整合分析揭示 H3 K27M 突变型弥漫性中线神经胶质瘤的两种具有预后意义的分子和临床明显不同亚型。
Integrated analyses reveal two molecularly and clinically distinct subtypes of H3 K27M-mutant diffuse midline gliomas with prognostic significance.
机构信息
Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Research Institute Children's Cancer Center Hamburg, Martinistrasse 52, N63 (HPI), 20251, Hamburg, Germany.
出版信息
Acta Neuropathol. 2024 Sep 10;148(1):40. doi: 10.1007/s00401-024-02800-3.
H3 K27M-altered diffuse midline gliomas (DMGs) are highly malignant tumours that arise in the midline structures of the CNS. Most DMGs carry an H3 K27M-mutation in one of the genes encoding for histone H3. Recent studies suggested that epigenetic subgroups of DMGs can be distinguished based on alterations in the MAPK-signalling pathway, tumour localisation, mutant H3-gene, or overall survival (OS). However, as these parameters were studied individually, it is unclear how they collectively influence survival. Hence, we analysed dependencies between different parameters, to define novel epigenetic, clinically meaningful subgroups of DMGs. We collected a multifaceted cohort of 149 H3 K27M-mutant DMGs, also incorporating data of published cases. DMGs were included in the study if they could be clearly allocated to the spinal cord (n = 31; one patient with an additional sellar tumour), medulla (n = 20), pons (n = 64) or thalamus (n = 33), irrespective of further known characteristics. We then performed global genome-wide DNA methylation profiling and, for a subset, DNA sequencing and survival analyses. Unsupervised hierarchical clustering of DNA methylation data indicated two clusters of DMGs, i.e. subtypes DMG-A and DMG-B. These subtypes differed in mutational spectrum, tumour localisation, age at diagnosis and overall survival. DMG-A was enriched for DMGs with MAPK-mutations, medullary localisation and adult age. 13% of DMG-A had a methylated MGMT promoter. Contrarily, DMG-B was enriched for cases with TP53-mutations, PDGFRA-amplifications, pontine localisation and paediatric patients. In univariate analyses, the features enriched in DMG-B were associated with a poorer survival. However, all significant parameters tested were dependent on the cluster attribution, which had the largest effect on survival: DMG-A had a significantly better survival compared to DMG-B (p < 0.001). Hence, the subtype attribution based on two methylation clusters can be used to predict survival as it integrates different molecular and clinical parameters.
H3 K27M 突变弥漫性中线胶质瘤(DMG)是一种高度恶性肿瘤,发生于中枢神经系统的中线结构。大多数 DMG 在编码组蛋白 H3 的基因之一中携带 H3 K27M 突变。最近的研究表明,DMG 可以基于 MAPK 信号通路、肿瘤定位、突变 H3 基因或总生存期(OS)的改变来区分表观遗传亚群。然而,由于这些参数是单独研究的,因此不清楚它们如何共同影响生存。因此,我们分析了不同参数之间的依赖性,以定义 DMG 的新的表观遗传、具有临床意义的亚群。我们收集了一个多方面的 149 例 H3 K27M 突变 DMG 队列,同时还纳入了已发表病例的数据。如果可以明确将 DMG 分配到脊髓(n=31;1 例患者伴有额外的鞍内肿瘤)、延髓(n=20)、脑桥(n=64)或丘脑(n=33),则将其纳入研究,无论其是否具有进一步的已知特征。然后,我们进行了全基因组 DNA 甲基化谱分析,并对一部分进行了 DNA 测序和生存分析。DNA 甲基化数据的无监督层次聚类表明 DMG 存在两个亚群,即 DMG-A 和 DMG-B。这些亚型在突变谱、肿瘤定位、诊断时的年龄和总生存期方面存在差异。DMG-A 中富含 MAPK 突变、延髓定位和成年患者的 DMG。13%的 DMG-A 存在甲基化 MGMT 启动子。相反,DMG-B 富含 TP53 突变、PDGFRA 扩增、脑桥定位和儿科患者的病例。在单变量分析中,在 DMG-B 中富集的特征与较差的生存相关。然而,所有经过测试的显著参数都依赖于聚类归属,这对生存的影响最大:与 DMG-B 相比,DMG-A 的生存明显更好(p<0.001)。因此,基于两个甲基化簇的亚型归属可用于预测生存,因为它整合了不同的分子和临床参数。