Hopp Children's Cancer Centre at National Centre for Tumour Diseases Heidelberg (KiTZ), Heidelberg, Germany.
Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Acta Neuropathol. 2019 Aug;138(2):309-326. doi: 10.1007/s00401-019-02020-0. Epub 2019 May 10.
In 2012, an international consensus paper reported that medulloblastoma comprises four molecular subgroups (WNT, SHH, Group 3, and Group 4), each associated with distinct genomic features and clinical behavior. Independently, multiple recent reports have defined further intra-subgroup heterogeneity in the form of biologically and clinically relevant subtypes. However, owing to differences in patient cohorts and analytical methods, estimates of subtype number and definition have been inconsistent, especially within Group 3 and Group 4. Herein, we aimed to reconcile the definition of Group 3/Group 4 MB subtypes through the analysis of a series of 1501 medulloblastomas with DNA-methylation profiling data, including 852 with matched transcriptome data. Using multiple complementary bioinformatic approaches, we compared the concordance of subtype calls between published cohorts and analytical methods, including assessments of class-definition confidence and reproducibility. While the lowest complexity solutions continued to support the original consensus subgroups of Group 3 and Group 4, our analysis most strongly supported a definition comprising eight robust Group 3/Group 4 subtypes (types I-VIII). Subtype II was consistently identified across all component studies, while all others were supported by multiple class-definition methods. Regardless of analytical technique, increasing cohort size did not further increase the number of identified Group 3/Group 4 subtypes. Summarizing the molecular and clinico-pathological features of these eight subtypes indicated enrichment of specific driver gene alterations and cytogenetic events amongst subtypes, and identified highly disparate survival outcomes, further supporting their biological and clinical relevance. Collectively, this study provides continued support for consensus Groups 3 and 4 while enabling robust derivation of, and categorical accounting for, the extensive intertumoral heterogeneity within Groups 3 and 4, revealed by recent high-resolution subclassification approaches. Furthermore, these findings provide a basis for application of emerging methods (e.g., proteomics/single-cell approaches) which may additionally inform medulloblastoma subclassification. Outputs from this study will help shape definition of the next generation of medulloblastoma clinical protocols and facilitate the application of enhanced molecularly guided risk stratification to improve outcomes and quality of life for patients and their families.
2012 年,一份国际共识文件报告称,髓母细胞瘤包含四个分子亚组(WNT、SHH、第 3 组和第 4 组),每个亚组都与独特的基因组特征和临床行为相关。独立地,最近的多项报告进一步定义了亚组内的异质性,形成了具有生物学和临床相关性的亚型。然而,由于患者队列和分析方法的差异,亚型数量和定义的估计一直不一致,尤其是在第 3 组和第 4 组内。在此,我们旨在通过分析一系列包含 1501 例髓母细胞瘤的 DNA 甲基化图谱数据,包括 852 例匹配的转录组数据,来协调第 3 组/第 4 组髓母细胞瘤亚型的定义。我们使用多种互补的生物信息学方法,比较了发表的队列和分析方法之间亚型分类的一致性,包括对类别定义置信度和可重复性的评估。虽然最低复杂度的解决方案仍然支持第 3 组和第 4 组的原始共识亚组,但我们的分析最有力地支持了一个包含 8 个稳健的第 3 组/第 4 组亚型(类型 I-VIII)的定义。亚型 II 在所有组成研究中均得到一致识别,而其他所有亚型均得到多种类别定义方法的支持。无论分析技术如何,增加队列大小都不会进一步增加第 3 组/第 4 组亚型的数量。总结这 8 个亚型的分子和临床病理学特征表明,特定驱动基因改变和细胞遗传学事件在亚型之间存在富集,并确定了高度不同的生存结果,进一步支持了它们的生物学和临床相关性。总的来说,这项研究为共识的第 3 组和第 4 组提供了持续的支持,同时能够稳健地推导出,并对第 3 组和第 4 组内广泛的肿瘤间异质性进行分类核算,这是由最近的高分辨率亚分类方法揭示的。此外,这些发现为新兴方法(例如蛋白质组学/单细胞方法)的应用提供了基础,这可能进一步为髓母细胞瘤的分类提供信息。本研究的结果将有助于定义下一代髓母细胞瘤临床方案,并促进增强的分子指导风险分层的应用,以改善患者及其家属的预后和生活质量。