Department of Neurology, Erasmus MC, Room Be 430A, POBox 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands.
Acta Neuropathol Commun. 2015 Dec 23;3:88. doi: 10.1186/s40478-015-0265-4.
INTRODUCTION: Recent advances in molecular diagnostics allow diffuse gliomas to be classified based on their genetic changes into distinct prognostic subtypes. However, a systematic analysis of all molecular markers has thus far not been performed; most classification schemes use a predefined and select set of genes/molecular markers. Here, we have analysed the TCGA dataset (combined glioblastoma (GBM) and lower grade glioma (LGG) datasets) to identify all prognostic genetic markers in diffuse gliomas in order to generate a comprehensive classification scheme. RESULTS: Of the molecular markers investigated (all genes mutated at a population frequency >1.7 % and frequent chromosomal imbalances) in the entire glioma dataset, 57 were significantly associated with overall survival. Of these, IDH1 or IDH2 mutations are associated with lowest hazard ratio, which confirms IDH as the most important prognostic marker in diffuse gliomas. Subsequent subgroup analysis largely confirms many of the currently used molecular classification schemes for diffuse gliomas (ATRX or TP53 mutations, 1p19q codeletion). Our analysis also identified PI3-kinase mutations as markers of poor prognosis in IDH-mutated + ATRX/TP53 mutated diffuse gliomas, median survival 3.7 v. 6.3 years (P = 0.02, Hazard rate (HR) 2.93, 95 % confidence interval (CI) 1.16 - 7.38). PI3-kinase mutations were also prognostic in two independent datasets. In our analysis, no additional molecular markers were identified that further refine the molecular classification of diffuse gliomas. Interestingly, these molecular classifiers do not fully explain the variability in survival observed for diffuse glioma patients. We demonstrate that tumor grade remains an important prognostic factor for overall survival in diffuse gliomas, even within molecular glioma subtypes. Tumor grade was correlated with the mutational load (the number of non-silent mutations) of the tumor: grade II diffuse gliomas harbour fewer genetic changes than grade III or IV, even within defined molecular subtypes (e.g. ATRX mutated diffuse gliomas). CONCLUSION: We have identified PI3K mutations as novel prognostic markers in gliomas. We also demonstrate that the mutational load is associated with tumor grade. The increase in mutational load may partially explain the increased aggressiveness of higher grade diffuse gliomas when a subset of the affected genes actively contributes to gliomagenesis and/or progression.
简介: 分子诊断学的最新进展使弥漫性神经胶质瘤能够根据其遗传变化分为不同的预后亚型。然而,迄今尚未对所有分子标志物进行系统分析;大多数分类方案使用预定义和精选的一组基因/分子标志物。在这里,我们分析了 TCGA 数据集(合并的胶质母细胞瘤 (GBM) 和低级别神经胶质瘤 (LGG) 数据集),以确定弥漫性神经胶质瘤中所有预后遗传标志物,从而生成一个全面的分类方案。 结果: 在整个神经胶质瘤数据集中研究的分子标志物(所有在人群频率中突变率>1.7%和频繁染色体失衡的基因)中,有 57 个与总生存时间显著相关。其中,IDH1 或 IDH2 突变与最低危险比相关,这证实 IDH 是弥漫性神经胶质瘤中最重要的预后标志物。随后的亚组分析在很大程度上证实了许多目前用于弥漫性神经胶质瘤的分子分类方案(ATRX 或 TP53 突变,1p19q 缺失)。我们的分析还发现,PI3-激酶突变是 IDH 突变阳性+ATRX/TP53 突变弥漫性神经胶质瘤中预后不良的标志物,中位生存期为 3.7 与 6.3 年(P=0.02,危险率 (HR) 2.93,95%置信区间 (CI) 1.16-7.38)。PI3-激酶突变在两个独立的数据集也是预后标志物。在我们的分析中,没有发现其他分子标志物可以进一步细化弥漫性神经胶质瘤的分子分类。有趣的是,这些分子分类器并不能完全解释弥漫性神经胶质瘤患者生存的可变性。我们证明,肿瘤分级仍然是弥漫性神经胶质瘤总生存的重要预后因素,即使在分子神经胶质瘤亚型内也是如此。肿瘤分级与肿瘤的突变负荷(非同义突变的数量)相关:与 III 级或 IV 级相比,II 级弥漫性神经胶质瘤的遗传变化较少,即使在定义明确的分子亚型内(例如,ATRX 突变的弥漫性神经胶质瘤)也是如此。 结论: 我们已经确定了 PI3K 突变是神经胶质瘤的新的预后标志物。我们还证明,突变负荷与肿瘤分级相关。突变负荷的增加可能部分解释了高级别弥漫性神经胶质瘤侵袭性增加的原因,即受影响基因的一部分积极促进了神经胶质瘤的发生和/或进展。
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