Pollack Ian F, Finkelstein Sydney D, Burnham Judith, Hamilton Ronald L, Yates Allan J, Holmes Emiko J, Boyett James M, Finlay Jonathan L
Department of Neurosurgery, University of Pittsburgh Medical Center and the Children's Hospital of Pittsburgh, Pittsburgh, Pa., USA.
Pediatr Neurosurg. 2003 Sep;39(3):114-21. doi: 10.1159/000071647.
Results of recent molecular studies on malignant gliomas in adults showed that deletions within the short arm of chromosome 1 and/or the long arm of chromosome 19 identified a prognostically favorable subgroup of tumors that often respond to conventional chemotherapy. To determine if this association applies to pediatric malignant gliomas, we examined the correlation between 1p and 19q deletions and outcome in the cohort derived from the Children's Cancer Group study 945, the largest randomized trial of such tumors completed to date.
Archival histopathologic material yielded tissue of sufficient quality and quantity for genotyping in 121 specimens. Sections were examined histologically and targets that contained malignant glioma were isolated by microdissection and subjected to polymerase-chain-reaction-based amplification of microsatellite loci using fluorochrome-labeled primers, followed by capillary electrophoresis, and fluorescent fragment analysis. One hundred and seven specimens had 2 alleles for at least 1 of the 3 1p loci examined, and were therefore informative for determining loss of heterozygosity, defined as at least a twofold difference in fluorescence intensity between the paired allelic bands; 99 were informative at 19q.
Thirty-two tumors (29.9%) had loss of heterozygosity involving 1p, 27 (28%) involving 19q, and 13 involving both, an incidence consistent with previous reports involving adult malignant gliomas. However, outcome analyses of the entire cohort found no favorable association between 1p loss, 19q loss, or the combination, and survival. Subset analysis disclosed no association with outcome in either arm of the study (which compared efficacy of 2 chemotherapeutic regimens) or in subgroups stratified by age, tumor location, or tumor histology.
In contrast to recent observations of adult malignant gliomas, deletions involving chromosomes 1p or 19q did not predict a survival advantage in this series of pediatric high-grade gliomas, which might indicate that frequencies of various histologic and molecular subtypes of malignant gliomas differ between children and adults, and supports further efforts to identify prognostic indicators relevant to pediatric gliomas.
近期针对成人恶性胶质瘤的分子研究结果显示,1号染色体短臂和/或19号染色体长臂的缺失确定了一个预后良好的肿瘤亚组,该亚组肿瘤通常对传统化疗有反应。为了确定这种关联是否适用于儿童恶性胶质瘤,我们在儿童癌症组研究945(迄今为止完成的此类肿瘤的最大规模随机试验)得出的队列中,研究了1p和19q缺失与预后之间的相关性。
存档的组织病理学材料为121份标本提供了质量和数量足够用于基因分型的组织。对切片进行组织学检查,通过显微切割分离出含有恶性胶质瘤的靶点,并使用荧光标记引物对微卫星位点进行基于聚合酶链反应的扩增,随后进行毛细管电泳和荧光片段分析。107份标本在检测的3个1p位点中至少有1个有2个等位基因,因此可用于确定杂合性缺失,杂合性缺失定义为配对等位基因条带之间荧光强度至少有两倍差异;99份标本在19q方面具有信息价值。
32例肿瘤(29.9%)存在涉及1p的杂合性缺失,27例(28%)涉及19q,13例同时涉及两者,这一发生率与先前关于成人恶性胶质瘤的报道一致。然而,对整个队列的预后分析发现,1p缺失、19q缺失或两者组合与生存率之间没有良好关联。亚组分析显示,在研究的任何一组(比较两种化疗方案疗效)或按年龄、肿瘤位置或肿瘤组织学分层的亚组中,均与预后无关。
与近期对成人恶性胶质瘤的观察结果相反,在这一系列儿童高级别胶质瘤中,涉及1号染色体p臂或19号染色体q臂的缺失并不能预测生存优势,这可能表明儿童和成人恶性胶质瘤的各种组织学和分子亚型的频率不同,并支持进一步努力确定与儿童胶质瘤相关的预后指标。