Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 15.238, New York, NY, 10029, USA.
Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Acta Neuropathol. 2024 Jul 16;148(1):5. doi: 10.1007/s00401-024-02761-7.
In recent years, the classification of adult-type diffuse gliomas has undergone a revolution, wherein specific molecular features now represent defining diagnostic criteria of IDH-wild-type glioblastomas, IDH-mutant astrocytomas, and IDH-mutant 1p/19q-codeleted oligodendrogliomas. With the introduction of the 2021 WHO CNS classification, additional molecular alterations are now integrated into the grading of these tumors, given equal weight to traditional histologic features. However, there remains a great deal of heterogeneity in patient outcome even within these established tumor subclassifications that is unexplained by currently codified molecular alterations, particularly in the IDH-mutant astrocytoma category. There is also significant intercellular genetic and epigenetic heterogeneity and plasticity with resulting phenotypic heterogeneity, making these tumors remarkably adaptable and robust, and presenting a significant barrier to the design of effective therapeutics. Herein, we review the mechanisms and consequences of genetic and epigenetic instability, including chromosomal instability (CIN), microsatellite instability (MSI)/mismatch repair (MMR) deficits, and epigenetic instability, in the underlying biology, tumorigenesis, and progression of IDH-mutant astrocytomas. We also discuss the contribution of recent high-resolution transcriptomics studies toward defining tumor heterogeneity with single-cell resolution. While intratumoral heterogeneity is a well-known feature of diffuse gliomas, the contribution of these various processes has only recently been considered as a potential driver of tumor aggressiveness. CIN has an independent, adverse effect on patient survival, similar to the effect of histologic grade and homozygous CDKN2A deletion, while MMR mutation is only associated with poor overall survival in univariate analysis but is highly correlated with higher histologic/molecular grade and other aggressive features. These forms of genomic instability, which may significantly affect the natural progression of these tumors, response to therapy, and ultimately clinical outcome for patients, are potentially measurable features which could aid in diagnosis, grading, prognosis, and development of personalized therapeutics.
近年来,成人弥漫性胶质瘤的分类发生了革命性的变化,特定的分子特征现在成为 IDH 野生型胶质母细胞瘤、IDH 突变型星形细胞瘤和 IDH 突变型 1p/19q 缺失性少突胶质细胞瘤的明确诊断标准。随着 2021 年世界卫生组织中枢神经系统分类的引入,现在将其他分子改变纳入这些肿瘤的分级中,与传统的组织学特征具有同等权重。然而,即使在这些已确立的肿瘤亚分类中,患者的预后仍然存在很大的异质性,这无法用目前编码的分子改变来解释,特别是在 IDH 突变型星形细胞瘤类别中。这些肿瘤还存在显著的细胞间遗传和表观遗传异质性和可塑性,导致表型异质性,使这些肿瘤具有很强的适应性和稳健性,这对有效治疗药物的设计构成了重大障碍。在此,我们回顾了遗传和表观遗传不稳定性的机制和后果,包括染色体不稳定性(CIN)、微卫星不稳定性(MSI)/错配修复(MMR)缺陷和表观遗传不稳定性,这些机制和后果在 IDH 突变型星形细胞瘤的基础生物学、肿瘤发生和进展中发挥作用。我们还讨论了最近高分辨率转录组学研究对定义具有单细胞分辨率的肿瘤异质性的贡献。虽然肿瘤内异质性是弥漫性神经胶质瘤的一个众所周知的特征,但这些不同过程的贡献最近才被认为是肿瘤侵袭性的潜在驱动因素。CIN 对患者生存有独立的不利影响,与组织学分级和纯合性 CDKN2A 缺失的影响相似,而 MMR 突变仅在单因素分析中与总体生存率差相关,但与较高的组织学/分子分级和其他侵袭性特征高度相关。这些形式的基因组不稳定性可能显著影响这些肿瘤的自然进展、对治疗的反应以及患者的临床结局,是潜在可测量的特征,可以辅助诊断、分级、预后和开发个体化治疗。
Cochrane Database Syst Rev. 2022-3-2
Cochrane Database Syst Rev. 2018-1-22
Cochrane Database Syst Rev. 2018-2-6
Acta Neuropathol. 2025-8-19
Int J Mol Sci. 2025-6-27
Biomedicines. 2025-5-7
Clin Cancer Res. 2024-8-15
Cancer Cell. 2024-5-13
Acta Neuropathol. 2024-1-6