glioma is one of the most common primary malignant tumors of the central nervous system. Temozolomide (TMZ) is the only effective chemotherapeutic agent, but it easily develops resistance and has unsatisfactory efficacy. Consequently, there is an urgent need to develop safe and effective compounds for glioma treatment. The cytotoxicity of 30 candidate compounds to glioma cells was detected by the CCK-8 assay. Daurisoline (DAS) was selected for further investigation due to its potent anti-glioma effects. Our study revealed that DAS induced glioma cell apoptosis through increasing caspase-3/6/9 activity. DAS significantly inhibited the proliferation of glioma cells by inducing G1-phase cell cycle arrest. Meanwhile, DAS remarkably suppressed the migration and invasion of glioma cells by regulating epithelial-mesenchymal transition. Mechanistically, our results revealed that DAS impaired the autophagic flux of glioma cells at a late stage by mediating the PI3K/AKT/mTOR pathway. DAS could inhibit TMZ-induced autophagy and then significantly promote TMZ chemosensitivity. Nude mice xenograft model revealed that DAS could restrain glioma proliferation and promote TMZ chemosensitivity. Thus, DAS is a potential anti-glioma drug that can improve glioma sensitivity to TMZ and provide a new therapeutic strategy for glioma in chemoresistance.
Collapse
Affiliation(s)
- Hai-Tang Yin
- Department of Pharmacy, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, PR China; College of Pharmacy, Guizhou Medical University, Guiyang, Guizhou Province, PR China
| | - Hui-Lu
- Department of Pharmacy, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, PR China; College of Pharmacy, Guizhou Medical University, Guiyang, Guizhou Province, PR China
| | - Ji-Hong Yang
- Department of Pharmacy, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, PR China; College of Pharmacy, Guizhou Medical University, Guiyang, Guizhou Province, PR China.
| | - Qin Li
- Centre of Clinical Trials, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, PR China
| | - Ming Li
- Department of Pharmacy, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, PR China; College of Pharmacy, Guizhou Medical University, Guiyang, Guizhou Province, PR China.
| | - Qing-Qing Zhao
- Clinical Research Center, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, PR China
| | - Zhi-Peng Wen
- Department of Pharmacy, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, PR China; College of Pharmacy, Guizhou Medical University, Guiyang, Guizhou Province, PR China.
| |
Collapse
|
3
|
Sahm F, Brandner S, Bertero L, Capper D, French PJ, Figarella-Branger D, Giangaspero F, Haberler C, Hegi ME, Kristensen BW, Kurian KM, Preusser M, Tops BBJ, van den Bent M, Wick W, Reifenberger G, Wesseling P. Molecular diagnostic tools for the World Health Organization (WHO) 2021 classification of gliomas, glioneuronal and neuronal tumors; an EANO guideline. Neuro Oncol 2023; 25:1731-1749. [PMID: 37279174 PMCID: PMC10547522 DOI: 10.1093/neuonc/noad100] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Indexed: 06/08/2023] Open
Abstract
In the 5th edition of the WHO CNS tumor classification (CNS5, 2021), multiple molecular characteristics became essential diagnostic criteria for many additional CNS tumor types. For those tumors, an integrated, "histomolecular" diagnosis is required. A variety of approaches exists for determining the status of the underlying molecular markers. The present guideline focuses on the methods that can be used for assessment of the currently most informative diagnostic and prognostic molecular markers for the diagnosis of gliomas, glioneuronal and neuronal tumors. The main characteristics of the molecular methods are systematically discussed, followed by recommendations and information on available evidence levels for diagnostic measures. The recommendations cover DNA and RNA next-generation-sequencing, methylome profiling, and select assays for single/limited target analyses, including immunohistochemistry. Additionally, because of its importance as a predictive marker in IDH-wildtype glioblastomas, tools for the analysis of MGMT promoter methylation status are covered. A structured overview of the different assays with their characteristics, especially their advantages and limitations, is provided, and requirements for input material and reporting of results are clarified. General aspects of molecular diagnostic testing regarding clinical relevance, accessibility, cost, implementation, regulatory, and ethical aspects are discussed as well. Finally, we provide an outlook on new developments in the landscape of molecular testing technologies in neuro-oncology.
Collapse
Affiliation(s)
- Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- CCU Neuropathology, German Concortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Brandner
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology and Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - David Capper
- Department of Neuropathology, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pim J French
- Department of Neurology, Brain Tumor Center at Erasmus MC Cancer Center, 3015 GD Rotterdam, The Netherlands
| | - Dominique Figarella-Branger
- Aix-Marseille University, APHM, CNRS, INP, Institute Neurophysiopathol, CHU Timone, Service d’Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University Sapienza of Rome, Rome, Italy
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Monika E Hegi
- Neuroscience Research Center and Neurosurgery, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Bjarne W Kristensen
- Department of Clinical Medicine and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Denmark
- Department of Pathology, The Bartholin Institute, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Austria
| | - Bastiaan B J Tops
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Martin van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Wolfgang Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Medical Faculty, and University Hospital Düsseldorf, and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Pieter Wesseling
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands (P.W.)
| |
Collapse
|
4
|
Jiang X, Li Z, Mehmood A, Wang H, Wang Q, Chu Y, Mao X, Zhao J, Jiang M, Zhao B, Lin G, Wang E, Wei D. A Self-attention Graph Convolutional Network for Precision Multi-tumor Early Diagnostics with DNA Methylation Data. Interdiscip Sci 2023:10.1007/s12539-023-00563-1. [PMID: 37247186 DOI: 10.1007/s12539-023-00563-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 05/30/2023]
Abstract
DNA methylation-based precision tumor early diagnostics is emerging as state-of-the-art technology that could capture early cancer signs 3 ~ 5 years in advance, even for clinically homogenous groups. Presently, the sensitivity of early detection for many tumors is ~ 30%, which needs significant improvement. Nevertheless, based on the genome-wide DNA methylation data, one could comprehensively characterize tumors' entire molecular genetic landscape and their subtle differences. Therefore, novel high-performance methods must be modeled by considering unbiased information using excessively available DNA methylation data. To fill this gap, we have designed a computational model involving a self-attention graph convolutional network and multi-class classification support vector machine to identify the 11 most common cancers using DNA methylation data. The self-attention graph convolutional network automatically learns key methylation sites in a data-driven way. Then, multi-tumor early diagnostics is realized by training a multi-class classification support vector machine based on the selected methylation sites. We evaluated our model's performance through several data sets of experiments, and our results demonstrate the effectiveness of the selected key methylation sites, which are highly relevant for blood diagnosis. The pipeline of the self-attention graph convolutional network based computational framework.
Collapse
Affiliation(s)
- Xue Jiang
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiqi Li
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Aamir Mehmood
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Heng Wang
- International School of Cosmetics, School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai, China
| | - Qiankun Wang
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Yanyi Chu
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Xueying Mao
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zhao
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Mingming Jiang
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Bowen Zhao
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Guanning Lin
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Edwin Wang
- Department of Biochemistry and Molecular Biology, Medical Genetics, and Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Dongqing Wei
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
5
|
Martin KC, Ma C, Yip S. From Theory to Practice: Implementing the WHO 2021 Classification of Adult Diffuse Gliomas in Neuropathology Diagnosis. Brain Sci 2023; 13:brainsci13050817. [PMID: 37239289 DOI: 10.3390/brainsci13050817] [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: 04/21/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Diffuse gliomas are the most common type of primary central nervous system (CNS) neoplasm to affect the adult population. The diagnosis of adult diffuse gliomas is dependent upon the integration of morphological features of the tumour with its underlying molecular alterations, and the integrative diagnosis has become of increased importance in the fifth edition of the WHO classification of CNS neoplasms (WHO CNS5). The three major diagnostic entities of adult diffuse gliomas are as follows: (1) astrocytoma, IDH-mutant; (2) oligodendroglioma, IDH-mutant and 1p/19q-codeleted; and (3) glioblastoma, IDH-wildtype. The aim of this review is to summarize the pathophysiology, pathology, molecular characteristics, and major diagnostic updates encountered in WHO CNS5 of adult diffuse gliomas. Finally, the application of implementing the necessary molecular tests for diagnostic workup of these entities in the pathology laboratory setting is discussed.
Collapse
Affiliation(s)
- Karina Chornenka Martin
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Crystal Ma
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| |
Collapse
|
6
|
Shin HJ, Hua JT, Li H. Recent advances in understanding DNA methylation of prostate cancer. Front Oncol 2023; 13:1182727. [PMID: 37234978 PMCID: PMC10206257 DOI: 10.3389/fonc.2023.1182727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Epigenetic modifications, such as DNA methylation, is widely studied in cancer. DNA methylation patterns have been shown to distinguish between benign and malignant tumors in various cancers, including prostate cancer. It may also contribute to oncogenesis, as it is frequently associated with downregulation of tumor suppressor genes. Aberrant patterns of DNA methylation, in particular the CpG island hypermethylator phenotype (CIMP), have shown associative evidence with distinct clinical features and outcomes, such as aggressive subtypes, higher Gleason score, prostate-specific antigen (PSA), and overall tumor stage, overall worse prognosis, as well as reduced survival. In prostate cancer, hypermethylation of specific genes is significantly different between tumor and normal tissues. Methylation patterns could distinguish between aggressive subtypes of prostate cancer, including neuroendocrine prostate cancer (NEPC) and castration resistant prostate adenocarcinoma. Further, DNA methylation is detectable in cell-free DNA (cfDNA) and is reflective of clinical outcome, making it a potential biomarker for prostate cancer. This review summarizes recent advances in understanding DNA methylation alterations in cancers with the focus on prostate cancer. We discuss the advanced methodology used for evaluating DNA methylation changes and the molecular regulators behind these changes. We also explore the clinical potential of DNA methylation as prostate cancer biomarkers and its potential for developing targeted treatment of CIMP subtype of prostate cancer.
Collapse
Affiliation(s)
- Hyun Jin Shin
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, United States
| | - Junjie T Hua
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, United States
| | - Haolong Li
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
7
|
Howell AE, Relton C, Martin RM, Zheng J, Kurian KM. Role of DNA methylation in the relationship between glioma risk factors and glioma incidence: a two-step Mendelian randomization study. Sci Rep 2023; 13:6590. [PMID: 37085538 PMCID: PMC10121678 DOI: 10.1038/s41598-023-33621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 04/15/2023] [Indexed: 04/23/2023] Open
Abstract
Genetic evidence suggests glioma risk is altered by leukocyte telomere length, allergic disease (asthma, hay fever or eczema), alcohol consumption, childhood obesity, low-density lipoprotein cholesterol (LDLc) and triglyceride levels. DNA methylation (DNAm) variation influences many of these glioma-related traits and is an established feature of glioma. Yet the causal relationship between DNAm variation with both glioma incidence and glioma risk factors is unknown. We applied a two-step Mendelian randomization (MR) approach and several sensitivity analyses (including colocalization and Steiger filtering) to assess the association of DNAm with glioma risk factors and glioma incidence. We used data from a recently published catalogue of germline genetic variants robustly associated with DNAm variation in blood (32,851 participants) and data from a genome-wide association study of glioma risk (12,488 cases and 18,169 controls, sub-divided into 6191 glioblastoma cases and 6305 non-glioblastoma cases). MR evidence indicated that DNAm at 3 CpG sites (cg01561092, cg05926943, cg01584448) in one genomic region (HEATR3) had a putative association with glioma and glioblastoma risk (False discovery rate [FDR] < 0.05). Steiger filtering provided evidence against reverse causation. Colocalization presented evidence against genetic confounding and suggested that differential DNAm at the 3 CpG sites and glioma were driven by the same genetic variant. MR provided little evidence to suggest that DNAm acts as a mediator on the causal pathway between risk factors previously examined and glioma onset. To our knowledge, this is the first study to use MR to appraise the causal link of DNAm with glioma risk factors and glioma onset. Subsequent analyses are required to improve the robustness of our results and rule out horizontal pleiotropy.
Collapse
Affiliation(s)
- Amy E Howell
- Brain Tumour Research Centre, Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
| | - Caroline Relton
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Richard M Martin
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Jie Zheng
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Kathreena M Kurian
- Brain Tumour Research Centre, Institute of Clinical Neurosciences, University of Bristol, Bristol, UK.
| |
Collapse
|
8
|
Xu Y, Xiao H, Hu W, Shen HC, Liu W, Tan S, Ren C, Zhang X, Yang X, Yu G, Yang T, Yu D, Zong L. CIMP-positive glioma is associated with better prognosis: A systematic analysis. Medicine (Baltimore) 2022; 101:e30635. [PMID: 36181110 PMCID: PMC9524892 DOI: 10.1097/md.0000000000030635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND CpG island methylator phenotype (CIMP) was closely related to the degree of pathological differentiation of tumors, and it's an important determinant of glioma pathogenicity. However, the molecular and pathological features of CIMP-positive glioma have not been fully elucidated. In addition, CIMP have been reported to be a useful prognostic marker in several human cancers, yet its prognostic value in gliomas is still controversial. Therefore, we aimed to evaluate gene mutations and pathological features of CIMP-positive glioma and explore the prognostic value of CIMP in gliomas. METHODS We comprehensively searched PubMed, Embase, and MEDLINE for studies describing gene mutations, pathological features and overall survival of gliomas stratified by CIMP status. Odds ratios (OR), hazard ratios (HR), and their 95% confidence intervals (CI) were used to estimate the correlation between CIMP and the outcome parameters. RESULTS Twelve studies with 2386 gliomas (1051 CIMP-positive and 1335 CIMP-negative) were included. Our results showed that CIMP was more frequent in isocitrate dehydrogenase 1 (IDH1)-mutated gliomas (OR 229.07; 95% CI 138.72-378.26) and 1p19q loss of heterozygosis (LOH) gliomas (OR 5.65; 95% CI 2.66-12.01). Pathological analysis showed that CIMP was common in low-malignant oligodendroglioma (OR 5.51; 95% CI 3.95-7.70) with molecular features including IDH1 mutations and 1p19q LOH, but rare in glioblastoma (OR 0.14; 95% CI 0.10-0.19). However, CIMP showed no obvious correlation with anaplastic oligoastrocytomas (OR 1.57; 95% CI 1.24-2.00) or oligoastrocytomas (OR 0.79; 95% CI 0.35-1.76). Concerning the prognosis, we found that CIMP-positive gliomas had longer overall survival (HR 0.57; 95% CI 0.97-0.16) than CIMP-negative gliomas. CONCLUSIONS CIMP could be used as a potential independent prognostic indicator for glioma.
Collapse
Affiliation(s)
- Yingying Xu
- Department of General Surgery, Yizhen People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Huashi Xiao
- Clinical Medical College, Dalian Medical University, Liaoning Province, China
| | - Wenqing Hu
- Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - He-Chun Shen
- Department of General Practice, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Wanjun Liu
- Department of Clinical Medical Testing Laboratory, Clinical Medical School of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu Province, China
| | - Siyuan Tan
- Department of General Surgery, Yizhen People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Chuanli Ren
- Department of Clinical Medical Testing Laboratory, Clinical Medical School of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu Province, China
| | - Xiaomin Zhang
- Central Laboratory, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Xishuai Yang
- Neurology Department, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Guo Yu
- Laboratory of Pharmacogenomics and Pharmacokinetic Research, Subei People’s Hospital, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Ting Yang
- Central Laboratory, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Duonan Yu
- Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Yangzhou University School of Medicine, Yangzhou, Jiangsu Province, China
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Disease and Zoonosis, Yangzhou, Jiangsu Province, China
| | - Liang Zong
- Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
- *Correspondence: Liang Zong, Department of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, 046000, Shanxi Province, China (e-mail: )
| |
Collapse
|
9
|
Brandner S, McAleenan A, Jones HE, Kernohan A, Robinson T, Schmidt L, Dawson S, Kelly C, Leal ES, Faulkner CL, Palmer A, Wragg C, Jefferies S, Vale L, Higgins JPT, Kurian KM. Diagnostic accuracy of 1p/19q codeletion tests in oligodendroglioma: A comprehensive meta-analysis based on a Cochrane systematic review. Neuropathol Appl Neurobiol 2022; 48:e12790. [PMID: 34958131 PMCID: PMC9208578 DOI: 10.1111/nan.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/23/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
Codeletion of chromosomal arms 1p and 19q, in conjunction with a mutation in the isocitrate dehydrogenase 1 or 2 gene, is the molecular diagnostic criterion for oligodendroglioma, IDH mutant and 1p/19q codeleted. 1p/19q codeletion is a diagnostic marker and allows prognostication and prediction of the best drug response within IDH-mutant tumours. We performed a Cochrane review and simple economic analysis to establish the most sensitive, specific and cost-effective techniques for determining 1p/19q codeletion status. Fluorescent in situ hybridisation (FISH) and polymerase chain reaction (PCR)-based loss of heterozygosity (LOH) test methods were considered as reference standard. Most techniques (FISH, chromogenic in situ hybridisation [CISH], PCR, real-time PCR, multiplex ligation-dependent probe amplification [MLPA], single nucleotide polymorphism [SNP] array, comparative genomic hybridisation [CGH], array CGH, next-generation sequencing [NGS], mass spectrometry and NanoString) showed good sensitivity (few false negatives) for detection of 1p/19q codeletions in glioma, irrespective of whether FISH or PCR-based LOH was used as the reference standard. Both NGS and SNP array had a high specificity (fewer false positives) for 1p/19q codeletion when considered against FISH as the reference standard. Our findings suggest that G banding is not a suitable test for 1p/19q analysis. Within these limits, considering cost per diagnosis and using FISH as a reference, MLPA was marginally more cost-effective than other tests, although these economic analyses were limited by the range of available parameters, time horizon and data from multiple healthcare organisations.
Collapse
Affiliation(s)
- Sebastian Brandner
- Division of Neuropathology, The National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
- Department of Neurodegenerative Disease, Queen Square Instituite of NeurologyUniversity College LondonLondonUK
| | - Alexandra McAleenan
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Hayley E. Jones
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Ashleigh Kernohan
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Tomos Robinson
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Claire Kelly
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | | | - Claire L. Faulkner
- Bristol Genetics Laboratory, Pathology SciencesSouthmead HospitalBristolUK
| | - Abigail Palmer
- Bristol Genetics Laboratory, Pathology SciencesSouthmead HospitalBristolUK
| | - Christopher Wragg
- Bristol Genetics Laboratory, Pathology SciencesSouthmead HospitalBristolUK
| | | | - Luke Vale
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Julian P. T. Higgins
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Kathreena M. Kurian
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Bristol Medical School: Brain Tumour Research Centre, Public Health SciencesUniversity of BristolBristolUK
| |
Collapse
|
10
|
Brat DJ, Aldape K, Bridge JA, Canoll P, Colman H, Hameed MR, Harris BT, Hattab EM, Huse JT, Jenkins RB, Lopez-Terrada DH, McDonald WC, Rodriguez FJ, Souter LH, Colasacco C, Thomas NE, Yount MH, van den Bent MJ, Perry A. Molecular Biomarker Testing for the Diagnosis of Diffuse Gliomas. Arch Pathol Lab Med 2022; 146:547-574. [PMID: 35175291 PMCID: PMC9311267 DOI: 10.5858/arpa.2021-0295-cp] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The diagnosis and clinical management of patients with diffuse gliomas (DGs) have evolved rapidly over the past decade with the emergence of molecular biomarkers that are used to classify, stratify risk, and predict treatment response for optimal clinical care. OBJECTIVE.— To develop evidence-based recommendations for informing molecular biomarker testing for pediatric and adult patients with DGs and provide guidance for appropriate laboratory test and biomarker selection for optimal diagnosis, risk stratification, and prediction. DESIGN.— The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. A systematic review of literature was conducted to address the overarching question, "What ancillary tests are needed to classify DGs and sufficiently inform the clinical management of patients?" Recommendations were derived from quality of evidence, open comment feedback, and expert panel consensus. RESULTS.— Thirteen recommendations and 3 good practice statements were established to guide pathologists and treating physicians on the most appropriate methods and molecular biomarkers to include in laboratory testing to inform clinical management of patients with DGs. CONCLUSIONS.— Evidence-based incorporation of laboratory results from molecular biomarker testing into integrated diagnoses of DGs provides reproducible and clinically meaningful information for patient management.
Collapse
Affiliation(s)
- Daniel J. Brat
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Julia A. Bridge
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE; Cytogenetics, ProPath, Dallas, TX
| | - Peter Canoll
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Howard Colman
- Department of Neurosurgery and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Meera R. Hameed
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Brent T. Harris
- Department of Neurology and Pathology, MedStar Georgetown University Hospital, Washington, DC
| | - Eyas M. Hattab
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY
| | - Jason T. Huse
- Departments of Pathology and Translational Molecular Pathology, University of Texas MD, Anderson Cancer Center, Houston, TX
| | - Robert B. Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Dolores H. Lopez-Terrada
- Departments of Pathology and Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | | | | | | | | | | | | | - Martin J. van den Bent
- Brain Tumor Center at Erasmus MC Cancer Institute University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arie Perry
- Departments of Pathology and Neurological Surgery University of California San Francisco School of Medicine, San Francisco, CA
| |
Collapse
|
11
|
McAleenan A, Jones HE, Kernohan A, Robinson T, Schmidt L, Dawson S, Kelly C, Spencer Leal E, Faulkner CL, Palmer A, Wragg C, Jefferies S, Brandner S, Vale L, Higgins JP, Kurian KM. Diagnostic test accuracy and cost-effectiveness of tests for codeletion of chromosomal arms 1p and 19q in people with glioma. Cochrane Database Syst Rev 2022; 3:CD013387. [PMID: 35233774 PMCID: PMC8889390 DOI: 10.1002/14651858.cd013387.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Complete deletion of both the short arm of chromosome 1 (1p) and the long arm of chromosome 19 (19q), known as 1p/19q codeletion, is a mutation that can occur in gliomas. It occurs in a type of glioma known as oligodendroglioma and its higher grade counterpart known as anaplastic oligodendroglioma. Detection of 1p/19q codeletion in gliomas is important because, together with another mutation in an enzyme known as isocitrate dehydrogenase, it is needed to make the diagnosis of an oligodendroglioma. Presence of 1p/19q codeletion also informs patient prognosis and prediction of the best drug treatment. The main two tests in use are fluorescent in situ hybridisation (FISH) and polymerase chain reaction (PCR)-based loss of heterozygosity (LOH) assays (also known as PCR-based short tandem repeat or microsatellite analysis). Many other tests are available. None of the tests is perfect, although PCR-based LOH is expected to have very high sensitivity. OBJECTIVES To estimate the sensitivity and specificity and cost-effectiveness of different deoxyribonucleic acid (DNA)-based techniques for determining 1p/19q codeletion status in glioma. SEARCH METHODS We searched MEDLINE, Embase and BIOSIS up to July 2019. There were no restrictions based on language or date of publication. We sought economic evaluation studies from the results of this search and using the National Health Service Economic Evaluation Database. SELECTION CRITERIA We included cross-sectional studies in adults with glioma or any subtype of glioma, presenting raw data or cross-tabulations of two or more DNA-based tests for 1p/19q codeletion. We also sought economic evaluations of these tests. DATA COLLECTION AND ANALYSIS We followed procedures outlined in the Cochrane Handbook for Diagnostic Test Accuracy Reviews. Two review authors independently screened titles/abstracts/full texts, performed data extraction, and undertook applicability and risk of bias assessments using QUADAS-2. Meta-analyses used the hierarchical summary ROC model to estimate and compare test accuracy. We used FISH and PCR-based LOH as alternate reference standards to examine how tests compared with those in common use, and conducted a latent class analysis comparing FISH and PCR-based LOH. We constructed an economic model to evaluate cost-effectiveness. MAIN RESULTS We included 53 studies examining: PCR-based LOH, FISH, single nucleotide polymorphism (SNP) array, next-generation sequencing (NGS), comparative genomic hybridisation (CGH), array comparative genomic hybridisation (aCGH), multiplex-ligation-dependent probe amplification (MLPA), real-time PCR, chromogenic in situ hybridisation (CISH), mass spectrometry (MS), restriction fragment length polymorphism (RFLP) analysis, G-banding, methylation array and NanoString. Risk of bias was low for only one study; most gave us concerns about how patients were selected or about missing data. We had applicability concerns about many of the studies because only patients with specific subtypes of glioma were included. 1520 participants contributed to analyses using FISH as the reference, 1304 participants to analyses involving PCR-based LOH as the reference and 262 participants to analyses of comparisons between methods from studies not including FISH or PCR-based LOH. Most evidence was available for comparison of FISH with PCR-based LOH (15 studies, 915 participants): PCR-based LOH detected 94% of FISH-determined codeletions (95% credible interval (CrI) 83% to 98%) and FISH detected 91% of codeletions determined by PCR-based LOH (CrI 78% to 97%). Of tumours determined not to have a deletion by FISH, 94% (CrI 87% to 98%) had a deletion detected by PCR-based LOH, and of those determined not to have a deletion by PCR-based LOH, 96% (CrI 90% to 99%) had a deletion detected by FISH. The latent class analysis suggested that PCR-based LOH may be slightly more accurate than FISH. Most other techniques appeared to have high sensitivity (i.e. produced few false-negative results) for detection of 1p/19q codeletion when either FISH or PCR-based LOH was considered as the reference standard, although there was limited evidence. There was some indication of differences in specificity (false-positive rate) with some techniques. Both NGS and SNP array had high specificity when considered against FISH as the reference standard (NGS: 6 studies, 243 participants; SNP: 6 studies, 111 participants), although we rated certainty in the evidence as low or very low. NGS and SNP array also had high specificity when PCR-based LOH was considered the reference standard, although with much more uncertainty as these results were based on fewer studies (just one study with 49 participants for NGS and two studies with 33 participants for SNP array). G-banding had low sensitivity and specificity when PCR-based LOH was the reference standard. Although MS had very high sensitivity and specificity when both FISH and PCR-based LOH were considered the reference standard, these results were based on only one study with a small number of participants. Real-time PCR also showed high specificity with FISH as a reference standard, although there were only two studies including 40 participants. We found no relevant economic evaluations. Our economic model using FISH as the reference standard suggested that the resource-optimising test depends on which measure of diagnostic accuracy is most important. With FISH as the reference standard, MLPA is likely to be cost-effective if society was willing to pay GBP 1000 or less for a true positive detected. However, as the value placed on a true positive increased, CISH was most cost-effective. Findings differed when the outcome measure changed to either true negative detected or correct diagnosis. When PCR-based LOH was used as the reference standard, MLPA was likely to be cost-effective for all measures of diagnostic accuracy at lower threshold values for willingness to pay. However, as the threshold values increased, none of the tests were clearly more likely to be considered cost-effective. AUTHORS' CONCLUSIONS In our review, most techniques (except G-banding) appeared to have good sensitivity (few false negatives) for detection of 1p/19q codeletions in glioma against both FISH and PCR-based LOH as a reference standard. However, we judged the certainty of the evidence low or very low for all the tests. There are possible differences in specificity, with both NGS and SNP array having high specificity (fewer false positives) for 1p/19q codeletion when considered against FISH as the reference standard. The economic analysis should be interpreted with caution due to the small number of studies.
Collapse
Affiliation(s)
- Alexandra McAleenan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne , UK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire Kelly
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emmelyn Spencer Leal
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire L Faulkner
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Abigail Palmer
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Christopher Wragg
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Sarah Jefferies
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Sebastian Brandner
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Luke Vale
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kathreena M Kurian
- Bristol Medical School: Brain Tumour Research Centre, Public Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
12
|
Li G, Huang R, Fan W, Wang D, Wu F, Zeng F, Yu M, Zhai Y, Chang Y, Pan C, Jiang T, Yan W, Wang H, Zhang W. Galectin-9/TIM-3 as a Key Regulator of Immune Response in Gliomas With Chromosome 1p/19q Codeletion. Front Immunol 2021; 12:800928. [PMID: 34956239 PMCID: PMC8692744 DOI: 10.3389/fimmu.2021.800928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Gliomas with chromosome 1p/19q codeletion were considered a specific tumor entity. This study was designed to reveal the biological function alterations tightly associated with 1p/19q codeletion in gliomas. Clinicopathological and RNA sequencing data from glioma patients were obtained from The Cancer Genome Atlas and Chinese Glioma Genome Atlas databases. Gene set variation analysis was performed to explore the differences in biological functions between glioma subgroups stratified by 1p/19q codeletion status. The abundance of immune cells in each sample was detected using the CIBERSORT analytical tool. Single-cell sequencing data from public databases were analyzed using the t-distributed stochastic neighbor embedding (t-SNE) algorithm, and the findings were verified by in vitro and in vivo experiments and patient samples.We found that the activation of immune and inflammatory responses was tightly associated with 1p/19q codeletion in gliomas. As the most important transcriptional regulator of Galectin-9 in gliomas, the expression level of CCAAT enhancer-binding protein alpha in samples with 1p/19q codeletion was significantly decreased, which led to the downregulation of the immune checkpoints Galectin-9 and TIM-3. These results were validated in three independent datasets. The t-SNE analysis showed that the loss of chromosome 19q was the main reason for the promotion of the antitumor immune response. IHC protein staining, in vitro and in vivo experiments verified the results of bioinformatics analysis. In gliomas, 1p/19q codeletion can promote the antitumor immune response by downregulating the expression levels of the immune checkpoint TIM-3 and its ligand Galectin-9.
Collapse
Affiliation(s)
- Guanzhang Li
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruoyu Huang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhua Fan
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Di Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fan Wu
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Fan Zeng
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Mingchen Yu
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - You Zhai
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yuanhao Chang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Changqing Pan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA) and Asian Glioma Genome Atlas Network (AGGA), Beijing, China
| | - Wei Yan
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongjun Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Zhang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA) and Asian Glioma Genome Atlas Network (AGGA), Beijing, China
| |
Collapse
|
13
|
Lyon JF, Vasudevaraja V, Mirchia K, Walker JM, Corona RJ, Chin LS, Tran I, Snuderl M, Richardson TE, Viapiano MS. Spatial progression and molecular heterogeneity of IDH-mutant glioblastoma determined by DNA methylation-based mapping. Acta Neuropathol Commun 2021; 9:120. [PMID: 34193272 PMCID: PMC8243907 DOI: 10.1186/s40478-021-01221-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/19/2021] [Indexed: 01/16/2023] Open
Abstract
Glioblastoma (GBM) is the most common malignant primary central nervous system (CNS) neoplasm in adults, and has an almost universally poor prognosis. Recently, an emphasis on genetic and epigenetic profiling has revealed a number of molecular features useful in the diagnostic and prognostic classification of GBM, advancing our understanding of the underlying features that make these tumors so aggressive and providing the rationale for the creation of better targeted therapeutics. One such method, DNA methylation profiling, has recently emerged as an important technique for the classification of CNS tumors, with diagnostic accuracy in some cases surpassing traditional methods. However, how DNA methylation profiles change with the course of the disease remains less understood. Here, we present a case of a 30-year-old male with primary IDH-mutant GBM with widespread recurrence and death two years later. Using unsupervised hierarchical clustering of methylation probes, we created a phylogenetic map to trace the tumor path as it spread from the initial biopsy site throughout the right hemisphere, across the corpus callosum to the contralateral hemisphere, and into the brainstem. We identified molecular divergence between the right and left hemisphere GBM samples marked by distinct copy number profile alterations, alterations in specific methylation sites, and regional loss of MGMT promoter methylation, providing a potential mechanism for treatment resistance in this case. In summary, this case both highlights the molecular diversity in GBM, and illustrates a novel use for methylation profiling in establishing a phylogenetic profile to allow for spatial mapping of tumor progression.
Collapse
|
14
|
Wick A, Kessler T, Platten M, Meisner C, Bamberg M, Herrlinger U, Felsberg J, Weyerbrock A, Papsdorf K, Steinbach JP, Sabel M, Vesper J, Debus J, Meixensberger J, Ketter R, Hertler C, Mayer-Steinacker R, Weisang S, Bölting H, Reuss D, Reifenberger G, Sahm F, von Deimling A, Weller M, Wick W. Superiority of temozolomide over radiotherapy for elderly patients with RTK II methylation class, MGMT promoter methylated malignant astrocytoma. Neuro Oncol 2021; 22:1162-1172. [PMID: 32064499 DOI: 10.1093/neuonc/noaa033] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND O6-methylguanine DNA-methyl transferase (MGMT) promoter methylation status is predictive for alkylating chemotherapy, but there are non-benefiting subgroups. METHODS This is the long-term update of NOA-08 (NCT01502241), which compared efficacy and safety of radiotherapy (RT, n = 176) and temozolomide (TMZ, n = 193) at 7/14 days in patients >65 years old with anaplastic astrocytoma or glioblastoma. DNA methylation patterns and copy number variations were assessed in the biomarker cohort of 104 patients and in an independent cohort of 188 patients treated with RT+TMZ-containing regimens in Heidelberg. RESULTS In the full NOA-08 cohort, median overall survival (OS) was 8.2 [7.0-10.0] months for TMZ treatment versus 9.4 [8.1-10.4] months for RT; hazard ratio (HR) = 0.93 (95% CI: 0.76-1.15) of TMZ versus RT. Median event-free survival (EFS) [3.4 (3.2-4.1) months vs 4.6 (4.2-5.0) months] did not differ, with HR = 1.02 (0.83-1.25). Patients with MGMT methylated tumors had markedly longer OS and EFS when treated with TMZ (18.4 [13.9-24.4] mo and 8.5 [6.9-13.3] mo) versus RT (9.6 [6.4-13.7] mo and 4.8 [4.3-6.2] mo, HR 0.44 [0.27-0.70], P < 0.001 for OS and 0.46 [0.29-0.73], P = 0.001 for EFS). Patients with glioblastomas of the methylation classes receptor tyrosine kinase I (RTK I) and mesenchymal subgroups lacked a prognostic impact of MGMT in both cohorts. CONCLUSION MGMT promoter methylation is a strong predictive biomarker for the choice between RT and TMZ. It indicates favorable long-term outcome with initial TMZ monotherapy in patients with MGMT promoter-methylated tumors primarily in the RTK II subgroup.
Collapse
Affiliation(s)
- Antje Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Kessler
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Michael Platten
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.,Department of Neurology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.,General Neurology, Tübingen, Germany
| | - Christoph Meisner
- Institute for Clinical Epidemiology and Applied Biometry, Tübingen, Germany
| | - Michael Bamberg
- Radiation Oncology, and German Cancer Consortium, partner site Tübingen, University of Tübingen, Tübingen, Germany
| | - Ulrich Herrlinger
- Department of Neurology and Neurooncology, University of Bonn, Bonn, Germany
| | - Jörg Felsberg
- Institute of Neuropathology, Heinrich Heine University, German Cancer Consortium, partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Astrid Weyerbrock
- Neurosurgery Clinic, University Clinic Freiburg, and German Cancer Consortium, partner site Freiburg, Freiburg, Germany.,Kantonsspital St Gallen, Neurosurgery Clinic, St-Gallen, Switzerland
| | | | - Joachim P Steinbach
- Dr Senckenbergisches Institute for Neurooncology, and German Cancer Consortium, partner site Frankfurt, University of Frankfurt, Frankfurt, Germany
| | - Michael Sabel
- Department of Neurosurgery, Heinrich Heine University and German Cancer Consortium, partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Jan Vesper
- Department of Neurosurgery, Heinrich Heine University and German Cancer Consortium, partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Jürgen Debus
- Radiation Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ralf Ketter
- Department of Neurosurgery, University of Homburg, Homburg/Saar, Germany
| | - Caroline Hertler
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Sarah Weisang
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Hanna Bölting
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - David Reuss
- Germany Clinical Cooperation Unit Neuropathology, German Cancer Research Center, Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, German Cancer Consortium, partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
15
|
Gitto L, Serinelli S, Galbraith K, Williams M, Mirchia K, Galgano MA, Krishnamurthy S, de la Roza G, Viapiano MS, Walker JM, Jour G, Serrano J, DeLorenzo M, Snuderl M, Richardson TE. Anaplastic Transformation in Myxopapillary Ependymoma: A Report of 2 Cases and Review of the Literature. J Neuropathol Exp Neurol 2021; 79:1044-1053. [PMID: 32743660 DOI: 10.1093/jnen/nlaa077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/04/2020] [Accepted: 06/29/2020] [Indexed: 12/12/2022] Open
Abstract
Myxopapillary ependymoma (MPE) is a relatively common neoplasm arising primarily in the filum terminale/lumbosacral region of the spinal cord. It is designated as a grade I tumor in the most recent WHO Classification of Tumours of the CNS, although aggressive clinical behavior can be observed, especially in cases arising in an extradural location. Anaplastic transformation in MPE is exceedingly rare with <20 examples reported in the English literature, and consensus on diagnostic features and definitive grading remain to be determined. Here, we present 2 cases of recurrent MPE with anaplastic features, both of which had histology consistent with conventional MPE as well as areas with significant atypia, frequent mitotic figures, elevated Ki-67 proliferation indices (>10%-50%), necrosis, and focal vascular proliferation. Targeted next-generation sequencing panels revealed no definitive pathogenic mutations or fusion proteins in either case. Copy number profiling, methylation profiling, and t-Distributed Stochastic Neighbor Embedding were performed to investigate the molecular characteristics of these tumors. To the best of our knowledge, these are the first reported cases of MPE with anaplastic features with methylation profiling data. In addition, we review the literature and discuss common histologic and molecular findings associated with anaplastic features in MPE.
Collapse
|
16
|
Tang K, Kurland D, Vasudevaraja V, Serrano J, Delorenzo M, Radmanesh A, Thomas C, Spino M, Gardner S, Allen JC, Nicolaides T, Osorio DS, Finlay JL, Boué DR, Snuderl M. Exploring DNA Methylation for Prognosis and Analyzing the Tumor Microenvironment in Pleomorphic Xanthoastrocytoma. J Neuropathol Exp Neurol 2021; 79:880-890. [PMID: 32594172 DOI: 10.1093/jnen/nlaa051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022] Open
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a rare type of brain tumor that affects children and young adults. Molecular prognostic markers of PXAs remain poorly established. Similar to gangliogliomas, PXAs show prominent immune cell infiltrate, but its composition also remains unknown. In this study, we correlated DNA methylation and BRAF status with clinical outcome and explored the tumor microenvironment. We performed DNA methylation in 21 tumor samples from 18 subjects with a histological diagnosis of PXA. MethylCIBERSORT was used to deconvolute the PXA microenvironment by analyzing the associated immune cell-types. Median age at diagnosis was 16 years (range 7-32). At median follow-up of 30 months, 3-year and 5-year overall survival was 73% and 71%, respectively. Overall survival ranged from 1 to 139 months. Eleven out of 18 subjects (61%) showed disease progression. Progression-free survival ranged from 1 to 89 months. Trisomy 7 and CDKN2A/B (p16) homozygous deletion did not show any association with overall survival (p = 0.67 and p = 0.74, respectively). Decreased overall survival was observed for subjects with tumors lacking the BRAF V600E mutation (p = 0.02). PXAs had significantly increased CD8 T-cell epigenetic signatures compared with previously profiled gangliogliomas (p = 0.0019). The characterization of immune cell-types in PXAs may have implications for future development of immunotherapy.
Collapse
Affiliation(s)
- Karen Tang
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York.,Clinical and Translational Science Institute, New York University Langone Health, New York, New York
| | - David Kurland
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Varshini Vasudevaraja
- Department of Biomedical Informatics, New York University Langone Health, New York, New York
| | - Jonathan Serrano
- Department of Biomedical Informatics, New York University Langone Health, New York, New York
| | - Michael Delorenzo
- Department of Neuropathology, New York University Langone Health, New York, New York
| | - Alireza Radmanesh
- Department of Neuroradiology, New York University Langone Health, New York, New York
| | - Cheddhi Thomas
- Department of Neuropathology, New York University Langone Health, New York, New York.,Department of Neuropathology, Incyte Diagnostics, Spokane Valley, Washington
| | - Marissa Spino
- Department of Neuropathology, New York University Langone Health, New York, New York
| | - Sharon Gardner
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York
| | - Jeffrey C Allen
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York
| | - Theodore Nicolaides
- From the Department of Pediatrics, Division of Hematology/Oncology, New York University Langone Health, New York, New York
| | - Diana S Osorio
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant
| | - Jonathan L Finlay
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, and the Ohio State University, Columbus, Ohio
| | - Matija Snuderl
- Department of Neuropathology, New York University Langone Health, New York, New York
| |
Collapse
|
17
|
Chai R, Li G, Liu Y, Zhang K, Zhao Z, Wu F, Chang Y, Pang B, Li J, Li Y, Jiang T, Wang Y. Predictive value of MGMT promoter methylation on the survival of TMZ treated IDH-mutant glioblastoma. Cancer Biol Med 2021; 18:272-282. [PMID: 33628600 PMCID: PMC7877176 DOI: 10.20892/j.issn.2095-3941.2020.0179] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
Objective O6methylguanine-DNA methyltransferase (MGMT) promoter methylation is a biomarker widely used to predict the sensitivity of IDH-wildtype glioblastoma to temozolomide therapy. Given that the IDH status has critical effects on the survival and epigenetic features of glioblastoma, we aimed to assess the role of MGMT promoter methylation in IDH-mutant glioblastoma. Methods This study included 187 IDH-mutant glioblastomas and used 173 IDH-wildtype glioblastomas for comparison. Kaplan-Meier curves and multivariate Cox regression were used to study the predictive effects. Results Compared with IDH-wildtype glioblastomas, IDH-mutant glioblastomas showed significantly higher (P < 0.0001) MGMT promoter methylation. We demonstrated that MGMT promoter methylation status, as determined by a high cutoff value (≥30%) in pyrosequencing, could be used to significantly stratify the survival of 50 IDH-mutant glioblastomas receiving temozolomide therapy (cohort A); this result was validated in another cohort of 25 IDH-mutant glioblastomas (cohort B). The median progression-free survival and median overall survival in cohort A were 9.33 and 13.76 months for unmethylated cases, and 18.37 and 41.61 months for methylated cases, and in cohort B were 6.97 and 9.10 months for unmethylated cases, and 23.40 and 26.40 months for methylated cases. In addition, we confirmed that the MGMT promoter methylation was significantly (P = 0.0001) correlated with longer OS in IDH-mutant patients with GBM, independently of age, gender distribution, tumor type (primary or recurrent/secondary), and the extent of resection. Conclusions MGMT promoter methylation has predictive value in IDH-mutant glioblastoma, but its cutoff value should be higher than that for IDH-wildtype glioblastoma.
Collapse
Affiliation(s)
- Ruichao Chai
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China
| | - Guanzhang Li
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China
| | - Yuqing Liu
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China
| | - Kenan Zhang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China
| | - Zheng Zhao
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China
| | - Fan Wu
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China
| | - Yuzhou Chang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Bo Pang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China
| | - Jingjun Li
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China
| | - Yangfang Li
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China
| | - Tao Jiang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yongzhi Wang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute; Chinese Glioma Genome Atlas Network (CGGA), Capital Medical University, Beijing 100070, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| |
Collapse
|
18
|
Abstract
BACKGROUND The revised fourth edition of the World Health Organization Classification of Tumors of the Central Nervous System-published in 2016-established 1p19q codeletion as the molecular hallmark for the diagnosis of oligodendrogliomas. Fluorescence in situ hybridization (FISH) is currently the most commonly used modality for 1p19q testing. However, as with most laboratory testing, 1p19q FISH testing has a false-positive rate, potentially resulting in an erroneous diagnosis of oligodendroglioma with significant implications for the choice of therapy and prognosis. METHODS The authors describe a case series of 5 patients treated at the Ohio State University James Cancer Center to illustrate the problem of false-positive 1p19q FISH results. RESULTS In our case series, the authors present a spectrum of possibilities for conflicting 1p19q testing results and the clinical consequences. The authors present 4 cases that, in retrospect, are believed to have had a false 1p19q FISH results. One other case may represent a true transformation of oligodendroglioma to glioblastoma or a second malignancy. Neuro-oncologists should pay attention to additional molecular markers, namely ATRX, TP53, and MGMT methylation status, before discussing the pathology with the patient and formulating a treatment plan. CONCLUSIONS Pathologists and neuro-oncologists should be aware of false-positive 1p19q FISH results as they can significantly change treatment and prognosis for glioma patients. Moreover, this issue should be taken into account when designing clinical trials specific to this disease cohort.
Collapse
|
19
|
Saw PE, Xu X, Kang BR, Lee J, Lee YS, Kim C, Kim H, Kang SH, Na YJ, Moon HJ, Kim JH, Park YK, Yoon W, Kim JH, Kwon TH, Choi C, Jon S, Chong K. Extra-domain B of fibronectin as an alternative target for drug delivery and a cancer diagnostic and prognostic biomarker for malignant glioma. Am J Cancer Res 2021; 11:941-957. [PMID: 33391514 PMCID: PMC7738868 DOI: 10.7150/thno.44948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Extra-domain B of fibronectin (EDB-FN) is an alternatively spliced form of fibronectin with high expression in the extracellular matrix of neovascularized tissues and malignant cancer cells. In this study, we evaluated the practicality of using EDB-FN as a biomarker and therapeutic target for malignant gliomas (MGs), representative intractable diseases involving brain tumors. Methods: The microarray- and sequence-based patient transcriptomic database 'Oncopression' and tissue microarray of MG patient tissue samples were analyzed. EDB-FN data were extracted and evaluated from 23,344 patient samples of 17 types of cancer to assess its effectiveness and selectivity as a molecular target. To strengthen the results of the patient data analysis, the utility of EDB-FN as a molecular marker and target for MG was verified using active EDB-FN-targeting ultrasmall lipidic micellar nanoparticles (~12 nm), which had a high drug-loading capacity and were efficiently internalized by MG cells in vitro and in vivo. Results: Brain tumors had a 1.42-fold cancer-to-normal ratio (p < 0.0001), the second highest among 17 cancers after head and neck cancer. Patient tissue microarray analysis showed that the EDB-FN high-expression group had a 5.5-fold higher risk of progression than the EDB-FN low-expression group (p < 0.03). By labeling docetaxel-containing ultrasmall micelles with a bipodal aptide targeting EDB-FN (termed APTEDB-DSPE-DTX), we generated micelles that could specifically bind to MG cells, leading to superior antitumor efficacy of EDB-FN-targeting nanoparticles compared to nontargeting controls. Conclusions: Taken together, these results show that EDB-FN can be an effective drug delivery target and biomarker for MG.
Collapse
|
20
|
Tzaridis T, Schäfer N, Weller J, Steinbach JP, Schlegel U, Seidel S, Sabel M, Hau P, Seidel C, Krex D, Goldbrunner R, Tonn JC, Grauer O, Kebir S, Schneider M, Schaub C, Vatter H, Coch C, Glas M, Fimmers R, Pietsch T, Reifenberger G, Herrlinger U, Felsberg J. MGMT promoter methylation analysis for allocating combined CCNU/TMZ chemotherapy: Lessons learned from the CeTeG/NOA-09 trial. Int J Cancer 2020; 148:1695-1707. [PMID: 33113214 DOI: 10.1002/ijc.33363] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/26/2020] [Accepted: 10/12/2020] [Indexed: 11/08/2022]
Abstract
The CeTeG/NOA-09 trial showed a survival benefit for combined CCNU/TMZ therapy in MGMT-promoter-methylated glioblastoma patients (quantitative methylation-specific PCR [qMSP] ratio > 2). Here, we report on the prognostic value of the MGMT promoter methylation ratio determined by qMSP and evaluate the concordance of MGMT methylation results obtained by qMSP, pyrosequencing (PSQ) or DNA methylation arrays (MGMT-STP27). A potential association of qMSP ratio with survival was analyzed in the CeTeG/NOA-09 trial population (n = 129; log-rank tests, Cox regression analyses). The concordance of MGMT methylation assays (qMSP, PSQ and MGMT-STP27) was evaluated in 76 screened patients. Patients with tumors of qMSP ratio > 4 showed superior survival compared to those with ratios 2-4 (P = .0251, log-rank test). In multivariate analysis, the qMSP ratio was not prognostic across the study cohort (hazard ratio [HR] = 0.88; 95% CI: 0.72-1.08). With different cutoffs for qMSP ratio (4, 9, 12 or 25), the CCNU/TMZ benefit tended to be larger in subgroups with lower ratios (eg, for cutoff 9: HR 0.32 for lower subgroup, 0.73 for higher subgroup). The concordance rates with qMSP were 94.4% (PSQ) and 90.2% (MGMT-STP27). Discordant results were restricted to tumors with qMSP ratios ≤4 and PSQ mean methylation rate ≤25%. Despite a shorter survival in MGMT-promoter-methylated patients with lower methylation according to qMSP, these patients had a benefit from combined CCNU/TMZ therapy, which even tended to be stronger than in patients with higher methylation rates. With acceptable concordance rates, decisions on CCNU/TMZ therapy may also be based on PSQ or MGMT-STP27.
Collapse
Affiliation(s)
- Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany.,Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Joachim-Peter Steinbach
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt am Main, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Sabine Seidel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Dietmar Krex
- Department of Neurosurgery, University of Dresden, Dresden, Germany
| | | | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig Maximillian University of Munich and German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Oliver Grauer
- Department of Neurology with Institute for Translational Neurology, University of Münster, Münster, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany.,Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center (WTZ), German Cancer Consortium, Partner Site Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University of Bonn, Bonn, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany.,Study Center Bonn, University of Bonn, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany.,Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center (WTZ), German Cancer Consortium, Partner Site Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology and DGNN Brain Tumor Reference Center, University of Bonn, Bonn, Germany
| | - Guido Reifenberger
- Institute of Neuropathology and DGNN Brain Tumor Reference Center, Medical Faculty, Heinrich Heine University and German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Jörg Felsberg
- Institute of Neuropathology and DGNN Brain Tumor Reference Center, Medical Faculty, Heinrich Heine University and German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
21
|
Wenger KJ, Steinbach JP, Bähr O, Pilatus U, Hattingen E. Lower Lactate Levels and Lower Intracellular pH in Patients with IDH-Mutant versus Wild-Type Gliomas. AJNR Am J Neuroradiol 2020; 41:1414-1422. [PMID: 32646946 DOI: 10.3174/ajnr.a6633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Preclinical evidence points toward a metabolic reprogramming in isocitrate dehydrogenase (IDH) mutated tumor cells with down-regulation of the expression of genes that encode for glycolytic metabolism. We noninvasively investigated lactate and Cr concentrations, as well as intracellular pH using 1H/phosphorus 31 (31P) MR spectroscopy in a cohort of patients with gliomas. MATERIALS AND METHODS Thirty prospectively enrolled, mostly untreated patients with gliomas met the spectral quality criteria (World Health Organization II [n = 7], III [n = 16], IV [n = 7]; IDH-mutant [n = 23]; IDH wild-type [n = 7]; 1p/19q codeletion [n = 9]). MR imaging protocol included 3D 31P chemical shift imaging and 1H single-voxel spectroscopy (point-resolved spectroscopy sequence at TE = 30 ms and TE = 97 ms with optimized echo spacing for detection of 2-hydroxyglutarate) from the tumor area. Values for absolute metabolite concentrations were calculated (phantom replacement method). Intracellular pH was determined from 31P chemical shift imaging. RESULTS At TE = 97 ms, lactate peaks can be fitted with little impact of lipid/macromolecule contamination. We found a significant difference in lactate concentrations, lactate/Cr ratios, and intracellular pH when comparing tumor voxels of patients with IDH-mutant with those of patients with IDH wild-type gliomas, with reduced lactate levels and near-normal intracellular pH in patients with IDH-mutant gliomas. We additionally found evidence for codependent effects of 1p/19q codeletion and IDH mutations with regard to lactate concentrations for World Health Organization tumor grades II and III, with lower lactate levels in patients exhibiting the codeletion. There was no statistical significance when comparing lactate concentrations between IDH-mutant World Health Organization II and III gliomas. CONCLUSIONS We found indirect evidence for metabolic reprogramming in IDH-mutant tumors with significantly lower lactate concentrations compared with IDH wild-type tumors and a near-normal intracellular pH.
Collapse
Affiliation(s)
- K J Wenger
- From the Departments of Neuroradiology (K.J.W., U.P., E.H.) .,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
| | - J P Steinbach
- Neurooncology (J.P.S., O.B.), University Hospital Frankfurt, Frankfurt am Main, Germany.,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
| | - O Bähr
- Neurooncology (J.P.S., O.B.), University Hospital Frankfurt, Frankfurt am Main, Germany.,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
| | - U Pilatus
- From the Departments of Neuroradiology (K.J.W., U.P., E.H.).,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
| | - E Hattingen
- From the Departments of Neuroradiology (K.J.W., U.P., E.H.).,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
| |
Collapse
|
22
|
Richardson TE, Tang K, Vasudevaraja V, Serrano J, William CM, Mirchia K, Pierson CR, Leonard JR, AbdelBaki MS, Schieffer KM, Cottrell CE, Tovar-Spinoza Z, Comito MA, Boué DR, Jour G, Snuderl M. GOPC-ROS1 Fusion Due to Microdeletion at 6q22 Is an Oncogenic Driver in a Subset of Pediatric Gliomas and Glioneuronal Tumors. J Neuropathol Exp Neurol 2020; 78:1089-1099. [PMID: 31626289 DOI: 10.1093/jnen/nlz093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
ROS1 is a transmembrane receptor tyrosine kinase proto-oncogene that has been shown to have rearrangements with several genes in glioblastoma and other neoplasms, including intrachromosomal fusion with GOPC due to microdeletions at 6q22.1. ROS1 fusion events are important findings in these tumors, as they are potentially targetable alterations with newer tyrosine kinase inhibitors; however, whether these tumors represent a distinct entity remains unknown. In this report, we identify 3 cases of unusual pediatric glioma with GOPC-ROS1 fusion. We reviewed the clinical history, radiologic and histologic features, performed methylation analysis, whole genome copy number profiling, and next generation sequencing analysis for the detection of oncogenic mutation and fusion events to fully characterize the genetic and epigenetic alterations present in these tumors. Two of 3 tumors showed pilocytic features with focal expression of synaptophysin staining and variable high-grade histologic features; the third tumor aligned best with glioblastoma and showed no evidence of neuronal differentiation. Copy number profiling revealed chromosome 6q22 microdeletions corresponding to the GOPC-ROS1 fusion in all 3 cases and methylation profiling showed that the tumors did not cluster together as a single entity or within known methylation classes by t-Distributed Stochastic Neighbor Embedding.
Collapse
Affiliation(s)
- Timothy E Richardson
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, New York
| | | | | | - Jonathan Serrano
- Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital and The Ohio State University
| | | | - Kanish Mirchia
- Department of Hematology, Oncology, and Bone Marrow Transplant, Nationwide Children's Hospital and The Ohio State University
| | | | | | - Mohamed S AbdelBaki
- Department of Pediatrics (MAC), State University of New York, Upstate Medical University, Syracuse, New York
| | - Kathleen M Schieffer
- Waters Center for Children's Cancer and Blood Disorders, State University of New York, Upstate Cancer Center, Syracuse, New York
| | - Catherine E Cottrell
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, New York
| | | | - Melanie A Comito
- Department of Pathology, New York University Langone Health, New York, New York
| | - Daniel R Boué
- Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital and The Ohio State University
| | - George Jour
- Department of Neurological Surgery, Nationwide Children's Hospital
| | - Matija Snuderl
- Department of Hematology, Oncology, and Bone Marrow Transplant, Nationwide Children's Hospital and The Ohio State University
| |
Collapse
|
23
|
Machine learning workflows to estimate class probabilities for precision cancer diagnostics on DNA methylation microarray data. Nat Protoc 2020; 15:479-512. [PMID: 31932775 DOI: 10.1038/s41596-019-0251-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 10/04/2019] [Indexed: 01/01/2023]
Abstract
DNA methylation data-based precision cancer diagnostics is emerging as the state of the art for molecular tumor classification. Standards for choosing statistical methods with regard to well-calibrated probability estimates for these typically highly multiclass classification tasks are still lacking. To support this choice, we evaluated well-established machine learning (ML) classifiers including random forests (RFs), elastic net (ELNET), support vector machines (SVMs) and boosted trees in combination with post-processing algorithms and developed ML workflows that allow for unbiased class probability (CP) estimation. Calibrators included ridge-penalized multinomial logistic regression (MR) and Platt scaling by fitting logistic regression (LR) and Firth's penalized LR. We compared these workflows on a recently published brain tumor 450k DNA methylation cohort of 2,801 samples with 91 diagnostic categories using a 5 × 5-fold nested cross-validation scheme and demonstrated their generalizability on external data from The Cancer Genome Atlas. ELNET was the top stand-alone classifier with the best calibration profiles. The best overall two-stage workflow was MR-calibrated SVM with linear kernels closely followed by ridge-calibrated tuned RF. For calibration, MR was the most effective regardless of the primary classifier. The protocols developed as a result of these comparisons provide valuable guidance on choosing ML workflows and their tuning to generate well-calibrated CP estimates for precision diagnostics using DNA methylation data. Computation times vary depending on the ML algorithm from <15 min to 5 d using multi-core desktop PCs. Detailed scripts in the open-source R language are freely available on GitHub, targeting users with intermediate experience in bioinformatics and statistics and using R with Bioconductor extensions.
Collapse
|
24
|
Karimi S, Zuccato JA, Mamatjan Y, Mansouri S, Suppiah S, Nassiri F, Diamandis P, Munoz DG, Aldape KD, Zadeh G. The central nervous system tumor methylation classifier changes neuro-oncology practice for challenging brain tumor diagnoses and directly impacts patient care. Clin Epigenetics 2019; 11:185. [PMID: 31806041 PMCID: PMC6896594 DOI: 10.1186/s13148-019-0766-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Molecular signatures are being increasingly incorporated into cancer classification systems. DNA methylation-based central nervous system (CNS) tumor classification is being recognized as having the potential to aid in cases of difficult histopathological diagnoses. Here, we present our institutional clinical experience in integrating a DNA-methylation-based classifier into clinical practice and report its impact on CNS tumor patient diagnosis and treatment. Methods Prospective case review was undertaken at CNS tumor board discussions over a 3-year period and 55 tumors with a diagnosis that was not certain to two senior neuropathologists were recommended for methylation profiling based on diagnostic needs. Tumor classification, calibrated scores, and copy number variant (CNV) plots were obtained for all 55 cases. These results were integrated with histopathological findings to reach a final diagnosis. We retrospectively reviewed each patient's clinical course to determine final neuro-pathology diagnoses and the impact of methylation profiling on their clinical management, with a focus on changes that were made to treatment decisions. Results Following methylation profiling, 46 of the 55 (84%) challenging cases received a clinically relevant diagnostic alteration, with two-thirds having a change in the histopathological diagnosis and the other one-third obtaining clinically important molecular diagnostic or subtyping alterations. WHO grading changed by 27% with two-thirds receiving a higher grade. Patient care was directly changed in 15% of all cases with major changes in clinical decision-making being made for these patients to avoid unnecessary or insufficient treatment. Conclusions The integration of methylation-based CNS tumor classification into diagnostics has a substantial clinical benefit for patients with challenging CNS tumors while also avoiding unnecessary health care costs. The clinical impact shown here may prompt the expanded use of DNA methylation profiling for CNS tumor diagnostics within prominent neuro-oncology centers globally.
Collapse
Affiliation(s)
- Shirin Karimi
- MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Princess Margaret Cancer Research Tower, 101 College Street, 14th floor, Room 601, Toronto, ON, M5G 1L7, Canada
| | - Jeffrey A Zuccato
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Princess Margaret Cancer Research Tower, 101 College Street, 14th floor, Room 601, Toronto, ON, M5G 1L7, Canada
| | - Yasin Mamatjan
- MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Princess Margaret Cancer Research Tower, 101 College Street, 14th floor, Room 601, Toronto, ON, M5G 1L7, Canada
| | - Sheila Mansouri
- MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Princess Margaret Cancer Research Tower, 101 College Street, 14th floor, Room 601, Toronto, ON, M5G 1L7, Canada
| | - Suganth Suppiah
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Princess Margaret Cancer Research Tower, 101 College Street, 14th floor, Room 601, Toronto, ON, M5G 1L7, Canada
| | - Farshad Nassiri
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Princess Margaret Cancer Research Tower, 101 College Street, 14th floor, Room 601, Toronto, ON, M5G 1L7, Canada
| | - Phedias Diamandis
- MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Princess Margaret Cancer Research Tower, 101 College Street, 14th floor, Room 601, Toronto, ON, M5G 1L7, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - David G Munoz
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kenneth D Aldape
- MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Princess Margaret Cancer Research Tower, 101 College Street, 14th floor, Room 601, Toronto, ON, M5G 1L7, Canada. .,Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Building 10, Room 2S235, Bethesda, MD, 20892-1500, USA.
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. .,MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Princess Margaret Cancer Research Tower, 101 College Street, 14th floor, Room 601, Toronto, ON, M5G 1L7, Canada.
| |
Collapse
|
25
|
Tejada Neyra MA, Neuberger U, Reinhardt A, Brugnara G, Bonekamp D, Sill M, Wick A, Jones DTW, Radbruch A, Unterberg A, Debus J, Heiland S, Schlemmer HP, Herold-Mende C, Pfister S, von Deimling A, Wick W, Capper D, Bendszus M, Kickingereder P. Voxel-wise radiogenomic mapping of tumor location with key molecular alterations in patients with glioma. Neuro Oncol 2019; 20:1517-1524. [PMID: 30107597 DOI: 10.1093/neuonc/noy134] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This study aims to evaluate the impact of tumor location on key molecular alterations on a single voxel level in patients with newly diagnosed glioma. Methods A consecutive series of n = 237 patients with newly diagnosed glioblastoma and n = 131 patients with lower-grade glioma was analyzed. Volumetric tumor segmentation was performed on preoperative MRI with a semi-automated approach and images were registered to the standard Montreal Neurological Institute 152 space. Using a voxel-based lesion symptom mapping (VLSM) analysis, we identified specific brain regions that were associated with tumor-specific molecular alterations. We assessed a predefined set of n = 17 molecular characteristics in the glioblastoma cohort and n = 2 molecular characteristics in the lower-grade glioma cohort. Permutation adjustment (n = 1000 iterations) was used to correct for multiple testing, and voxel t-values that were greater than the t-value in >95% of the permutations were retained in the VLSM results (α = 0.05, power > 0.8). Results Tumor location predilection for isocitrate dehydrogenase (IDH) mutant tumors was found in both glioblastoma and lower-grade glioma cohorts, each showing a concordant predominance in the frontal lobe adjacent to the rostral extension of the lateral ventricles (permutation-adjusted P = 0.021 for the glioblastoma and 0.013 for the lower-grade glioma cohort). Apart from that, the VLSM analysis did not reveal a significant association of the tumor location with any other key molecular alteration in both cohorts (permutation-adjusted P > 0.05 each). Conclusion Our study highlights the unique properties of IDH mutations and underpins the hypothesis that the rostral extension of the lateral ventricles is a potential location for the cell of origin in IDH-mutant gliomas.
Collapse
Affiliation(s)
| | - Ulf Neuberger
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Annekathrin Reinhardt
- Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Gianluca Brugnara
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Sill
- Hopp-Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, DKFZ, Heidelberg, Germany.,German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany
| | - Antje Wick
- Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany
| | - David T W Jones
- Hopp-Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, DKFZ, Heidelberg, Germany.,German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany
| | - Alexander Radbruch
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg Institute of Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCOR), Heidelberg, Germany.,Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital and DKFZ, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | | | - Christel Herold-Mende
- Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Stefan Pfister
- Hopp-Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, DKFZ, Heidelberg, Germany.,German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany.,Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany.,DKTK, Clinical Cooperation Unit Neuropathology, DKFZ, Heidelberg, Germany
| | - Wolfgang Wick
- Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, DKTK, DKFZ, Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Neuropathology, Berlin, Germany.,DKTK, Partner Site Berlin, DKFZ, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Philipp Kickingereder
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| |
Collapse
|
26
|
Malmström A, Łysiak M, Kristensen BW, Hovey E, Henriksson R, Söderkvist P. Do we really know who has an MGMT methylated glioma? Results of an international survey regarding use of MGMT analyses for glioma. Neurooncol Pract 2019; 7:68-76. [PMID: 32025325 PMCID: PMC6993038 DOI: 10.1093/nop/npz039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Glioma O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status informs clinical decision making. Worldwide different methods and cutoff levels are used, which can lead to discordant methylation results. Methods We conducted an international survey to clarify which methods are regularly used and why. We also explored opinions regarding international consensus on methods and cutoff. Results The survey had 152 respondents from 25 countries. MGMT methylation status is determined for all glioblastomas in 37% of laboratories. The most common methods are methylation-specific polymerase chain reaction (msPCR) (37%) and pyrosequencing (34%). A method is selected for simplicity (56%), cost-effectiveness (50%), and reproducibility of results (52%). For sequencing, the number of CpG sites analyzed varies from 1–3 up to more than 16. For 50% of laboratories, the company producing the kit determines which CpG sites are examined, whereas 33% select the sites themselves. Selection of cutoff is equally distributed among a cutoff defined in the literature, by the local laboratory, or by the outside laboratory performing the analysis. This cutoff varies, reported from 1% to 30%, and in 1 laboratory tumor is determined as methylated in case of 1 methylated CpG site of 17 analyzed. Some report tumors as unmethylated or weakly vs highly methylated. An international consensus on MGMT methylation method and cutoff is warranted by 66% and 76% of respondents, respectively. The method preferred would be msPCR (45%) or pyrosequencing (42%), whereas 18% suggest next-generation sequencing. Conclusion Although analysis of MGMT methylation status is routine, there is controversy regarding laboratory methods and cutoff level. Most respondents favor development of international consensus guidelines.
Collapse
Affiliation(s)
- Annika Malmström
- Department of Advanced Home Care, Linköping University, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Małgorzata Łysiak
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Bjarne Winther Kristensen
- Department of Pathology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark
| | - Elizabeth Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia.,University of New South Wales, Sydney, Australia
| | | | | |
Collapse
|
27
|
Wang S, Liu F, Wang Y, Fan W, Zhao H, Liu L, Cen C, Jiang X, Sun M, Han P. Integrated analysis of 34 microarray datasets reveals CBX3 as a diagnostic and prognostic biomarker in glioblastoma. J Transl Med 2019; 17:179. [PMID: 31138312 PMCID: PMC6540543 DOI: 10.1186/s12967-019-1930-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/20/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Glioblastomas have a high degree of malignancy, high recurrence rate, high mortality rate, and low cure rate. Searching for new markers of glioblastomas is of great significance for improving the diagnosis, prognosis and treatment of glioma. METHODS Using the GEO public database, we combined 34 glioma microarray datasets containing 1893 glioma samples and conducted genetic data mining through statistical analysis, bioclustering, and pathway analysis. The results were validated in TCGA, CGGA, and internal cohorts. We further selected a gene for subsequent experiments and conducted cell proliferation and cell cycle analyses to verify the biological function of this gene. RESULTS Eight glioblastoma-specific differentially expressed genes were screened using GEO. In the TCGA and CGGA cohorts, patients with high CBX3, BARD1, EGFR, or IFRD1 expression had significantly shorter survival but patients with high GUCY1A3 or MOBP expression had significantly longer survival than patients with lower expression of these genes. After reviewing the literature, we selected the CBX3 gene for further experiments. We confirmed that CBX3 was overexpressed in glioblastoma by immunohistochemical analysis of tissue microarrays and qPCR analysis of surgical specimens. The functional assay results showed that silencing CBX3 arrests the cell cycle in the G2/M phase, thereby weakening the cell proliferation ability. CONCLUSIONS We used a multidisciplinary approach to analyze glioblastoma samples in 34 microarray datasets, revealing novel diagnostic and prognostic biomarkers in patients with glioblastoma and providing a new direction for screening tumor markers.
Collapse
Affiliation(s)
- Siqi Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuhui Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Hongyang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Liying Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chunyuan Cen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaobin Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Min Sun
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China.
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| |
Collapse
|
28
|
Richardson TE, Patel S, Serrano J, Sathe AA, Daoud EV, Oliver D, Maher EA, Madrigales A, Mickey BE, Taxter T, Jour G, White CL, Raisanen JM, Xing C, Snuderl M, Hatanpaa KJ. Genome-Wide Analysis of Glioblastoma Patients with Unexpectedly Long Survival. J Neuropathol Exp Neurol 2019; 78:501-507. [PMID: 31034050 PMCID: PMC9891105 DOI: 10.1093/jnen/nlz025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Glioblastoma (GBM), representing WHO grade IV astrocytoma, is a relatively common primary brain tumor in adults with an exceptionally dismal prognosis. With an incidence rate of over 10 000 cases in the United States annually, the median survival rate ranges from 10-15 months in IDH1/2-wildtype tumors and 24-31 months in IDH1/2-mutant tumors, with further variation depending on factors such as age, MGMT methylation status, and treatment regimen. We present a cohort of 4 patients, aged 37-60 at initial diagnosis, with IDH1-mutant GBMs that were associated with unusually long survival intervals after the initial diagnosis, currently ranging from 90 to 154 months (all still alive). We applied genome-wide profiling with a methylation array (Illumina EPIC Array 850k) and a next-generation sequencing panel to screen for genetic and epigenetic alterations in these tumors. All 4 tumors demonstrated methylation patterns and genomic alterations consistent with GBM. Three out of four cases showed focal amplification of the CCND2 gene or gain of the region on 12p that included CCND2, suggesting that this may be a favorable prognostic factor in GBM. As this study has a limited sample size, further evaluation of patients with similar favorable outcome is warranted to validate these findings.
Collapse
Affiliation(s)
- Timothy E Richardson
- Send correspondence to: Timothy E. Richardson, DO, PhD, Department of Pathology, State University of New York, Upstate Medical University, 750 E. Adams St., Syracuse, New York, 13210; E-mail:
| | - Seema Patel
- Department of Pathology, New York University Langone Medical Center, New York City, New York
| | - Jonathan Serrano
- Department of Pathology, New York University Langone Medical Center, New York City, New York
| | - Adwait Amod Sathe
- Eugene McDermott Center for Human Growth & Development, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elena V Daoud
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dwight Oliver
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth A Maher
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alejandra Madrigales
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bruce E Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - George Jour
- Department of Pathology, New York University Langone Medical Center, New York City, New York
| | - Charles L White
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jack M Raisanen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chao Xing
- Eugene McDermott Center for Human Growth & Development, University of Texas Southwestern Medical Center, Dallas, Texas,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas,Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matija Snuderl
- Department of Pathology, New York University Langone Medical Center, New York City, New York
| | - Kimmo J Hatanpaa
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
29
|
Pfaff E, Kessler T, Balasubramanian GP, Berberich A, Schrimpf D, Wick A, Debus J, Unterberg A, Bendszus M, Herold-Mende C, Capper D, Schenkel I, Eisenmenger A, Dettmer S, Brors B, Platten M, Pfister SM, von Deimling A, Jones DTW, Wick W, Sahm F. Feasibility of real-time molecular profiling for patients with newly diagnosed glioblastoma without MGMT promoter hypermethylation-the NCT Neuro Master Match (N2M2) pilot study. Neuro Oncol 2019; 20:826-837. [PMID: 29165638 DOI: 10.1093/neuonc/nox216] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status is a predictive biomarker in glioblastoma patients. Glioblastoma without hypermethylated MGMT promoter is largely resistant to treatment with temozolomide. These patients are in particular need of new treatment approaches, which are offered by biomarker-driven clinical trials with targeted drugs based on molecular characterization of individual tumors. Methods In preparation for an upcoming clinical study, a comprehensive molecular profiling approach was undertaken on tissues from 43 glioblastoma patients harboring an unmethylated MGMT promoter at diagnosis. The diagnostic pipeline covered various levels of molecular characteristics, including whole-exome sequencing, low-coverage whole-genome sequencing, RNA sequencing, as well as microarray-based gene expression profiling and DNA methylation arrays. Results Complex multilayer molecular diagnostics were feasible in this setting with a median turnaround time of 4-5 weeks from surgery to the molecular tumor board. In 35% of cases, potentially relevant therapeutic decisions were derived from the data. Alterations were most frequently found in receptor tyrosine kinases, members of the phosphoinositide 3-kinase/Akt/mechanistic target of rapamycin and mitogen-activated protein kinase pathway as well as cell cycle control and p53 regulation cascades. Individual tumors harbored clonal alterations such as oncogenic fusions of tyrosine kinases which constitute promising targets for targeted therapies. A prioritization algorithm is proposed to allocate patients with multiple targets to the potentially best treatment option. Conclusion With this feasibility study, a comprehensive molecular profiling approach for patients with newly diagnosed glioblastoma harboring an unmethylated MGMT promoter is presented. Analyses in this pilot cohort serve as a basis for trials based on targetable alterations and on the question of allocation of patients to the best treatment arm.
Collapse
Affiliation(s)
- Elke Pfaff
- Division of Pediatric Neuro-oncology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology, and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Kessler
- Clinical Cooperation Unit Neuro-oncology, DKTK, DKFZ, Heidelberg, Germany.,Department of Neurology and Neuro-oncology Program, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Gnana Prakash Balasubramanian
- Division of Pediatric Neuro-oncology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,Division of Applied Bioinformatics, DKFZ, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Berberich
- Clinical Cooperation Unit Neuro-oncology, DKTK, DKFZ, Heidelberg, Germany.,Department of Neurology and Neuro-oncology Program, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, DKTK, DKFZ, Heidelberg, Germany
| | - Antje Wick
- Department of Neurology and Neuro-oncology Program, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, DKFZ, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Irini Schenkel
- NCT Trial Center, National Center for Tumor Diseases, DKFZ, Heidelberg, Germany
| | - Andreas Eisenmenger
- NCT Trial Center, National Center for Tumor Diseases, DKFZ, Heidelberg, Germany
| | - Susan Dettmer
- NCT Trial Center, National Center for Tumor Diseases, DKFZ, Heidelberg, Germany
| | - Benedikt Brors
- Division of Applied Bioinformatics, DKFZ, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.,DKTK, Heidelberg, Germany
| | - Michael Platten
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, DKTK, DKFZ, Heidelberg, Germany.,Department of Neurology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan M Pfister
- Division of Pediatric Neuro-oncology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology, and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, DKTK, DKFZ, Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neuro-oncology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neuro-oncology, DKTK, DKFZ, Heidelberg, Germany.,Department of Neurology and Neuro-oncology Program, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, DKTK, DKFZ, Heidelberg, Germany
| |
Collapse
|
30
|
Malta TM, de Souza CF, Sabedot TS, Silva TC, Mosella MS, Kalkanis SN, Snyder J, Castro AVB, Noushmehr H. Glioma CpG island methylator phenotype (G-CIMP): biological and clinical implications. Neuro Oncol 2019; 20:608-620. [PMID: 29036500 DOI: 10.1093/neuonc/nox183] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Gliomas are a heterogeneous group of brain tumors with distinct biological and clinical properties. Despite advances in surgical techniques and clinical regimens, treatment of high-grade glioma remains challenging and carries dismal rates of therapeutic success and overall survival. Challenges include the molecular complexity of gliomas, as well as inconsistencies in histopathological grading, resulting in an inaccurate prediction of disease progression and failure in the use of standard therapy. The updated 2016 World Health Organization (WHO) classification of tumors of the central nervous system reflects a refinement of tumor diagnostics by integrating the genotypic and phenotypic features, thereby narrowing the defined subgroups. The new classification recommends molecular diagnosis of isocitrate dehydrogenase (IDH) mutational status in gliomas. IDH-mutant gliomas manifest the cytosine-phosphate-guanine (CpG) island methylator phenotype (G-CIMP). Notably, the recent identification of clinically relevant subsets of G-CIMP tumors (G-CIMP-high and G-CIMP-low) provides a further refinement in glioma classification that is independent of grade and histology. This scheme may be useful for predicting patient outcome and may be translated into effective therapeutic strategies tailored to each patient. In this review, we highlight the evolution of our understanding of the G-CIMP subsets and how recent advances in characterizing the genome and epigenome of gliomas may influence future basic and translational research.
Collapse
Affiliation(s)
- Tathiane M Malta
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Genetics, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Camila F de Souza
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Genetics, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Thais S Sabedot
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Genetics, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Tiago C Silva
- Department of Genetics, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Maritza S Mosella
- Department of Genetics, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - James Snyder
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Houtan Noushmehr
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Genetics, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
31
|
Liu S, Liu Y, Lu Q, Zhou X, Chen L, Liang W. The lncRNA TUG1 promotes epithelial ovarian cancer cell proliferation and invasion via the WNT/β-catenin pathway. Onco Targets Ther 2018; 11:6845-6851. [PMID: 30349317 PMCID: PMC6190633 DOI: 10.2147/ott.s167900] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Epithelial ovarian cancer (EOC) is among the most common malignant tumors of the endocrine system. Numerous studies have shown that genetic factors are important in the development of EOC, and there is evidence that long noncoding RNA molecules (lncRNAs) can regulate gene expression at the transcription, posttranscription, and epigenetic levels to influence cancer proliferation and invasion, cell differentiation, and apoptosis. However, the roles of lncRNAs in the pathogenesis of EOC remain unclear. Here, we investigated the role of the lncRNA, taurine upregulated gene 1 (TUG1), in EOC. Patients and methods TUG1 mRNA levels were evaluated in EOC and matched normal tissue samples and in EOC cell lines by quantitative real-time PCR. Lentiviral vectors expressing the lncRNA, TUG1, and siRNA targeting TUG1 were constructed and transfected into EOC cells. MTT and Transwell assays were used to determine the effects of TUG1 on cell proliferation, migration, and invasion. Western blotting was performed to determine the influence of TUG1 up- or downregulation on WNT/β-catenin signaling, which is involved in the occurrence and development of cancer. Results TUG1 expression was clearly elevated in EOC compared with control tissue and cells. Moreover, TUG1 expression was associated with lymphatic metastasis, T stage, and clinical stage in patients with EOC. Downregulation of TUG1 in EOC inhibited cell proliferation, migration, and invasion. In EOC cells, levels of the WNT/β-catenin pathway factors, β-catenin, cyclin D1, and c-Myc, were significantly up- and downregulated in response to TUG1 over- and underexpression, respectively. Conclusion Our data suggest that knockdown of TUG1 may represent a novel therapeutic approach for the management of EOC.
Collapse
Affiliation(s)
- Shankun Liu
- Department of Gynecology, Tai'an City Center Hospital, Tai'an, Shandong, People's Republic of China
| | - Ying Liu
- Department of Gynecology, Tai'an City Center Hospital, Tai'an, Shandong, People's Republic of China
| | - Qiang Lu
- Department of Obstetrics and Gynecology, The Affiliated Qingdao Hiser Hospital of Qingdao University (Qingdao Hospital of Traditional Chinese Medicine), Qingdao, Shandong, People's Republic of China
| | - Xiao Zhou
- Department of Obstetrics and Gynecology, The Affiliated Qingdao Hiser Hospital of Qingdao University (Qingdao Hospital of Traditional Chinese Medicine), Qingdao, Shandong, People's Republic of China
| | - Li Chen
- Department of Obstetrics and Gynecology, The Affiliated Qingdao Hiser Hospital of Qingdao University (Qingdao Hospital of Traditional Chinese Medicine), Qingdao, Shandong, People's Republic of China
| | - Weifeng Liang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Qingdao, Shandong, People's Republic of China,
| |
Collapse
|
32
|
Hypermethylated gene ANKDD1A is a candidate tumor suppressor that interacts with FIH1 and decreases HIF1α stability to inhibit cell autophagy in the glioblastoma multiforme hypoxia microenvironment. Oncogene 2018; 38:103-119. [PMID: 30082910 PMCID: PMC6318269 DOI: 10.1038/s41388-018-0423-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/01/2018] [Accepted: 06/25/2018] [Indexed: 01/28/2023]
Abstract
Ectopic epigenetic mechanisms play important roles in facilitating tumorigenesis. Here, we first demonstrated that ANKDD1A is a functional tumor suppressor gene, especially in the hypoxia microenvironment. ANKDD1A directly interacts with FIH1 and inhibits the transcriptional activity of HIF1α by upregulating FIH1. In addition, ANKDD1A decreases the half-life of HIF1α by upregulating FIH1, decreases glucose uptake and lactate production, inhibits glioblastoma multiforme (GBM) autophagy, and induces apoptosis in GBM cells under hypoxia. Moreover, ANKDD1A is highly frequently methylated in GBM. The tumor-specific methylation of ANKDD1A indicates that it could be used as a potential epigenetic biomarker as well as a possible therapeutic target.
Collapse
|
33
|
Lv Z, Zhang Y, Yu X, Lin Y, Ge Y. RETRACTED: The function of long non-coding RNA MT1JP in the development and progression of gastric cancer. Pathol Res Pract 2018; 214:1218-1223. [PMID: 30006025 DOI: 10.1016/j.prp.2018.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/15/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).
This article has been retracted at the request of the Executive Editor (Chairman) as panels from Figures 3A,B and 4D are similar to panels from Figures 4A,B and 5E of the article published by Mingjun Bi, Hongmei Yu, Bin Huang and Cuiyan Tang in Gene 626 (2017) 337–343 http://dx.doi.org/10.1016/j.gene.2017.05.049.
Also, Figures 3C and 4A are similar to Figures 4C and 5A of the Gene article.
One of the conditions of submission of a paper for publication is that authors declare explicitly that their work is original and has not appeared in a publication elsewhere. As such this article represents an abuse of the scientific publishing system. The scientific community takes a very strong view on this matter and apologies are offered to readers of the journal that this was not detected during the submission process.
Collapse
Affiliation(s)
- Zhongchuan Lv
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, China
| | - Yong Zhang
- Department of Gastrointestinal Surgery, Penglai People's Hospital, China
| | - Xiang Yu
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, China
| | - Yang Lin
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, China.
| | - Yinlin Ge
- Department of Biochemistry and Molecular Biology, School of Medicine, Qingdao University, China.
| |
Collapse
|
34
|
Abe H, Natsumeda M, Kanemaru Y, Watanabe J, Tsukamoto Y, Okada M, Yoshimura J, Oishi M, Fujii Y. MGMT Expression Contributes to Temozolomide Resistance in H3K27M-Mutant Diffuse Midline Gliomas and MGMT Silencing to Temozolomide Sensitivity in IDH-Mutant Gliomas. Neurol Med Chir (Tokyo) 2018; 58:290-295. [PMID: 29848907 PMCID: PMC6048353 DOI: 10.2176/nmc.ra.2018-0044] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Histone H3 mutations are frequently found in diffuse midline gliomas (DMGs), which include diffuse intrinsic pontine gliomas and thalamic gliomas. These tumors have dismal prognoses. Recent evidence suggests that one reason for the poor prognoses is that O6-methylguanine-DNA methyltransferase (MGMT) promoter frequently lacks methylation in DMGs. This review compares the epigenetic changes brought about by histone mutations to those by isocitrate dehydrogenase-mutant gliomas, which frequently have methylated MGMT promoters and are known to be sensitive to temozolomide.
Collapse
Affiliation(s)
- Hideaki Abe
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Yu Kanemaru
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Jun Watanabe
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | | | - Masayasu Okada
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Junichi Yoshimura
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
| |
Collapse
|
35
|
Wu Q, Xiang S, Ma J, Hui P, Wang T, Meng W, Shi M, Wang Y. Long non-coding RNA CASC15 regulates gastric cancer cell proliferation, migration and epithelial mesenchymal transition by targeting CDKN1A and ZEB1. Mol Oncol 2018; 12:799-813. [PMID: 29489064 PMCID: PMC5983148 DOI: 10.1002/1878-0261.12187] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/17/2018] [Accepted: 01/24/2018] [Indexed: 01/26/2023] Open
Abstract
Long non‐coding RNA (lncRNA) is responsible for a diverse range of cellular functions, such as transcriptional and translational regulation and variance in gene expression. The lncRNA CASC15 (cancer susceptibility candidate 15) is a long intergenic non‐coding RNA (lincRNA) locus in chromosome 6p22.3. Previous research shows that lncRNA CASC15 is implicated in the biological behaviors of several cancers such as neuroblastoma and melanoma. Here, we aimed to explore in detail how CASC15 contributes to the growth of gastric cancer (GC). As predicted, the expression of CASC15 was enriched in GC tissues and cell lines as compared with healthy tissues and cells using qRT‐PCR. The Kaplan–Meier method was used to demonstrate that high expression of CASC15 is linked to a poor prognosis for patients suffering from GC. Additionally, functional experiments proved that the down‐ or up‐regulation of CASC15 inhibited or facilitated cell proliferation via the induction of cell cycle arrest and apoptosis, and also suppressed or accelerated cell migration and invasion by affecting the progression of the epithelial‐to‐mesenchymal transition (EMT). In vivo experiments showed that the knockdown of CASC15 lessened the tumor volume and weight and influenced the EMT process. This was confirmed by western blot assays and immunohistochemistry, indicating impaired metastatic ability in nude mice. CASC15 involvement in the tumorigenesis of GC occurs when CASC15 interacts with EZH2 and WDR5 to modulate CDKN1A in nucleus. Additionally, the knockdown of CASC15 triggered the silencing of ZEB1 in cytoplasm, which was shown to be associated with the competitive binding of CASC15 to miR‐33a‐5p.
Collapse
Affiliation(s)
- Qiong Wu
- Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Shihao Xiang
- Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Jiali Ma
- Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Pingping Hui
- Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Ting Wang
- Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Wenying Meng
- Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Min Shi
- Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Yugang Wang
- Department of Gastroenterology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, China
| |
Collapse
|
36
|
Barthel FP, Wesseling P, Verhaak RGW. Reconstructing the molecular life history of gliomas. Acta Neuropathol 2018; 135:649-670. [PMID: 29616301 PMCID: PMC5904231 DOI: 10.1007/s00401-018-1842-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/16/2018] [Accepted: 03/18/2018] [Indexed: 12/20/2022]
Abstract
At the time of their clinical manifestation, the heterogeneous group of adult and pediatric gliomas carries a wide range of diverse somatic genomic alterations, ranging from somatic single-nucleotide variants to structural chromosomal rearrangements. Somatic abnormalities may have functional consequences, such as a decrease, increase or change in mRNA transcripts, and cells pay a penalty for maintaining them. These abnormalities, therefore, must provide cells with a competitive advantage to become engrained into the glioma genome. Here, we propose a model of gliomagenesis consisting of the following five consecutive phases that glioma cells have traversed prior to clinical manifestation: (I) initial growth; (II) oncogene-induced senescence; (III) stressed growth; (IV) replicative senescence/crisis; (V) immortal growth. We have integrated the findings from a large number of studies in biology and (neuro)oncology and relate somatic alterations and other results discussed in these papers to each of these five phases. Understanding the story that each glioma tells at presentation may ultimately facilitate the design of novel, more effective therapeutic approaches.
Collapse
Affiliation(s)
- Floris P Barthel
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06030, USA.
- Department of Pathology, VU University Medical Center/Brain Tumor Center Amsterdam, Amsterdam, The Netherlands.
| | - Pieter Wesseling
- Department of Pathology, VU University Medical Center/Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Department of Pathology, Princess Máxima Center for Pediatric Oncology and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel G W Verhaak
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06030, USA
| |
Collapse
|
37
|
Infarct volume after glioblastoma surgery as an independent prognostic factor. Oncotarget 2018; 7:61945-61954. [PMID: 27566556 PMCID: PMC5308702 DOI: 10.18632/oncotarget.11482] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 07/29/2016] [Indexed: 11/25/2022] Open
Abstract
Postoperative ischemia is associated with reduced functional independence measured by karnofsky performance score (KPS), which correlates well with overall survival. Other studies suggest that postoperative hypoxia might initiate infiltrative tumor growth. Therefore, aim of this study was to analyze the impact of infarct volume on overall survival and progression free survival (PFS) of glioblastoma patients. 251 patients with surgery for a newly diagnosed glioblastoma (WHO IV) were retrospectively assessed. Pre- and postoperative KPS, date of death/last follow-up and histopathological markers were recorded. Pre- and postoperative tumor volume and the volume of postoperative infarction were manually segmented. A significant correlation of infarct volume with postoperative KPS decrease (P = 0.001) was observed. Infarct volume showed a significant impact on overall survival (P = 0.014), but not on PFS (P = 0.112) in univariate analysis. This effect increased in the subgroup of patients with near-total tumor resection (> 90%) (overall survival: P = 0.006, PFS: P = 0.066). Infarct volume remained as an independent prognostic factor for overall survival in multivariate analysis (HR 1.013 [1.000–1.026], P = 0.042) including other prognostic factors (age, extent of resection, postoperative KPS). Postoperative infarct volume significantly correlates as an independent factor with overall survival after glioblastoma surgery. Besides the influence of perioperative infarction on postoperative KPS, postoperative hypoxia might also have an effect on tumor biology initiating infiltrative growth and therefore impaired survival.
Collapse
|
38
|
Schliesser MG, Claus R, Hielscher T, Grimm C, Weichenhan D, Blaes J, Wiestler B, Hau P, Schramm J, Sahm F, Weiß EK, Weiler M, Baer C, Schmidt-Graf F, Schackert G, Westphal M, Hertenstein A, Roth P, Galldiks N, Hartmann C, Pietsch T, Felsberg J, Reifenberger G, Sabel MC, Winkler F, von Deimling A, Meisner C, Vajkoczy P, Platten M, Weller M, Plass C, Wick W. Prognostic relevance of miRNA-155 methylation in anaplastic glioma. Oncotarget 2018; 7:82028-82045. [PMID: 27880937 PMCID: PMC5347671 DOI: 10.18632/oncotarget.13452] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/13/2016] [Indexed: 02/03/2023] Open
Abstract
The outcome of patients with anaplastic gliomas varies considerably depending on single molecular markers, such as mutations of the isocitrate dehydrogenase (IDH) genes, as well as molecular classifications based on epigenetic or genetic profiles. Remarkably, 98% of the RNA within a cell is not translated into proteins. Of those, especially microRNAs (miRNAs) have been shown not only to have a major influence on physiologic processes but also to be deregulated and prognostic in malignancies.To find novel survival markers and treatment options we performed unbiased DNA methylation screens that revealed 12 putative miRNA promoter regions with differential DNA methylation in anaplastic gliomas. Methylation of these candidate regions was validated in different independent patient cohorts revealing a set of miRNA promoter regions with prognostic relevance across data sets. Of those, miR-155 promoter methylation and miR-155 expression were negatively correlated and especially the methylation showed superior correlation with patient survival compared to established biomarkers.Functional examinations in malignant glioma cells further cemented the relevance of miR-155 for tumor cell viability with transient and stable modifications indicating an onco-miRNA activity. MiR-155 also conferred resistance towards alkylating temozolomide and radiotherapy as consequence of nuclear factor (NF)κB activation.Preconditioning glioma cells with an NFκB inhibitor reduced therapy resistance of miR-155 overexpressing cells. These cells resembled tumors with a low methylation of the miR-155 promoter and thus mir-155 or NFκB inhibition may provide treatment options with a special focus on patients with IDH wild type tumors.
Collapse
Affiliation(s)
- Maximilian Georg Schliesser
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rainer Claus
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christiane Grimm
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Weichenhan
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jonas Blaes
- Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benedikt Wiestler
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Hau
- Neurology Clinic, Regensburg University, Regensburg, Germany
| | - Johannes Schramm
- Neurosurgery Clinic, University of Bonn Medical Center, TU Munich, Munich, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisa K Weiß
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of General Neurology, University Hospital Tübingen, Germany
| | - Constance Baer
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Friederike Schmidt-Graf
- Department of General Neurology, University Hospital Tübingen, Germany.,Neurology Clinic, TU Munich, Munich, Germany
| | | | - Manfred Westphal
- Neurosurgery Clinic, University Clinic Hamburg, Eppendorf, Germany
| | - Anne Hertenstein
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Roth
- Department of General Neurology, University Hospital Tübingen, Germany.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christian Hartmann
- Department of Neuropathology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department for Neuropathology, Institute of Pathology, Medical University of Hannover, Hannover, Germany
| | - Torsten Pietsch
- Department of Neuropathology, Heinrich-Heine-University, Germany
| | - Joerg Felsberg
- Department of Neurosurgery, Heinrich-Heine-University, Germany.,Neurosurgery Clinic, Charité, Berlin, Germany
| | - Guido Reifenberger
- Department of Neurosurgery, Heinrich-Heine-University, Germany.,Neurosurgery Clinic, Charité, Berlin, Germany
| | | | - Frank Winkler
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Peter Vajkoczy
- Department Hematology, Oncology and Stem Cell Transplantation, University Hospital Freiburg, Germany
| | - Michael Platten
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of General Neurology, University Hospital Tübingen, Germany
| | - Michael Weller
- Department of General Neurology, University Hospital Tübingen, Germany.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Plass
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of General Neurology, University Hospital Tübingen, Germany
| |
Collapse
|
39
|
Wick W, Gorlia T, Bendszus M, Taphoorn M, Sahm F, Harting I, Brandes AA, Taal W, Domont J, Idbaih A, Campone M, Clement PM, Stupp R, Fabbro M, Le Rhun E, Dubois F, Weller M, von Deimling A, Golfinopoulos V, Bromberg JC, Platten M, Klein M, van den Bent MJ. Lomustine and Bevacizumab in Progressive Glioblastoma. N Engl J Med 2017; 377:1954-1963. [PMID: 29141164 DOI: 10.1056/nejmoa1707358] [Citation(s) in RCA: 573] [Impact Index Per Article: 81.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bevacizumab is approved for the treatment of patients with progressive glioblastoma on the basis of uncontrolled data. Data from a phase 2 trial suggested that the addition of bevacizumab to lomustine might improve overall survival as compared with monotherapies. We sought to determine whether the combination would result in longer overall survival than lomustine alone among patients at first progression of glioblastoma. METHODS We randomly assigned patients with progression after chemoradiation in a 2:1 ratio to receive lomustine plus bevacizumab (combination group, 288 patients) or lomustine alone (monotherapy group, 149 patients). The methylation status of the promoter of O6-methylguanine-DNA methyltransferase (MGMT) was assessed. Health-related quality of life and neurocognitive function were evaluated at baseline and every 12 weeks. The primary end point of the trial was overall survival. RESULTS A total of 437 patients underwent randomization. The median number of 6-week treatment cycles was three in the combination group and one in the monotherapy group. With 329 overall survival events (75.3%), the combination therapy did not provide a survival advantage; the median overall survival was 9.1 months (95% confidence interval [CI], 8.1 to 10.1) in the combination group and 8.6 months (95% CI, 7.6 to 10.4) in the monotherapy group (hazard ratio for death, 0.95; 95% CI, 0.74 to 1.21; P=0.65). Locally assessed progression-free survival was 2.7 months longer in the combination group than in the monotherapy group: 4.2 months versus 1.5 months (hazard ratio for disease progression or death, 0.49; 95% CI, 0.39 to 0.61; P<0.001). Grade 3 to 5 adverse events occurred in 63.6% of the patients in the combination group and 38.1% of the patients in the monotherapy group. The addition of bevacizumab to lomustine affected neither health-related quality of life nor neurocognitive function. The MGMT status was prognostic. CONCLUSIONS Despite somewhat prolonged progression-free survival, treatment with lomustine plus bevacizumab did not confer a survival advantage over treatment with lomustine alone in patients with progressive glioblastoma. (Funded by an unrestricted educational grant from F. Hoffmann-La Roche and by the EORTC Cancer Research Fund; EORTC 26101 ClinicalTrials.gov number, NCT01290939 ; Eudra-CT number, 2010-023218-30 .).
Collapse
Affiliation(s)
- Wolfgang Wick
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Thierry Gorlia
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Martin Bendszus
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Martin Taphoorn
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Felix Sahm
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Inga Harting
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Alba A Brandes
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Walter Taal
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Julien Domont
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Ahmed Idbaih
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Mario Campone
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Paul M Clement
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Roger Stupp
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Michel Fabbro
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Emilie Le Rhun
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Francois Dubois
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Michael Weller
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Andreas von Deimling
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Vassilis Golfinopoulos
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Jacoline C Bromberg
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Michael Platten
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Martin Klein
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Martin J van den Bent
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| |
Collapse
|
40
|
Wenger KJ, Hattingen E, Franz K, Steinbach J, Bähr O, Pilatus U. In vivo Metabolic Profiles as Determined by 31P and short TE 1H MR-Spectroscopy : No Difference Between Patients with IDH Wildtype and IDH Mutant Gliomas. Clin Neuroradiol 2017; 29:27-36. [PMID: 28983683 DOI: 10.1007/s00062-017-0630-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/15/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Previous ex vivo spectroscopic data from tissue samples revealed differences in phospholipid metabolites between isocitrate dehydrogenase mutated (IDHmut) and IDH wildtype (IDHwt) gliomas. We investigated whether these changes can be found in vivo using 1H-decoupled 31P magnetic resonance spectroscopic imaging (MRSI) with 3D chemical shift imaging (CSI) at 3 T in patients with low and high-grade gliomas. METHODS The study included 33 prospectively enrolled, mostly untreated patients who met spectral quality criteria according to the World Health Organization (WHO II n = 7, WHO III n = 17, WHO IV n = 9; 25 patients IDHmut, 8 patients IDHwt). The MRSI protocol included 1H decoupled 31P MRSI with 3D CSI (3D 31P CSI), 2D 1H CSI and a 1H single voxel spectroscopy sequence (TE 30 ms) from the tumor area. For 1H MRS, absolute metabolite concentration values were calculated (phantom replacement method). For 31P MRS, metabolite intensity ratios were calculated for the choline (C) and ethanolamine (E)-containing metabolites. RESULTS In our patient cohort we did not find significant differences for the ratio of phosphocholine (PC) and phosphoethanolamine (PE), PC/PE, (p = 0.24) for IDHmut compared to IDHwt gliomas. Furthermore, we found no elevated ratios of glycerophosphocholine (GPC) and glycerophosphoethanolamine (GPE), GPC/GPE, (p = 0.68) or GPC/PE (p = 0.12) for IDHmut gliomas. Even the ratio (PC+GPC)/(PE+GPE) showed no significant differences with respect to mutation status (p = 0.16). Nonetheless, changes related to tumor grade regarding intracellular pH (pHi) and phospholipid metabolism as well as absolute metabolite concentrations of co-registered 2D 1H CSI data for tumor and control tissue showed the anticipated results. CONCLUSION Using 3D-CSI data acquisition, in vivo 31P MR spectroscopic measurement of phospholipid metabolites could not distinguish between IDHmut and IDHwt.
Collapse
Affiliation(s)
- Katharina J Wenger
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany. .,Institute of Neuroradiology, University Hospital Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Germany.
| | - Kea Franz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Joachim Steinbach
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| |
Collapse
|
41
|
Wu H, Hu Y, Liu X, Song W, Gong P, Zhang K, Chen Z, Zhou M, Shen X, Qian Y, Fan H. LncRNA TRERNA1 Function as an Enhancer of SNAI1 Promotes Gastric Cancer Metastasis by Regulating Epithelial-Mesenchymal Transition. MOLECULAR THERAPY. NUCLEIC ACIDS 2017; 8:291-299. [PMID: 28918030 PMCID: PMC5537167 DOI: 10.1016/j.omtn.2017.06.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 01/26/2023]
Abstract
Long noncoding RNA (lncRNA) has been implicated in cancer, but little is known about the role of lncRNAs as regulators of tumor metastasis. In the present study, we demonstrate that lncRNA TRERNA1 acts like an enhancer of SNAI1 to promote cell invasion and migration and to contribute to metastasis of gastric cancer (GC). TRERNA1 is significantly unregulated in GCs and GC cell lines. Increased TRERNA1 is positively correlated with lymph node metastasis of GCs. RNA immunoprecipitation (RIP) and chromatin immunoprecipitation (ChIP) assays revealed that TRERNA1 functions as a scaffold to recruit EZH2 to epigenetically silence epithelial-mesenchymal transition marker CDH1 by H3K27me3 of its promoter region. TRERNA1 knockdown markedly reduced GC cell migration, invasion, tumorigenicity, and metastasis. Depletion of TRERNA1 reduced cell metastasis of GCs in vivo. Taken together, our findings indicated that TRERNA1 serves as a critical effector in GC progression by regulating CDH1 at the transcription level. It is implied that TRERNA1/CDH1 is a new potential target for GC therapy.
Collapse
Affiliation(s)
- Huazhang Wu
- Department of Medical Genetics and Developmental Biology, Medical School of Southeast University, The Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, Southeast University, Nanjing 210009, China; School of Life Science, Bengbu Medical College, Bengbu 233030, China
| | - Ying Hu
- Department of Medical Genetics and Developmental Biology, Medical School of Southeast University, The Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, Southeast University, Nanjing 210009, China
| | - Xiufang Liu
- Department of Medical Genetics and Developmental Biology, Medical School of Southeast University, The Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, Southeast University, Nanjing 210009, China
| | - Wei Song
- Department of Medical Genetics and Developmental Biology, Medical School of Southeast University, The Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, Southeast University, Nanjing 210009, China
| | - Pihai Gong
- Department of Medical Genetics and Developmental Biology, Medical School of Southeast University, The Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, Southeast University, Nanjing 210009, China
| | - Kun Zhang
- Third Affiliated Hospital of Harbin Medical University (Harbin Medical University Cancer Hospital), Harbin 150040, China
| | - Zhenxing Chen
- Department of Pathophysiology, Medical School of Southeast University, Nanjing 210009, China
| | - Menghan Zhou
- Department of Medical Genetics and Developmental Biology, Medical School of Southeast University, The Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, Southeast University, Nanjing 210009, China
| | - Xiaohui Shen
- Department of Medical Genetics and Developmental Biology, Medical School of Southeast University, The Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, Southeast University, Nanjing 210009, China
| | - Yanyan Qian
- Department of Medical Genetics and Developmental Biology, Medical School of Southeast University, The Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, Southeast University, Nanjing 210009, China
| | - Hong Fan
- Department of Medical Genetics and Developmental Biology, Medical School of Southeast University, The Key Laboratory of Developmental Genes and Human Diseases, Ministry of Education, Southeast University, Nanjing 210009, China.
| |
Collapse
|
42
|
Practical implications of integrated glioma classification according to the World Health Organization classification of tumors of the central nervous system 2016. Curr Opin Oncol 2017; 28:494-501. [PMID: 27606698 DOI: 10.1097/cco.0000000000000327] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Morphological features identifiable by light microscopy have been the basis of brain tumor diagnostics for many decades. The revised WHO classification of tumors of the central nervous system 2016 combines histological and molecular features for an integrated classification. This new approach builds upon advances in brain tumor molecular genetics and has important practical implications. RECENT FINDINGS Molecular genetic studies revealed distinct glioma entities with specific genetic and epigenetic profiles. Evidence has been accumulated that molecular classification more reliably discriminates glioma entities and better predicts patient outcome than histological classification. Major glioma entities can be distinguished by four molecular biomarkers included in the new WHO classification, namely isocitrate dehydrogenase mutation, codeletion of chromosome arms 1p and 19q, codon 27 lysine-to-methionine mutation in H3 histones, and C11orf95-RELA gene fusions. Each is detectable by common techniques in routinely processed tissue specimens. Their integration into glioma classification greatly improves diagnostic accuracy but also has practical implications concerning establishment and quality control of novel techniques, increased costs and prolonged time to diagnosis. SUMMARY We summarize the relevant changes in the revised WHO classification of gliomas, outline the integrated approach, and discuss its practical implications and potential challenges.
Collapse
|
43
|
Park SH, Won J, Kim SI, Lee Y, Park CK, Kim SK, Choi SH. Molecular Testing of Brain Tumor. J Pathol Transl Med 2017; 51:205-223. [PMID: 28535583 PMCID: PMC5445205 DOI: 10.4132/jptm.2017.03.08] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/08/2017] [Indexed: 01/12/2023] Open
Abstract
The World Health Organization (WHO) classification of central nervous system (CNS) tumors was revised in 2016 with a basis on the integrated diagnosis of molecular genetics. We herein provide the guidelines for using molecular genetic tests in routine pathological practice for an accurate diagnosis and appropriate management. While astrocytomas and IDH-mutant (secondary) glioblastomas are characterized by the mutational status of IDH, TP53, and ATRX, oligodendrogliomas have a 1p/19q codeletion and mutations in IDH, CIC, FUBP1, and the promoter region of telomerase reverse transcriptase (TERTp). IDH-wildtype (primary) glioblastomas typically lack mutations in IDH, but are characterized by copy number variations of EGFR, PTEN, CDKN2A/B, PDGFRA, and NF1 as well as mutations of TERTp. High-grade pediatric gliomas differ from those of adult gliomas, consisting of mutations in H3F3A, ATRX, and DAXX, but not in IDH genes. In contrast, well-circumscribed low-grade neuroepithelial tumors in children, such as pilocytic astrocytoma, pleomorphic xanthoastrocytoma, and ganglioglioma, often have mutations or activating rearrangements in the BRAF, FGFR1, and MYB genes. Other CNS tumors, such as ependymomas, neuronal and glioneuronal tumors, embryonal tumors, meningothelial, and other mesenchymal tumors have important genetic alterations, many of which are diagnostic, prognostic, and predictive markers and therapeutic targets. Therefore, the neuropathological evaluation of brain tumors is increasingly dependent on molecular genetic tests for proper classification, prediction of biological behavior and patient management. Identifying these gene abnormalities requires cost-effective and high-throughput testing, such as next-generation sequencing. Overall, this paper reviews the global guidelines and diagnostic algorithms for molecular genetic testing of brain tumors.
Collapse
Affiliation(s)
- Sung-Hye Park
- Department of Pathology, Seoul National University, College of Medicine, Seoul, Korea.,Neurosicence Institute, Seoul National University, College of Medicine, Seoul, Korea
| | - Jaekyung Won
- Department of Pathology, Seoul National University, College of Medicine, Seoul, Korea
| | - Seong-Ik Kim
- Department of Pathology, Seoul National University, College of Medicine, Seoul, Korea
| | - Yujin Lee
- Department of Pathology, Seoul National University, College of Medicine, Seoul, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Seung-Hong Choi
- Department of Radiology, Seoul National University, College of Medicine, Seoul, Korea
| |
Collapse
|
44
|
Wick W, Roth P, Hartmann C, Hau P, Nakamura M, Stockhammer F, Sabel MC, Wick A, Koeppen S, Ketter R, Vajkoczy P, Eyupoglu I, Kalff R, Pietsch T, Happold C, Galldiks N, Schmidt-Graf F, Bamberg M, Reifenberger G, Platten M, von Deimling A, Meisner C, Wiestler B, Weller M. Long-term analysis of the NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide. Neuro Oncol 2016; 18:1529-1537. [PMID: 27370396 PMCID: PMC5063521 DOI: 10.1093/neuonc/now133] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/18/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Optimal treatment and precise classification for anaplastic glioma are needed. METHODS The objective for long-term follow-up of NOA-04 is to optimize the treatment sequence for patients with anaplastic gliomas. Patients were randomized 2:1:1 to receive the standard radiotherapy (RT) (arm A), procarbazine, lomustine and vincristine (PCV) (arm B1), or temozolomide (TMZ) (arm B2). RESULTS Primary endpoint was time-to-treatment-failure (TTF), defined as progression after 2 lines of therapy or any time before if no further therapy was administered. Exploratory analyses examined associations of molecular marker status with TTF, progression-free survival (PFS), and overall survival (OS). At 9.5 (95% CI: 8.6-10.2) years, no difference between arms (A vs B1/B2) was observed: median TTF (4.6 [3.4-5.1] y vs 4.4 [3.3-5.3) y), PFS (2.5 [1.3-3.5] y vs 2.7 [1.9-3.2] y), and OS (8 [5.5-10.3] y vs 6.5 [5.4-8.3] y). Oligodendroglial versus astrocytic histology-but more so the subgroups according to CpG island methylator phenotype (CIMP) and 1p/19q co-deletion status-revealed a strong prognostic value of CIMPpos with (CIMPcodel) versus without 1p/19 co-deletion (CIMPnon-codel) versus CIMPneg. but no differential efficacy of RT versus chemotherapy for any of the endpoints. PFS was better for PCV- than for TMZ-treated patients with CIMPcodel tumors (HR B1 vs B2 0.39 [0.17-0.92], P = .031). In CIMPneg. tumors, hypermethylation of the O6-methyl-guanyl-DNA methyltransferase promoter (MGMT) provided a risk reduction for PFS with chemotherapy. CONCLUSIONS There is no differential activity of primary chemotherapy versus RT in any subgroup of anaplastic glioma. Molecular diagnosis is superior to histology. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00717210.
Collapse
Affiliation(s)
- Wolfgang Wick
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Patrick Roth
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Christian Hartmann
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Peter Hau
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Makoto Nakamura
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Florian Stockhammer
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Michael C Sabel
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Antje Wick
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Susanne Koeppen
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Ralf Ketter
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Peter Vajkoczy
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Ilker Eyupoglu
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Rolf Kalff
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Torsten Pietsch
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Caroline Happold
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Norbert Galldiks
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Friederike Schmidt-Graf
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Michael Bamberg
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Guido Reifenberger
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Michael Platten
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Andreas von Deimling
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Christoph Meisner
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Benedikt Wiestler
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| | - Michael Weller
- Department of Neurology Clinic, University of Heidelberg, Heidelberg, Germany (W.W., A.W., M.P., B.W.); Clinical Cooperation Unit (CCU Neurooncology), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany (W.W., B.W.); Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (P.R., C.H., M.W.); Department of Neuropathology, Hannover Medical School, Hannover, Germany (C.H.); Department of Neurology, Regensburg University, Regensburg, Germany (P.H.); Department of Neurosurgery Clinic, Hannover Medical School, Hannover, Germany (M.N.); Department of Neurosurgery Clinic, Charité, Berlin, Germany (F.S., P.V.); Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany (M.C.S.); Department of Neurology Clinic, Essen Medical Center, Essen, Germany (S.K.); Department of Neurosurgery Clinic, Saarland University, Homburg, Germany (R.K.); Department of Neurosurgery Clinic, University of Göttingen, Göttingen, Germany (F.S.); Department of Neurosurgery Clinic, University of Erlangen, Erlangen, Germany (I.E.); Department of Neurosurgery Clinic, University of Jena, Jena, Germany (R.K.); Department of Neurology Clinic, Cologne University, Cologne, Germany (N.G.); Department of Neurology Clinic, TU Munich, Munich, Germany (F.S.-G.); Department of Neuropathology, University of Heidelberg, Heidelberg, Germany (A.v.D.); CCU Neuropathology, (C.H., A.v.D.); CCU Brain Tumor Immunology, DKFZ, all Heidelberg, Germany (M.P.); Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany (G.R.); DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany (G.R.), Department of General Neurology, Tübingen, Germany (W.W., A.W., F.S.-G., M.P., M.W.), Department of Radiation Oncology, Tübingen, Germany (M.B.), Department of Medical Biometry, University Hospital Tübingen, Tübingen, Germany (C.M.)
| |
Collapse
|
45
|
Kickingereder P, Bonekamp D, Nowosielski M, Kratz A, Sill M, Burth S, Wick A, Eidel O, Schlemmer HP, Radbruch A, Debus J, Herold-Mende C, Unterberg A, Jones D, Pfister S, Wick W, von Deimling A, Bendszus M, Capper D. Radiogenomics of Glioblastoma: Machine Learning-based Classification of Molecular Characteristics by Using Multiparametric and Multiregional MR Imaging Features. Radiology 2016; 281:907-918. [PMID: 27636026 DOI: 10.1148/radiol.2016161382] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To evaluate the association of multiparametric and multiregional magnetic resonance (MR) imaging features with key molecular characteristics in patients with newly diagnosed glioblastoma. Materials and Methods Retrospective data evaluation was approved by the local ethics committee, and the requirement to obtain informed consent was waived. Preoperative MR imaging features were correlated with key molecular characteristics within a single-institution cohort of 152 patients with newly diagnosed glioblastoma. Preoperative MR imaging features (n = 31) included multiparametric (anatomic and diffusion-, perfusion-, and susceptibility-weighted images) and multiregional (contrast-enhancing regions and hyperintense regions at nonenhanced fluid-attenuated inversion recovery imaging) information with histogram quantification of tumor volumes, volume ratios, apparent diffusion coefficients, cerebral blood flow, cerebral blood volume, and intratumoral susceptibility signals. Molecular characteristics determined included global DNA methylation subgroups (eg, mesenchymal, RTK I "PGFRA," RTK II "classic"), MGMT promoter methylation status, and hallmark copy number variations (EGFR, PDGFRA, MDM4, and CDK4 amplification; PTEN, CDKN2A, NF1, and RB1 loss). Univariate analyses (voxel-lesion symptom mapping for tumor location, Wilcoxon test for all other MR imaging features) and machine learning models were applied to study the strength of association and discriminative value of MR imaging features for predicting underlying molecular characteristics. Results There was no tumor location predilection for any of the assessed molecular parameters (permutation-adjusted P > .05). Univariate imaging parameter associations were noted for EGFR amplification and CDKN2A loss, with both demonstrating increased Gaussian-normalized relative cerebral blood volume and Gaussian-normalized relative cerebral blood flow values (area under the receiver operating characteristics curve: 63%-69%, false discovery rate-adjusted P < .05). Subjecting all MR imaging features to machine learning-based classification enabled prediction of EGFR amplification status and the RTK II glioblastoma subgroup with a moderate, yet significantly greater, accuracy (63% for EGFR [P < .01], 61% for RTK II [P = .01]) than prediction by chance; prediction accuracy for all other molecular parameters was not significant. Conclusion The authors found associations between established MR imaging features and molecular characteristics, although not of sufficient strength to enable generation of machine learning classification models for reliable and clinically meaningful prediction of molecular characteristics in patients with glioblastoma. © RSNA, 2016 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Philipp Kickingereder
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - David Bonekamp
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Martha Nowosielski
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Annekathrin Kratz
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Martin Sill
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Sina Burth
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Antje Wick
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Oliver Eidel
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Heinz-Peter Schlemmer
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Alexander Radbruch
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Jürgen Debus
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Christel Herold-Mende
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Andreas Unterberg
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - David Jones
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Stefan Pfister
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Wolfgang Wick
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Andreas von Deimling
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - Martin Bendszus
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| | - David Capper
- From the Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (P.K., S.B., O.E., M.B.); German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany (D.B., H.P.S., A.R.); Department of Neurology, Medical University Innsbruck, Austria (M.N.); Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany (A.K., A.v.D., D.C.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.K., A.v.D., D.C.); Division of Biostatistics, DKFZ, Heidelberg, Germany (M.S.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (M.N., S.B., A.W., W.W.); Department of Radiation Oncology, University of Heidelberg Medical Center, Heidelberg, Germany (J.D.); Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (J.D.); Division of Neurosurgical Research, Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (C.H.M.); Department of Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany (A.U.); Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.J., S.P.); German Cancer Consortium (DKTK) Core Center Heidelberg, Heidelberg, Germany (D.J., S.P.); Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany (S.P.); and German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, DKFZ, Heidelberg, Germany (W.W.)
| |
Collapse
|
46
|
Huber T, Bette S, Wiestler B, Gempt J, Gerhardt J, Delbridge C, Barz M, Meyer B, Zimmer C, Kirschke JS. Fractional Anisotropy Correlates with Overall Survival in Glioblastoma. World Neurosurg 2016; 95:525-534.e1. [PMID: 27565465 DOI: 10.1016/j.wneu.2016.08.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Glioblastoma (GB) is an infiltrative disease that results in microstructural damage on a cellular level. Fractional anisotropy (FA) is an important estimate of diffusion tensor imaging (DTI) that can be used to assess microstructural integrity. The aim of this study was to examine the correlation between FA values and overall survival (OS) in patients with GB. METHODS This retrospective single-center study included 122 consecutive patients with GB (50 women; median age, 63 years) with preoperative MRI including fluid attenuated inversion recovery (FLAIR), contrast-enhanced T1-weighted sequences, and DTI. FA and apparent diffusion coefficient (ADC) values in contrast-enhancing lesions (FA-CEL, FA-ADC), nonenhancing lesions, and central tumor regions were correlated to histopathologic and clinical parameters. Univariate and multivariate survival analyses were performed. RESULTS Patients with low FA-CEL (median <0.31) showed significantly improved OS in univariate analysis (P = 0.028). FA-CEL also showed a positive correlation with Ki-67 proliferation index (P = 0.003). However, in a multivariate survival model, FA values could not be identified as independent prognostic parameters beside established factors such as age and Karnofsky performance scale score. FA values in nonenhancing lesions and central tumor regions and mean ADC values had no distinct influence on OS. CONCLUSIONS FA values can provide prognostic information regarding OS in patients with GB. There is a correlation between FA-CEL values and Ki-67 proliferation index, a marker for malignancy. Noninvasive identification of more aggressive GB growth patterns might be beneficial for preoperative risk evaluation and estimation of prognosis.
Collapse
Affiliation(s)
- Thomas Huber
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Stefanie Bette
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Gerhardt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claire Delbridge
- Department of Neuropathology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Melanie Barz
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
47
|
Affiliation(s)
- Stephanie E Combs
- Institut für Innovative Radiotherapie (iRT) Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Deutschland.
- Klinik und Poliklinik für RadioOnkologie und Strahlentherapie, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Friederike Schmidt-Graf
- Klinik für Neurologie, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Deutschland
| | - Bernhard Meyer
- Klinik für Neurochirurgie, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Deutschland
| |
Collapse
|
48
|
Prognostic value of the extent of resection in supratentorial WHO grade II astrocytomas stratified for IDH1 mutation status: a single-center volumetric analysis. J Neurooncol 2016; 129:319-28. [PMID: 27344556 PMCID: PMC4992014 DOI: 10.1007/s11060-016-2177-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/04/2016] [Indexed: 01/16/2023]
Abstract
Current evidence supports a maximized extent of resection (EOR) in low-grade gliomas (LGG), regardless of different histological subtypes and molecular markers. We therefore evaluated the prognostic impact of extensive, mainly intraoperative (i)MRI-guided surgery in low-grade astrocytomas stratified for IDH1 mutation status. Retrospective assessment of 46 consecutive cases of newly diagnosed supratentorial WHO grade II astrocytomas treated during the last decade was performed. IDH1 mutation status was obtained for all patients. Volumetric analysis of tumor volumes was performed pre-, intra-, early postoperatively and at first follow-up. Survival analysis was conducted with uni-and multivariate regression models implementing clinical parameters and continuous volumetric variables. Median EOR was 90.4 % (range 17.5–100 %) and was increased to 94.9 % (range 34.8–100 %) in iMRI-guided resections (n = 33). A greater EOR was prognostic for increased progression-free survival (HR 0.23, p = 0.031) and time to re-intervention (TTR) (HR 0.23, p = 0.03). In IDH1 mutant patients, smaller residual tumor volumes were associated with increased TTR (HR 1.01, p = 0.03). IDH1 mutation (38/46 cases) was an independent positive prognosticator for overall survival (OS) in multivariate analysis (HR 0.09, p = 0.002), while extensive surgery had limited impact upon OS. In a subgroup of patients with ≥40 % EOR (n = 39), however, initial and residual tumor volumes were prognostic for OS (HR 1.03, p = 0.005 and HR 1.08, p = 0.007, respectively), persistent to adjustment for IDH1. No association between EOR and neurologic morbidity was found. In this analysis of low-grade astrocytomas stratified for IDH1, extensive tumor resections were prognostic for progression and TTR and, in patients with ≥40 % EOR, for OS.
Collapse
|
49
|
Jiang T, Mao Y, Ma W, Mao Q, You Y, Yang X, Jiang C, Kang C, Li X, Chen L, Qiu X, Wang W, Li W, Yao Y, Li S, Li S, Wu A, Sai K, Bai H, Li G, Chen B, Yao K, Wei X, Liu X, Zhang Z, Dai Y, Lv S, Wang L, Lin Z, Dong J, Xu G, Ma X, Cai J, Zhang W, Wang H, Chen L, Zhang C, Yang P, Yan W, Liu Z, Hu H, Chen J, Liu Y, Yang Y, Wang Z, Wang Z, Wang Y, You G, Han L, Bao Z, Liu Y, Wang Y, Fan X, Liu S, Liu X, Wang Y, Wang Q. CGCG clinical practice guidelines for the management of adult diffuse gliomas. Cancer Lett 2016; 375:263-273. [PMID: 26966000 DOI: 10.1016/j.canlet.2016.01.024] [Citation(s) in RCA: 304] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 02/05/2023]
Abstract
The Chinese Glioma Cooperative Group (CGCG) Guideline Panel for adult diffuse gliomas provided recommendations for diagnostic and therapeutic procedures. The Panel covered all fields of expertise in neuro-oncology, i.e. neurosurgeons, neurologists, neuropathologists, neuroradiologists, radiation and medical oncologists and clinical trial experts. The task made clearer and more transparent choices about outcomes considered most relevant through searching the references considered most relevant and evaluating their value. The scientific evidence of papers collected from the literature was evaluated and graded based on the Oxford Centre for Evidence-based Medicine Levels of Evidence and recommendations were given accordingly. The recommendations will provide a framework and assurance for the strategy of diagnostic and therapeutic measures to reduce complications from unnecessary treatment and cost. The guideline should serve as an application for all professionals involved in the management of patients with adult diffuse glioma and also as a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in China.
Collapse
Affiliation(s)
- Tao Jiang
- Beijing Neurosurgical Institute, Beijing 100050, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing 100069, China; China National Clinical Research Center for Neurological Diseases, Beijing 100050, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Qing Mao
- Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China.
| | - Yongping You
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Xuejun Yang
- Department of Neurosurgery, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Chuanlu Jiang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Chunsheng Kang
- Department of Neurosurgery, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Ling Chen
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaoguang Qiu
- Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Weimin Wang
- Department of Neurosurgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, China
| | - Wenbin Li
- Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yu Yao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shaowu Li
- Beijing Neurosurgical Institute, Beijing 100050, China
| | - Shouwei Li
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Anhua Wu
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Ke Sai
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Hongmin Bai
- Department of Neurosurgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, China
| | - Guilin Li
- Beijing Neurosurgical Institute, Beijing 100050, China
| | - Baoshi Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Kun Yao
- Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Xinting Wei
- Department of Neurosurgery, The 1st Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xianzhi Liu
- Department of Neurosurgery, The 1st Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhiwen Zhang
- Department of Neurosurgery, The First Hospital Affiliated to the Chinese PLA General Hospital, Beijing 100048, China
| | - Yiwu Dai
- Department of Neurosurgery, Beijing Military Region General Hospital, Beijing 100700, China
| | - Shengqing Lv
- Department of Neurosurgery, Xinqiao Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Liang Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Zhixiong Lin
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Jun Dong
- Department of Neurosurgery, Medical College of Soochow University, Suzhou 215123, China
| | - Guozheng Xu
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Guangzhou, Wuhan 430070, China
| | - Xiaodong Ma
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Jinquan Cai
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Hongjun Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Lingchao Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | | | - Pei Yang
- Beijing Neurosurgical Institute, Beijing 100050, China
| | - Wei Yan
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Huimin Hu
- Beijing Neurosurgical Institute, Beijing 100050, China
| | - Jing Chen
- Beijing Neurosurgical Institute, Beijing 100050, China
| | - Yuqing Liu
- Beijing Neurosurgical Institute, Beijing 100050, China
| | - Yuan Yang
- Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China
| | - Zheng Wang
- Beijing Neurosurgical Institute, Beijing 100050, China
| | - Zhiliang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Yongzhi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Gan You
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Lei Han
- Department of Neurosurgery, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zhaoshi Bao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Yanwei Liu
- Beijing Neurosurgical Institute, Beijing 100050, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Xing Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Shuai Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xing Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Yu Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qixue Wang
- Department of Neurosurgery, Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin Medical University General Hospital, Tianjin 300052, China
| | | |
Collapse
|
50
|
Heiland DH, Staszewski O, Hirsch M, Masalha W, Franco P, Grauvogel J, Capper D, Schrimpf D, Urbach H, Weyerbrock A. Malignant Transformation of a Dysembryoplastic Neuroepithelial Tumor (DNET) Characterized by Genome-Wide Methylation Analysis. J Neuropathol Exp Neurol 2016; 75:358-65. [DOI: 10.1093/jnen/nlw007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/27/2015] [Indexed: 01/06/2023] Open
|