Department of Pathology, Odense University Hospital, Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Neuropathol Appl Neurobiol. 2021 Feb;47(1):108-126. doi: 10.1111/nan.12645. Epub 2020 Aug 17.
AIMS: We aimed to reclassify a population-based cohort of 529 adult glioma patients to evaluate the prognostic impact of the 2016 World Health Organization (WHO) central nervous system tumour classification. Moreover, we evaluated the feasibility of gene panel next-generation sequencing (NGS) in daily diagnostics of 225 prospective glioma patients. METHODS: The retrospective cohort was reclassified according to WHO 2016 criteria by immunohistochemistry for IDH-R132H, fluorescence in situ hybridization for 1p/19q-codeletion and gene panel NGS. All tumours of the prospective cohort were subjected to NGS analysis up-front. RESULTS: The entire population-based cohort was successfully reclassified according to WHO 2016 criteria. NGS results were obtained for 98% of the prospective patients. Survival analyses in the population-based cohort confirmed three major prognostic subgroups, that is, isocitrate dehydrogenase (IDH)-mutant and 1p/19q-codeleted oligodendrogliomas, IDH-mutant astrocytomas and IDH-wildtype glioblastomas. The distinction between WHO grade II and III was prognostic in patients with IDH-mutant astrocytoma. The survival of patients with IDH-wildtype diffuse astrocytomas carrying TERT promoter mutation and/or EGFR amplification overlapped with the poor survival of IDH-wildtype glioblastoma patients. CONCLUSIONS: Gene panel NGS proved feasible in daily diagnostics. In addition, our study confirms the prognostic role of glioma classification according to WHO 2016 in a large population-based cohort. Molecular features of glioblastoma in IDH-wildtype diffuse glioma were linked to poor survival corresponding to IDH-wildtype glioblastoma patients. The distinction between WHO grade II and III retained prognostic significance in patients with IDH-mutant diffuse astrocytic gliomas.
目的:我们旨在对 529 例成人胶质细胞瘤患者的基于人群的队列进行重新分类,以评估 2016 年世界卫生组织(WHO)中枢神经系统肿瘤分类对预后的影响。此外,我们还评估了基因面板下一代测序(NGS)在 225 例前瞻性胶质细胞瘤患者日常诊断中的可行性。
方法:通过 IDH-R132H 的免疫组织化学、1p/19q 缺失的荧光原位杂交和基因面板 NGS 对回顾性队列进行了 2016 年 WHO 标准的重新分类。前瞻性队列的所有肿瘤均进行了 NGS 分析。
结果:根据 WHO 2016 标准,成功地对整个基于人群的队列进行了重新分类。98%的前瞻性患者获得了 NGS 结果。基于人群的队列的生存分析证实了三个主要的预后亚组,即异柠檬酸脱氢酶(IDH)突变和 1p/19q 缺失性少突胶质细胞瘤、IDH 突变型星形细胞瘤和 IDH 野生型胶质母细胞瘤。IDH 突变型星形细胞瘤患者中,WHO 分级 II 和 III 的区别具有预后意义。携带 TERT 启动子突变和/或 EGFR 扩增的 IDH 野生型弥漫性星形细胞瘤患者的生存与 IDH 野生型胶质母细胞瘤患者的不良生存重叠。
结论:基因面板 NGS 已被证明在日常诊断中是可行的。此外,我们的研究在一个大型基于人群的队列中证实了根据 2016 年 WHO 分类对胶质细胞瘤的预后作用。IDH 野生型弥漫性神经胶质瘤中胶质母细胞瘤的分子特征与 IDH 野生型胶质母细胞瘤患者的不良生存相关。IDH 突变型弥漫性星形细胞瘤患者中,WHO 分级 II 和 III 的区别仍具有预后意义。
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