Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA; Department of Pathology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
World Neurosurg. 2021 May;149:e894-e912. doi: 10.1016/j.wneu.2021.01.079. Epub 2021 Jan 28.
Previous studies have demonstrated possible differences in glioblastoma (GBM) survival attributable to ethnicity. The goal of this study was to quantify oncogenic differences and evaluate the overall survival (OS) and progression-free survival (PFS) differences in GBM patients across race/ethnicity using both population-based surveillance and institutional data sets from the United States (US) and Mexico.
Retrospective cohort study comprising the Texas Cancer Registry (TCR, n = 4134) and referral institutions located in US (n = 254) and Mexico (n = 47) were evaluated. Primary outcomes include OS and PFS. Oncogenic differences attributable to ethnicity were assessed. IDH1/IDH2 status was evaluated by sequencing in US and Mexico samples. Kaplan-Meier and Cox proportional hazards regression for survival analysis.
A total of 4134 GBM patients were identified from the TCR data set, ethnicity comparison demonstrated that Hispanic patients were diagnosed at a significantly younger age compared to non-Hispanic white patients (NHW) (median: 58 vs. 62, P < 0.001) and had improved OS (hazard ratio: 0.82, P < 0.001). In the oncogenic analysis, we observed a significant enrichment of IDH1/IDH2 mutations in Mexican Hispanic patients compared to US Hispanic patients (29.8% vs. 7.9%, P = 0.012); IDH2 mutations drove this difference. Post-progression survival was significantly shorter in patients from Mexico than US (3.0 vs. 11.4 months; P < 0.001), while OS remained similar.
IDH2 mutations are more prevalent in Mexican Hispanic individuals compared to US individuals and may be a crucial contributor to the previously reported survival benefit of Hispanic individuals in large population databases. These findings are critical for both screening of IDH2 mutations and targeted interventions in GBM.
先前的研究表明，种族因素可能导致胶质母细胞瘤（GBM）患者的存活率存在差异。本研究旨在使用美国（US）和墨西哥的人群监测数据和机构数据集，量化肿瘤发生差异，并评估不同种族/族裔的 GBM 患者的总生存（OS）和无进展生存（PFS）差异。
回顾性队列研究包括德克萨斯癌症登记处（TCR，n=4134）和位于美国（n=254）和墨西哥（n=47）的转诊机构。主要结局包括 OS 和 PFS。评估归因于种族的肿瘤发生差异。通过测序评估 US 和墨西哥样本中的 IDH1/IDH2 状态。Kaplan-Meier 和 Cox 比例风险回归进行生存分析。
从 TCR 数据集共确定了 4134 例 GBM 患者，种族比较表明，与非西班牙裔白人患者（NHW）相比，西班牙裔患者的诊断年龄明显较小（中位数：58 岁比 62 岁，P<0.001），并且 OS 得到改善（风险比：0.82，P<0.001）。在肿瘤发生分析中，我们观察到与美国西班牙裔患者相比，墨西哥西班牙裔患者的 IDH1/IDH2 突变明显富集（29.8%比 7.9%，P=0.012）；IDH2 突变导致了这一差异。与美国患者相比，来自墨西哥的患者的疾病进展后生存时间明显更短（3.0 个月比 11.4 个月；P<0.001），而 OS 仍然相似。
与美国个体相比，IDH2 突变在墨西哥西班牙裔个体中更为普遍，并且可能是先前在大型人群数据库中报道的西班牙裔个体生存获益的重要原因。这些发现对于 IDH2 突变的筛查和 GBM 的靶向干预都至关重要。
