151
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Liau LM, Ashkan K, Tran DD, Campian JL, Trusheim JE, Cobbs CS, Heth JA, Salacz M, Taylor S, D'Andre SD, Iwamoto FM, Dropcho EJ, Moshel YA, Walter KA, Pillainayagam CP, Aiken R, Chaudhary R, Goldlust SA, Bota DA, Duic P, Grewal J, Elinzano H, Toms SA, Lillehei KO, Mikkelsen T, Walbert T, Abram SR, Brenner AJ, Brem S, Ewend MG, Khagi S, Portnow J, Kim LJ, Loudon WG, Thompson RC, Avigan DE, Fink KL, Geoffroy FJ, Lindhorst S, Lutzky J, Sloan AE, Schackert G, Krex D, Meisel HJ, Wu J, Davis RP, Duma C, Etame AB, Mathieu D, Kesari S, Piccioni D, Westphal M, Baskin DS, New PZ, Lacroix M, May SA, Pluard TJ, Tse V, Green RM, Villano JL, Pearlman M, Petrecca K, Schulder M, Taylor LP, Maida AE, Prins RM, Cloughesy TF, Mulholland P, Bosch ML. Correction to: First results on survival from a large Phase 3 clinical trial of an autologous dendritic cell vaccine in newly diagnosed glioblastoma. J Transl Med 2018; 16:179. [PMID: 29958537 PMCID: PMC6026340 DOI: 10.1186/s12967-018-1552-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Linda M Liau
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
| | | | | | | | | | - Charles S Cobbs
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Jason A Heth
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Salacz
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Sarah Taylor
- University of Kansas Cancer Center, Kansas City, KS, USA
| | | | | | | | | | - Kevin A Walter
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Robert Aiken
- Rutgers Cancer Institute, New Brunswick, NJ, USA
| | - Rekha Chaudhary
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | | | - Paul Duic
- Winthrop-University Hospital, Mineola, NY, USA
| | | | | | | | | | | | | | | | | | - Steven Brem
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Simon Khagi
- University of North Carolina, Chapel Hill, NC, USA
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA, USA
| | - Lyndon J Kim
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Karen L Fink
- Baylor University Medical Center, Dallas, TX, USA
| | | | | | - Jose Lutzky
- Mount Sinai Comprehensive Cancer Center, Miami, FL, USA
| | - Andrew E Sloan
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Gabriele Schackert
- University Hospital Carl-Gustav-Carus of Technical University, Dresden, Germany
| | - Dietmar Krex
- University Hospital Carl-Gustav-Carus of Technical University, Dresden, Germany
| | | | - Julian Wu
- Tufts University School of Medicine, Boston, MA, USA
| | | | | | - Arnold B Etame
- H. Lee Moffit Cancer Center and Research Institute, Tampa, FL, USA
| | - David Mathieu
- CHUSHopital Fleurimont, Sherbrooke University, Sherbrooke, QC, Canada
| | | | | | - Manfred Westphal
- Neurochirurgische Klinik University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | - Victor Tse
- Kaiser Permanente Northern California, Redwood City, CA, USA
| | | | - John L Villano
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Kevin Petrecca
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | | | - Lynne P Taylor
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
| | | | - Robert M Prins
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Timothy F Cloughesy
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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152
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Sauvigny T, Mohme M, Grensemann J, Dührsen L, Regelsberger J, Kluge S, Schmidt NO, Westphal M, Czorlich P. Rate and risk factors for a hyperactivity delirium in patients with aneurysmal subarachnoid haemorrhage. Neurosurg Rev 2018; 42:481-488. [DOI: 10.1007/s10143-018-0990-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022]
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153
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Colman H, Westphal M, Sampson JH. Introduction. Update on adult neuro-oncology. Neurosurg Focus 2018; 44:E1. [PMID: 29852765 DOI: 10.3171/2018.3.focus18149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Howard Colman
- 1Huntsman Cancer Institute and Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Manfred Westphal
- 2Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and
| | - John H Sampson
- 3Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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154
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Dührsen L, Sauvigny T, House PM, Stodieck S, Holst B, Matschke J, Schön G, Westphal M, Martens T. Impact of focal cortical dysplasia Type IIIa on seizure outcome following anterior mesial temporal lobe resection for the treatment of epilepsy. J Neurosurg 2018; 128:1668-1673. [DOI: 10.3171/2017.2.jns161295] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVETemporal lobe epilepsy (TLE) is the most common type of pharmacoresistant focal epilepsy, for which anterior mesial temporal lobe resection (AMTLR) is a treatment option. Focal cortical dysplasia Type IIIa (FCD IIIa), a developmental lesion resulting from defects in neuronal formation and migration into the temporal pole (FCD I) combined with hippocampal sclerosis (HS), can be a neuropathological finding. In this study, the authors investigate the impact of FCD IIIa on seizure outcome in patients with TLE who underwent AMTLR.METHODSThe authors performed a retrospective analysis of all patients with TLE who underwent AMTLR at their institution between June 2011 and April 2014. Histopathological analysis was used to determine whether patients had HS together with FCD I (FCD IIIa) or HS alone. The groups were compared with regard to age, sex, years of epilepsy, and seizure outcome using the Engel classification.RESULTSA total of 51 patients with TLE underwent AMTLR at the authors’ institution. FCD IIIa was diagnosed in 13 cases. The patients experienced seizures for a mean duration of 31.1 years. The mean length of follow-up after the procedure was 18 months. All patients with FCD IIIa had a favorable seizure outcome (Engel Class I or II) compared with 71% of the patients with no pathological findings in the temporal pole (p < 0.01).CONCLUSIONSPatients with histopathologically proven FCD IIIa had a significantly better seizure outcome after AMTLR than patients with HS alone. Further effort should be made during presurgical evaluation to detect FCD IIIa so that the most suitable resection technique can be chosen and postoperative seizure outcome can be predicted for patient counseling.
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Affiliation(s)
| | | | - Patrick M. House
- 2Department of Neurology and Epileptology, Hamburg Epilepsy Center, Hamburg, Germany
| | - Stefan Stodieck
- 2Department of Neurology and Epileptology, Hamburg Epilepsy Center, Hamburg, Germany
| | | | | | - Gerhard Schön
- 5Medical Biometry and Epidemiology, University Medical Center Hamburg–Eppendorf; and
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155
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Neidert MC, Kowalewski DJ, Silginer M, Kapolou K, Backert L, Freudenmann LK, Peper JK, Marcu A, Wang SSY, Walz JS, Wolpert F, Rammensee HG, Henschler R, Lamszus K, Westphal M, Roth P, Regli L, Stevanović S, Weller M, Eisele G. The natural HLA ligandome of glioblastoma stem-like cells: antigen discovery for T cell-based immunotherapy. Acta Neuropathol 2018; 135:923-938. [PMID: 29557506 DOI: 10.1007/s00401-018-1836-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 01/27/2023]
Abstract
Glioblastoma is the most frequent malignant primary brain tumor. In a hierarchical tumor model, glioblastoma stem-like cells (GSC) play a major role in tumor initiation and maintenance as well as in therapy resistance and recurrence. Thus, targeting this cellular subset may be key to effective immunotherapy. Here, we present a mass spectrometry-based analysis of HLA-presented peptidomes of GSC and glioblastoma patient specimens. Based on the analysis of patient samples (n = 9) and GSC (n = 3), we performed comparative HLA peptidome profiling against a dataset of normal human tissues. Using this immunopeptidome-centric approach we could clearly delineate a subset of naturally presented, GSC-associated HLA ligands, which might serve as highly specific targets for T cell-based immunotherapy. In total, we identified 17 antigens represented by 41 different HLA ligands showing natural and exclusive presentation both on GSC and patient samples. Importantly, in vitro immunogenicity and antigen-specific target cell killing assays suggest these peptides to be epitopes of functional CD8+ T cell responses, thus rendering them prime candidates for antigen-specific immunotherapy of glioblastoma.
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156
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Liau LM, Ashkan K, Tran DD, Campian JL, Trusheim JE, Cobbs CS, Heth JA, Salacz M, Taylor S, D'Andre SD, Iwamoto FM, Dropcho EJ, Moshel YA, Walter KA, Pillainayagam CP, Aiken R, Chaudhary R, Goldlust SA, Bota DA, Duic P, Grewal J, Elinzano H, Toms SA, Lillehei KO, Mikkelsen T, Walbert T, Abram SR, Brenner AJ, Brem S, Ewend MG, Khagi S, Portnow J, Kim LJ, Loudon WG, Thompson RC, Avigan DE, Fink KL, Geoffroy FJ, Lindhorst S, Lutzky J, Sloan AE, Schackert G, Krex D, Meisel HJ, Wu J, Davis RP, Duma C, Etame AB, Mathieu D, Kesari S, Piccioni D, Westphal M, Baskin DS, New PZ, Lacroix M, May SA, Pluard TJ, Tse V, Green RM, Villano JL, Pearlman M, Petrecca K, Schulder M, Taylor LP, Maida AE, Prins RM, Cloughesy TF, Mulholland P, Bosch ML. First results on survival from a large Phase 3 clinical trial of an autologous dendritic cell vaccine in newly diagnosed glioblastoma. J Transl Med 2018; 16:142. [PMID: 29843811 PMCID: PMC5975654 DOI: 10.1186/s12967-018-1507-6] [Citation(s) in RCA: 325] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023] Open
Abstract
Background Standard therapy for glioblastoma includes surgery, radiotherapy, and temozolomide. This Phase 3 trial evaluates the addition of an autologous tumor lysate-pulsed dendritic cell vaccine (DCVax®-L) to standard therapy for newly diagnosed glioblastoma. Methods After surgery and chemoradiotherapy, patients were randomized (2:1) to receive temozolomide plus DCVax-L (n = 232) or temozolomide and placebo (n = 99). Following recurrence, all patients were allowed to receive DCVax-L, without unblinding. The primary endpoint was progression free survival (PFS); the secondary endpoint was overall survival (OS). Results For the intent-to-treat (ITT) population (n = 331), median OS (mOS) was 23.1 months from surgery. Because of the cross-over trial design, nearly 90% of the ITT population received DCVax-L. For patients with methylated MGMT (n = 131), mOS was 34.7 months from surgery, with a 3-year survival of 46.4%. As of this analysis, 223 patients are ≥ 30 months past their surgery date; 67 of these (30.0%) have lived ≥ 30 months and have a Kaplan-Meier (KM)-derived mOS of 46.5 months. 182 patients are ≥ 36 months past surgery; 44 of these (24.2%) have lived ≥ 36 months and have a KM-derived mOS of 88.2 months. A population of extended survivors (n = 100) with mOS of 40.5 months, not explained by known prognostic factors, will be analyzed further. Only 2.1% of ITT patients (n = 7) had a grade 3 or 4 adverse event that was deemed at least possibly related to the vaccine. Overall adverse events with DCVax were comparable to standard therapy alone. Conclusions Addition of DCVax-L to standard therapy is feasible and safe in glioblastoma patients, and may extend survival. Trial registration Funded by Northwest Biotherapeutics; Clinicaltrials.gov number: NCT00045968; https://clinicaltrials.gov/ct2/show/NCT00045968?term=NCT00045968&rank=1; initially registered 19 September 2002
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Affiliation(s)
- Linda M Liau
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
| | | | | | | | | | - Charles S Cobbs
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Jason A Heth
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Salacz
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Sarah Taylor
- University of Kansas Cancer Center, Kansas City, KS, USA
| | | | | | | | | | - Kevin A Walter
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Robert Aiken
- Rutgers Cancer Institute, New Brunswick, NJ, USA
| | - Rekha Chaudhary
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | | | - Paul Duic
- Winthrop-University Hospital, Mineola, NY, USA
| | | | | | | | | | | | | | | | | | - Steven Brem
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Simon Khagi
- University of North Carolina, Chapel Hill, NC, USA
| | - Jana Portnow
- City of Hope National Medical Center, Duarte, CA, USA
| | - Lyndon J Kim
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Karen L Fink
- Baylor University Medical Center, Dallas, TX, USA
| | | | | | - Jose Lutzky
- Mount Sinai Comprehensive Cancer Center, Miami, FL, USA
| | - Andrew E Sloan
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Gabriele Schackert
- University Hospital Carl-Gustav-Carus of Technical University, Dresden, Germany
| | - Dietmar Krex
- University Hospital Carl-Gustav-Carus of Technical University, Dresden, Germany
| | | | - Julian Wu
- Tufts University School of Medicine, Boston, MA, USA
| | | | | | - Arnold B Etame
- H. Lee Moffit Cancer Center and Research Institute, Tampa, FL, USA
| | - David Mathieu
- CHUS-Hopital Fleurimont, Sherbrooke University, Sherbrooke, QC, Canada
| | | | | | - Manfred Westphal
- Neurochirurgische Klinik University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | - Victor Tse
- Kaiser Permanente Northern California, Redwood City, CA, USA
| | | | - John L Villano
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Kevin Petrecca
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | | | - Lynne P Taylor
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
| | | | - Robert M Prins
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Timothy F Cloughesy
- University of California Los Angeles (UCLA) David Geffen School of Medicine & Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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157
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Weller M, Papachristodoulou A, Hentschel B, Gramatzki D, Felsberg J, Loeffler M, Schackert G, Westphal M, Tonn J, Silginer M, von Deimling A, Pietsch T, Reifenberger G, Roth P. Differential elevation of TERT activity and sensitivity to temozolomide by type of TERT mutation in MGMT promoter-methylated glioblastoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Bettina Hentschel
- Institute for Medical Informatics, Statistics and Epidemology, University of Leipzig, Leipzig, Germany
| | - Dorothee Gramatzki
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Joerg Felsberg
- Department of Neuropathology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemology, University of Leipzig, Leipzig, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital Dresden, Dresden, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University of Hamburg, Hamburg, Germany
| | - Joerg Tonn
- Department of Neurosurgery, University of Munich (LMU), Munich, Germany
| | - Manuela Silginer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Torsten Pietsch
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Hospital, Düsseldorf, Germany
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158
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Capper D, Jones DTW, Sill M, Hovestadt V, Schrimpf D, Sturm D, Koelsche C, Sahm F, Chavez L, Reuss DE, Kratz A, Wefers AK, Huang K, Pajtler KW, Schweizer L, Stichel D, Olar A, Engel NW, Lindenberg K, Harter PN, Braczynski AK, Plate KH, Dohmen H, Garvalov BK, Coras R, Hölsken A, Hewer E, Bewerunge-Hudler M, Schick M, Fischer R, Beschorner R, Schittenhelm J, Staszewski O, Wani K, Varlet P, Pages M, Temming P, Lohmann D, Selt F, Witt H, Milde T, Witt O, Aronica E, Giangaspero F, Rushing E, Scheurlen W, Geisenberger C, Rodriguez FJ, Becker A, Preusser M, Haberler C, Bjerkvig R, Cryan J, Farrell M, Deckert M, Hench J, Frank S, Serrano J, Kannan K, Tsirigos A, Brück W, Hofer S, Brehmer S, Seiz-Rosenhagen M, Hänggi D, Hans V, Rozsnoki S, Hansford JR, Kohlhof P, Kristensen BW, Lechner M, Lopes B, Mawrin C, Ketter R, Kulozik A, Khatib Z, Heppner F, Koch A, Jouvet A, Keohane C, Mühleisen H, Mueller W, Pohl U, Prinz M, Benner A, Zapatka M, Gottardo NG, Driever PH, Kramm CM, Müller HL, Rutkowski S, von Hoff K, Frühwald MC, Gnekow A, Fleischhack G, Tippelt S, Calaminus G, Monoranu CM, Perry A, Jones C, Jacques TS, Radlwimmer B, Gessi M, Pietsch T, Schramm J, Schackert G, Westphal M, Reifenberger G, Wesseling P, Weller M, Collins VP, Blümcke I, Bendszus M, Debus J, Huang A, Jabado N, Northcott PA, Paulus W, Gajjar A, Robinson GW, Taylor MD, Jaunmuktane Z, Ryzhova M, Platten M, Unterberg A, Wick W, Karajannis MA, Mittelbronn M, Acker T, Hartmann C, Aldape K, Schüller U, Buslei R, Lichter P, Kool M, Herold-Mende C, Ellison DW, Hasselblatt M, Snuderl M, Brandner S, Korshunov A, von Deimling A, Pfister SM. DNA methylation-based classification of central nervous system tumours. Nature 2018; 555:469-474. [PMID: 29539639 PMCID: PMC6093218 DOI: 10.1038/nature26000] [Citation(s) in RCA: 1580] [Impact Index Per Article: 263.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
Abstract
Accurate pathological diagnosis is crucial for optimal management of patients with cancer. For the approximately 100 known tumour types of the central nervous system, standardization of the diagnostic process has been shown to be particularly challenging-with substantial inter-observer variability in the histopathological diagnosis of many tumour types. Here we present a comprehensive approach for the DNA methylation-based classification of central nervous system tumours across all entities and age groups, and demonstrate its application in a routine diagnostic setting. We show that the availability of this method may have a substantial impact on diagnostic precision compared to standard methods, resulting in a change of diagnosis in up to 12% of prospective cases. For broader accessibility, we have designed a free online classifier tool, the use of which does not require any additional onsite data processing. Our results provide a blueprint for the generation of machine-learning-based tumour classifiers across other cancer entities, with the potential to fundamentally transform tumour pathology.
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Affiliation(s)
- David Capper
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dominik Sturm
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Koelsche
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lukas Chavez
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David E Reuss
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annekathrin Kratz
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristin Huang
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristian W Pajtler
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Leonille Schweizer
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
| | - Damian Stichel
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Adriana Olar
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA
- Hollings Cancer Center, Charleston, South Carolina 29425, USA
| | - Nils W Engel
- Department of Oncology and Hematology with Sections Bone Marrow Transplant and Pneumology, Hubertus Wald Tumorzentrum/University Cancer Center Hamburg, University Medical Center Hamburg, Hamburg, Germany
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
| | - Kerstin Lindenberg
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick N Harter
- Institute of Neurology (Edinger Institute), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Anne K Braczynski
- Institute of Neurology (Edinger Institute), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Karl H Plate
- Institute of Neurology (Edinger Institute), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Hildegard Dohmen
- Institute of Neuropathology, University of Giessen, Giessen, Germany
| | - Boyan K Garvalov
- Institute of Neuropathology, University of Giessen, Giessen, Germany
| | - Roland Coras
- Neuropathological Institute, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Annett Hölsken
- Neuropathological Institute, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Schick
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roger Fischer
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudi Beschorner
- Institute of Pathology and Neuropathology, Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Jens Schittenhelm
- Institute of Pathology and Neuropathology, Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Ori Staszewski
- Institute of Neuropathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Khalida Wani
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Pascale Varlet
- Department of Neuropathology, Centre Hospitalier Sainte Anne, Paris, France
| | - Melanie Pages
- Department of Neuropathology, Centre Hospitalier Sainte Anne, Paris, France
| | - Petra Temming
- Pediatrics III, Pediatric Oncology and Hematology, University Hospital Essen, Essen, Germany
| | - Dietmar Lohmann
- Eye Cancer Research Group, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Florian Selt
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
- CCU Pediatric Oncology (G340), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Hendrik Witt
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Till Milde
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
- CCU Pediatric Oncology (G340), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Olaf Witt
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
- CCU Pediatric Oncology (G340), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Academic Medisch Centrum (AMC), University of Amsterdam, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Amsterdam, The Netherlands
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Elisabeth Rushing
- Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christoph Geisenberger
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Hubrecht Institute-KNAW (Royal Netherlands Academy of Arts and Sciences), Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Fausto J Rodriguez
- Division of Neuropathology of the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Albert Becker
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Matthias Preusser
- Department of Medicine I, Comprehensive Cancer Center Vienna, CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | | | - Rolf Bjerkvig
- Department of Biomedicine, University of Bergen, Bergen, Norway
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Jane Cryan
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Michael Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Martina Deckert
- Department of Neuropathology, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Hench
- Department of Neuropathology, Institute of Pathology, Basel University Hospital, Basel, Switzerland
| | - Stephan Frank
- Department of Neuropathology, Institute of Pathology, Basel University Hospital, Basel, Switzerland
| | | | | | | | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Silvia Hofer
- Division of Oncology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Volkmar Hans
- Institut für Neuropathologie, Evangelisches Krankenhaus Bielefeld gGmbH, Bielefeld, Germany
- Institut für Neuropathologie, Universitätskinikum Essen, Essen, Germany
| | - Stephanie Rozsnoki
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Patricia Kohlhof
- Institute for Pathology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Bjarne W Kristensen
- Department of Pathology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Matt Lechner
- University College London Cancer Institute and University College London Hospitals, London, UK
| | - Beatriz Lopes
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Christian Mawrin
- Institute of Neuropathology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Ralf Ketter
- Department of Neurosurgery, University Hospital Saarland, Homburg, Saar, Germany
| | - Andreas Kulozik
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ziad Khatib
- Nicklaus Children's Hospital Brain Institute, Miami, Florida 33155, USA
| | - Frank Heppner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
- Cluster of Excellence, NeuroCure, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Arend Koch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
| | - Anne Jouvet
- Département de Pathologie et Neuropathologie, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France
| | - Catherine Keohane
- Department of Neuropathology, Cork University Hospital, Cork, Ireland
| | - Helmut Mühleisen
- Department of Pathology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Wolf Mueller
- Department of Neuropathology, Leipzig University, Leipzig, Germany
| | - Ute Pohl
- Department of Cellular Pathology, Queen's Hospital, Romford, UK
| | - Marco Prinz
- Institute of Neuropathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc Zapatka
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicholas G Gottardo
- Department of Pediatric Oncology and Haematology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia 6840, Australia
- Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia 6872, Australia
- School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia 6840, Australia
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, 26133 Oldenburg, Germany
| | - Stefan Rutkowski
- Department for Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department for Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Michael C Frühwald
- Children's Hospital Augsburg, Swabian Children's Cancer Centre, Augsburg, Germany
| | - Astrid Gnekow
- Children's Hospital Augsburg, Swabian Children's Cancer Centre, Augsburg, Germany
| | - Gudrun Fleischhack
- Pediatrics III, Pediatric Oncology and Hematology, University Hospital Essen, Essen, Germany
| | - Stephan Tippelt
- Pediatrics III, Pediatric Oncology and Hematology, University Hospital Essen, Essen, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology/Oncology, University of Bonn Medical Center, Bonn, Germany
| | - Camelia-Maria Monoranu
- Department of Neuropathology, Insitute of Pathology, Comprehensive Cancer Center (CCC) Mainfranken, University of Würzburg, Würzburg, Germany
| | - Arie Perry
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Chris Jones
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health and Histopathology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Bernhard Radlwimmer
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marco Gessi
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Johannes Schramm
- Medical Faculty, University of Bonn Medical School, Bonn, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pieter Wesseling
- Department of Pathology, Princess Máxima Center for Pediatric Oncology and University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Vincent Peter Collins
- Department of Pathology, Division of Molecular Histopathology, University of Cambridge, Cambridge, UK
| | - Ingmar Blümcke
- Neuropathological Institute, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Annie Huang
- Department of Pediatrics, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Nada Jabado
- Division of Hematology/Oncology, McGill University, Montreal, Quebec, Canada
| | - Paul A Northcott
- Department of Developmental Neurobiology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Amar Gajjar
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Giles W Robinson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michael D Taylor
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Zane Jaunmuktane
- Division of Neuropathology, UCL Hospitals, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
- Department of Molecular Neuroscience, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
- Department of Neurodegeneration, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
| | | | - Michael Platten
- Department of Neurology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias A Karajannis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michel Mittelbronn
- Institute of Neurology (Edinger Institute), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, German Cancer Research Center (DKFZ) Heidelberg, Germany
- NORLUX Neuro-Oncology Laboratory, Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg, Luxembourg
- Laboratoire national de santé (LNS), Dudelange, Luxembourg
- Luxembourg Centre of Neuropathology (LCNP), Luxembourg, Luxembourg
| | - Till Acker
- Institute of Neuropathology, University of Giessen, Giessen, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School (MHH), Hannover, Germany
| | - Kenneth Aldape
- Department of Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Ulrich Schüller
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children's Cancer Center, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf Buslei
- Neuropathological Institute, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Section Neuropathology, Institute of Pathology, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Germany
| | - Peter Lichter
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - David W Ellison
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Matija Snuderl
- Division of Neuropathology, Department of Pathology, NYU Langone Medical Center, New York, New York, USA
| | - Sebastian Brandner
- Division of Neuropathology, UCL Hospitals, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
- Department of Neurodegeneration, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
| | - Andrey Korshunov
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
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159
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Ricklefs FL, Alayo Q, Krenzlin H, Mahmoud AB, Speranza MC, Nakashima H, Hayes JL, Lee K, Balaj L, Passaro C, Rooj AK, Krasemann S, Carter BS, Chen CC, Steed T, Treiber J, Rodig S, Yang K, Nakano I, Lee H, Weissleder R, Breakefield XO, Godlewski J, Westphal M, Lamszus K, Freeman GJ, Bronisz A, Lawler SE, Chiocca EA. Immune evasion mediated by PD-L1 on glioblastoma-derived extracellular vesicles. Sci Adv 2018; 4:eaar2766. [PMID: 29532035 PMCID: PMC5842038 DOI: 10.1126/sciadv.aar2766] [Citation(s) in RCA: 368] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Binding of programmed death ligand-1 (PD-L1) to programmed cell death protein-1 (PD1) leads to cancer immune evasion via inhibition of T cell function. One of the defining characteristics of glioblastoma, a universally fatal brain cancer, is its profound local and systemic immunosuppression. Glioblastoma has also been shown to generate extracellular vesicles (EVs), which may play an important role in tumor progression. We thus hypothesized that glioblastoma EVs may be important mediators of immunosuppression and that PD-L1 could play a role. We show that glioblastoma EVs block T cell activation and proliferation in response to T cell receptor stimulation. PD-L1 was expressed on the surface of some, but not of all, glioblastoma-derived EVs, with the potential to directly bind to PD1. An anti-PD1 receptor blocking antibody significantly reversed the EV-mediated blockade of T cell activation but only when PD-L1 was present on EVs. When glioblastoma PD-L1 was up-regulated by IFN-γ, EVs also showed some PD-L1-dependent inhibition of T cell activation. PD-L1 expression correlated with the mesenchymal transcriptome profile and was anatomically localized in the perinecrotic and pseudopalisading niche of human glioblastoma specimens. PD-L1 DNA was present in circulating EVs from glioblastoma patients where it correlated with tumor volumes of up to 60 cm3. These results suggest that PD-L1 on EVs may be another mechanism for glioblastoma to suppress antitumor immunity and support the potential of EVs as biomarkers in tumor patients.
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Affiliation(s)
- Franz L. Ricklefs
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Quazim Alayo
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Harald Krenzlin
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ahmad B. Mahmoud
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- College of Applied Medical Sciences, Taibah University, Madinah Munawwarah, Saudi Arabia
| | - Maria C. Speranza
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Hiroshi Nakashima
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Josie L. Hayes
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Kyungheon Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Leonora Balaj
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Carmela Passaro
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Arun K. Rooj
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Susanne Krasemann
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bob S. Carter
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Clark C. Chen
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA 92121, USA
| | - Tyler Steed
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA 92121, USA
| | - Jeffrey Treiber
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA 92121, USA
| | - Scott Rodig
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Katherine Yang
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Ichiro Nakano
- Comprehensive Cancer Center, University of Birmingham, Birmingham, AL 35294, USA
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Xandra O. Breakefield
- Departments of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Boston, MA 02114, USA
| | - Jakub Godlewski
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gordon J. Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Agnieszka Bronisz
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sean E. Lawler
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Corresponding author. (E.A.C.); (S.E.L.)
| | - E. Antonio Chiocca
- Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Corresponding author. (E.A.C.); (S.E.L.)
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160
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Sauvigny T, Göttsche J, Czorlich P, Vettorazzi E, Westphal M, Regelsberger J. Intracranial pressure in patients undergoing decompressive craniectomy: new perspective on thresholds. J Neurosurg 2018; 128:819-827. [DOI: 10.3171/2016.11.jns162263] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVEDecompressive craniectomy (DC) is an established part of treatment in patients suffering from malignant infarction of the middle cerebral artery (MCA) or traumatic brain injury (TBI). However, no clear evidence for intracranial pressure (ICP)-guided therapy after DC exists. The lack of this evidence might be due to the frequently used, but simplified threshold for ICP of 20 mm Hg, which determines further therapy. Therefore, the objective of this study was to evaluate this threshold's accuracy and to investigate the course of ICP values with respect to neurological outcome.METHODSData on clinical characteristics and parameters of the ICP course on the intensive care unit were collected retrospectively in 102 patients who underwent DC between December 2007 and April 2014 at the authors' institution. The postoperative ICP course in the first 168 hours was recorded and analyzed. From these findings, ICP thresholds discriminating favorable from unfavorable outcome were calculated using conditional inference tree analysis. Additionally, survival analysis was performed using the Kaplan-Meier method. Prognostic factors were assessed via univariate analysis and multivariate logistic regression. Favorable outcome was defined as a score of 0–4 on the modified Rankin Scale.RESULTSMultivariate logistic regression revealed that anisocoria, diagnosis, and ICP values differed significantly between the outcome groups. ICP values in the favorable and unfavorable outcome groups differed significantly (p < 0.001), while the mean ICP of both groups lay below the limit of 20 mm Hg (17.5 and 11.5 mm Hg, respectively). These findings were reproduced when analyzing the underlying pathologies of TBI and MCA infarction separately. Based on these findings, optimized time-dependent threshold values were calculated and found to be between 10 and 17 mm Hg. These values significantly distinguished favorable from unfavorable outcome and predicted 30-day mortality (p < 0.001).CONCLUSIONSThis study systematically evaluated ICP levels in a long-term analysis after DC and provides new, surprisingly low, time-dependent ICP thresholds for these patients. Future trials investigating the benefit of ICP-guided therapy should take these thresholds into consideration and validate them in further patient cohorts.
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Affiliation(s)
| | | | | | - Eik Vettorazzi
- 2Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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161
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Hohensee I, Chuang HN, Grottke A, Werner S, Schulte A, Horn S, Lamszus K, Bartkowiak K, Witzel I, Westphal M, Matschke J, Glatzel M, Jücker M, Pukrop T, Pantel K, Wikman H. PTEN mediates the cross talk between breast and glial cells in brain metastases leading to rapid disease progression. Oncotarget 2018; 8:6155-6168. [PMID: 28008153 PMCID: PMC5351620 DOI: 10.18632/oncotarget.14047] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/13/2016] [Indexed: 12/31/2022] Open
Abstract
Despite improvement of therapeutic treatments for breast cancer, the development of brain metastases has become a major limitation to life expectancy for many patients. Brain metastases show very commonly alterations in EGFR and HER2 driven pathways, of which PTEN is an important regulator. Here, we analyzed PTEN expression in 111 tissue samples of breast cancer brain metastases (BCBM). Loss of PTEN was found in a substantial proportion of BCBM samples (48.6%) and was significantly associated with triple-negative breast cancer (67.5%, p = 0.001) and a shorter survival time after surgical resection of brain metastases (p = 0.048). Overexpression of PTEN in brain-seeking MDA-MB-231 BR cells in vitro reduced activation of the AKT pathway, notably by suppression of Akt1 kinase activity. Furthermore, the migration of MDA-MB-231 BR cells in vitro was promoted by co-culturing with both astrocytes and microglial cells. Interestingly, when PTEN was overexpressed the migration was significantly inhibited. Moreover, in an ex vivo organotypic brain slice model, PTEN overexpression reduced invasion of tumor cells. This was accompanied by reduced astrocyte activation that was mediated by autocrine and paracrine activation of GM-CSF/ CSF2RA and AKT/ PTEN pathways. In conclusion, loss of PTEN is frequently detected in triple-negative BCBM patients and associated with poor prognosis. The findings of our functional studies suggest that PTEN loss promotes a feedback loop between tumor cells and glial cells, which might contribute to disease progression.
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Affiliation(s)
- Ina Hohensee
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Han-Ning Chuang
- Department of Hematology/Oncology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - Astrid Grottke
- Institute of Biochemistry and Signal Transduction, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Stefan Werner
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Alexander Schulte
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Stefan Horn
- Bone Marrow Transplantation Unit, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Kai Bartkowiak
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jakob Matschke
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Manfred Jücker
- Institute of Biochemistry and Signal Transduction, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Tobias Pukrop
- Department of Hematology/Oncology, University Medical Center Göttingen, 37099 Göttingen, Germany.,Department of Medicine III, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Klaus Pantel
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Harriet Wikman
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
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162
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Schliesser MG, Claus R, Hielscher T, Grimm C, Weichenhan D, Blaes J, Wiestler B, Hau P, Schramm J, Sahm F, Weiß EK, Weiler M, Baer C, Schmidt-Graf F, Schackert G, Westphal M, Hertenstein A, Roth P, Galldiks N, Hartmann C, Pietsch T, Felsberg J, Reifenberger G, Sabel MC, Winkler F, von Deimling A, Meisner C, Vajkoczy P, Platten M, Weller M, Plass C, Wick W. Prognostic relevance of miRNA-155 methylation in anaplastic glioma. Oncotarget 2018; 7:82028-82045. [PMID: 27880937 PMCID: PMC5347671 DOI: 10.18632/oncotarget.13452] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/13/2016] [Indexed: 02/03/2023] Open
Abstract
The outcome of patients with anaplastic gliomas varies considerably depending on single molecular markers, such as mutations of the isocitrate dehydrogenase (IDH) genes, as well as molecular classifications based on epigenetic or genetic profiles. Remarkably, 98% of the RNA within a cell is not translated into proteins. Of those, especially microRNAs (miRNAs) have been shown not only to have a major influence on physiologic processes but also to be deregulated and prognostic in malignancies.To find novel survival markers and treatment options we performed unbiased DNA methylation screens that revealed 12 putative miRNA promoter regions with differential DNA methylation in anaplastic gliomas. Methylation of these candidate regions was validated in different independent patient cohorts revealing a set of miRNA promoter regions with prognostic relevance across data sets. Of those, miR-155 promoter methylation and miR-155 expression were negatively correlated and especially the methylation showed superior correlation with patient survival compared to established biomarkers.Functional examinations in malignant glioma cells further cemented the relevance of miR-155 for tumor cell viability with transient and stable modifications indicating an onco-miRNA activity. MiR-155 also conferred resistance towards alkylating temozolomide and radiotherapy as consequence of nuclear factor (NF)κB activation.Preconditioning glioma cells with an NFκB inhibitor reduced therapy resistance of miR-155 overexpressing cells. These cells resembled tumors with a low methylation of the miR-155 promoter and thus mir-155 or NFκB inhibition may provide treatment options with a special focus on patients with IDH wild type tumors.
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Affiliation(s)
- Maximilian Georg Schliesser
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rainer Claus
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christiane Grimm
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Weichenhan
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jonas Blaes
- Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benedikt Wiestler
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Hau
- Neurology Clinic, Regensburg University, Regensburg, Germany
| | - Johannes Schramm
- Neurosurgery Clinic, University of Bonn Medical Center, TU Munich, Munich, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisa K Weiß
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of General Neurology, University Hospital Tübingen, Germany
| | - Constance Baer
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Friederike Schmidt-Graf
- Department of General Neurology, University Hospital Tübingen, Germany.,Neurology Clinic, TU Munich, Munich, Germany
| | | | - Manfred Westphal
- Neurosurgery Clinic, University Clinic Hamburg, Eppendorf, Germany
| | - Anne Hertenstein
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Roth
- Department of General Neurology, University Hospital Tübingen, Germany.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christian Hartmann
- Department of Neuropathology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department for Neuropathology, Institute of Pathology, Medical University of Hannover, Hannover, Germany
| | - Torsten Pietsch
- Department of Neuropathology, Heinrich-Heine-University, Germany
| | - Joerg Felsberg
- Department of Neurosurgery, Heinrich-Heine-University, Germany.,Neurosurgery Clinic, Charité, Berlin, Germany
| | - Guido Reifenberger
- Department of Neurosurgery, Heinrich-Heine-University, Germany.,Neurosurgery Clinic, Charité, Berlin, Germany
| | | | - Frank Winkler
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Peter Vajkoczy
- Department Hematology, Oncology and Stem Cell Transplantation, University Hospital Freiburg, Germany
| | - Michael Platten
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of General Neurology, University Hospital Tübingen, Germany
| | - Michael Weller
- Department of General Neurology, University Hospital Tübingen, Germany.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Plass
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital and German Cancer Consortium, Clinical Cooperation Units, Germany.,Clinical Cooperation Unit of Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of General Neurology, University Hospital Tübingen, Germany
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163
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Mohme M, Schliffke S, Maire CL, Rünger A, Glau L, Mende KC, Matschke J, Gehbauer C, Akyüz N, Zapf S, Holz M, Schaper M, Martens T, Schmidt NO, Peine S, Westphal M, Binder M, Tolosa E, Lamszus K. Immunophenotyping of Newly Diagnosed and Recurrent Glioblastoma Defines Distinct Immune Exhaustion Profiles in Peripheral and Tumor-infiltrating Lymphocytes. Clin Cancer Res 2018; 24:4187-4200. [DOI: 10.1158/1078-0432.ccr-17-2617] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/24/2017] [Accepted: 02/06/2018] [Indexed: 11/16/2022]
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164
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Schmidt M, Mock A, Jungk C, Sahm F, Ull AT, Warta R, Lamszus K, Gousias K, Ketter R, Roesch S, Rapp C, Schefzyk S, Urbschat S, Lahrmann B, Kessler AF, Löhr M, Senft C, Grabe N, Reuss D, Beckhove P, Westphal M, von Deimling A, Unterberg A, Simon M, Herold-Mende C. Transcriptomic analysis of aggressive meningiomas identifies PTTG1 and LEPR as prognostic biomarkers independent of WHO grade. Oncotarget 2018; 7:14551-68. [PMID: 26894859 PMCID: PMC4924735 DOI: 10.18632/oncotarget.7396] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/27/2016] [Indexed: 12/20/2022] Open
Abstract
Meningiomas are frequent central nervous system tumors. Although most meningiomas are benign (WHO grade I) and curable by surgery, WHO grade II and III tumors remain therapeutically challenging due to frequent recurrence. Interestingly, relapse also occurs in some WHO grade I meningiomas. Hence, we investigated the transcriptional features defining aggressive (recurrent, malignantly progressing or WHO grade III) meningiomas in 144 cases. Meningiomas were categorized into non-recurrent (NR), recurrent (R), and tumors undergoing malignant progression (M) in addition to their WHO grade. Unsupervised transcriptomic analysis in 62 meningiomas revealed transcriptional profiles lining up according to WHO grade and clinical subgroup. Notably aggressive subgroups (R+M tumors and WHO grade III) shared a large set of differentially expressed genes (n=332; p<0.01, FC>1.25). In an independent multicenter validation set (n=82), differential expression of 10 genes between WHO grades was confirmed. Additionally, among WHO grade I tumors differential expression between NR and aggressive R+M tumors was affirmed for PTTG1, AURKB, ECT2, UBE2C and PRC1, while MN1 and LEPR discriminated between NR and R+M WHO grade II tumors. Univariate survival analysis revealed a significant association with progression-free survival for PTTG1, LEPR, MN1, ECT2, PRC1, COX10, UBE2C expression, while multivariate analysis identified a prediction for PTTG1 and LEPR mRNA expression independent of gender, WHO grade and extent of resection. Finally, stainings of PTTG1 and LEPR confirmed malignancy-associated protein expression changes. In conclusion, based on the so far largest study sample of WHO grade III and recurrent meningiomas we report a comprehensive transcriptional landscape and two prognostic markers.
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Affiliation(s)
- Melissa Schmidt
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Andreas Mock
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Christine Jungk
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Theresa Ull
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Rolf Warta
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ralf Ketter
- Department of Neurosurgery, Saarland University, Medical School, Homburg, Germany
| | - Saskia Roesch
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Carmen Rapp
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Schefzyk
- Department of Neuropathology, Heidelberg University Hospital, CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steffi Urbschat
- Department of Neurosurgery, Saarland University, Medical School, Homburg, Germany
| | - Bernd Lahrmann
- Bioquant, Medical Oncology, National Center for Tumor Diseases, Heidelberg, Germany
| | - Almuth F Kessler
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - Mario Löhr
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - Christian Senft
- Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany
| | - Niels Grabe
- Bioquant, Medical Oncology, National Center for Tumor Diseases, Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, Heidelberg University Hospital, CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Beckhove
- Regensburg Center for Interventional Immunology, RCI and University Medical Center of Regensburg, Regensburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas Unterberg
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Matthias Simon
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
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165
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Beyer U, Brand F, Martens H, Weder J, Christians A, Elyan N, Hentschel B, Westphal M, Schackert G, Pietsch T, Hong B, Krauss JK, Samii A, Raab P, Das A, Dumitru CA, Sandalcioglu IE, Hakenberg OW, Erbersdobler A, Lehmann U, Reifenberger G, Weller M, Reijns MAM, Preller M, Wiese B, Hartmann C, Weber RG. Rare ADAR and RNASEH2B variants and a type I interferon signature in glioma and prostate carcinoma risk and tumorigenesis. Acta Neuropathol 2017; 134:905-922. [PMID: 29030706 DOI: 10.1007/s00401-017-1774-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/22/2022]
Abstract
In search of novel germline alterations predisposing to tumors, in particular to gliomas, we studied a family with two brothers affected by anaplastic gliomas, and their father and paternal great-uncle diagnosed with prostate carcinoma. In this family, whole-exome sequencing yielded rare, simultaneously heterozygous variants in the Aicardi-Goutières syndrome (AGS) genes ADAR and RNASEH2B co-segregating with the tumor phenotype. AGS is a genetically induced inflammatory disease particularly of the brain, which has not been associated with a consistently increased cancer risk to date. By targeted sequencing, we identified novel ADAR and RNASEH2B variants, and a 3- to 17-fold frequency increase of the AGS mutations ADAR,c.577C>G;p.(P193A) and RNASEH2B,c.529G>A;p.(A177T) in the germline of familial glioma patients as well as in test and validation cohorts of glioblastomas and prostate carcinomas versus ethnicity-matched controls, whereby rare RNASEH2B variants were significantly more frequent in familial glioma patients. Tumors with ADAR or RNASEH2B variants recapitulated features of AGS, such as calcification and increased type I interferon expression. Patients carrying ADAR or RNASEH2B variants showed upregulation of interferon-stimulated gene (ISG) transcripts in peripheral blood as seen in AGS. An increased ISG expression was also induced by ADAR and RNASEH2B variants in tumor cells and was blocked by the JAK inhibitor Ruxolitinib. Our data implicate rare variants in the AGS genes ADAR and RNASEH2B and a type I interferon signature in glioma and prostate carcinoma risk and tumorigenesis, consistent with a genetic basis underlying inflammation-driven malignant transformation in glioma and prostate carcinoma development.
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166
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Mohme M, Maire C, Riecken K, Alawi M, Dührsen L, Neumann K, Lange T, Failla A, Zapf S, Fehse B, Westphal M, Lamszus K. IMMU-62. OPTICAL BARCODING REVEALS IMMUNOEDITING OF THE CLONAL ARCHITECTURE AND MODULATION OF GENE EXPRESSION SIGNATURES IN A SYNGENEIC GLIOMA MODEL. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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167
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Witt H, Gramatzki D, Hentschel B, Pajtler KW, Schackert G, Capper D, Sahm F, von Deimling A, Westphal M, Herrlinger U, Pietsch T, Löffler M, Reifenberger G, Pfister SM, Tonn JC, Weller M. PATH-24. MOLECULAR SUBGROUPS OF ADULT EPENDYMAL TUMORS: AN ANALYSIS OF THE GERMAN GLIOMA NETWORK. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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168
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Ricklefs F, Maire C, Kolbe K, Holz M, Reimer R, Glatzel M, Chiocca EA, Westphal M, Lamszus K. CBIO-26. SUBPOPULATIONS OF CIRCULATING EXTRACELLULAR VESICLES OF GLIOBLASTOMA PATIENTS CAN BE DISTINGUISHED BY IMAGING FLOW CYTOMETRY. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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169
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Ricklefs F, Hayes J, Speranza MC, Krenzlin H, Costello J, Freeman GJ, Westphal M, Lamszus K, Chiocca EA, Lawler SE. IMMU-10. EXPRESSION OF PD-L2, IN GLIOBLASTOMA; IMPLICATIONS AS A BIOMARKER FOR IMMUNOTHERAPY. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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170
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Sauvigny T, Dührsen L, Kuhl D, Westphal M, Ohana O, Martens T. TMIC-20. INHIBITION OF SLC7A11 REDUCES EXCITATORY SYNAPTIC INPUT OF PERITUMORAL NEURONS IN GLIOMA PATIENTS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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171
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Maire C, Mohme M, Riecken K, Failla A, Kolbe K, Helms M, Fehse B, Westphal M, Lamszus K. DRES-12. SINGLE CELL CLONAL ANALYSIS OF GBM TUMOR HIERARCHIES USING OPTICAL BARCODING. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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172
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Mende KC, Gelderblom M, Schwarz C, Czorlich P, Schmidt NO, Vettorazzi E, Regelsberger J, Westphal M, Abboud T. Somatosensory evoked potentials in patients with high-grade aneurysmal subarachnoid hemorrhage. Neurosurg Focus 2017; 43:E17. [PMID: 29088953 DOI: 10.3171/2017.7.focus17427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this prospective study was to investigate the value of somatosensory evoked potentials (SEPs) in predicting outcome in patients with high-grade aneurysmal subarachnoid hemorrhage (SAH). METHODS Between January 2013 and January 2015, 48 patients with high-grade SAH (Hunt and Hess Grade III, IV, or V) who were admitted within 3 days after hemorrhage were enrolled in the study. Right and left median and tibial nerve SEPs were recorded on Day 3 after hemorrhage and recorded again 2 weeks later. Glasgow Outcome Scale (GOS) scores were determined 6 months after hemorrhage and dichotomized as poor (Scores 1-3) or good (Scores 4-5). Results of SEP measurements were dichotomized (present or missing cortical responses or normal or prolonged latencies) for each nerve and side. These variables were summed and tested using logistic regression and a receiver operating characteristic curve to assess the value of SEPs in predicting long-term outcome. RESULTS At the 6-month follow-up visit, 29 (60.4%) patients had a good outcome, and 19 (39.6%) had a poor outcome. The first SEP measurement did not correlate with clinical outcome (area under the curve [AUC] 0.69, p = 0.52). At the second measurement of median nerve SEPs, all patients with a good outcome had cortical responses present bilaterally, and none of them had bilateral prolonged latencies (p = 0.014 and 0.003, respectively). In tibial nerve SEPs, 7.7% of the patients with a good GOS score had one or more missing cortical responses, and bilateral prolonged latencies were found in 23% (p = 0.001 and 0.034, respectively). The second measurement correlated with the outcome regarding each of the median and tibial nerve SEPs and the combination of both (AUC 0.75 [p = 0.010], 0.793 [p = 0.003], and 0.81 [p = 0.001], respectively). CONCLUSIONS Early SEP measurement after SAH did not correlate with clinical outcome, but measurement of median and tibial nerve SEPs 2 weeks after a hemorrhage did predict long-term outcome in patients with high-grade SAH.
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Affiliation(s)
| | | | | | | | | | - Eik Vettorazzi
- Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg; and
| | | | | | - Tammam Abboud
- Department of Neurosurgery, University Medical Center Göttingen, Germany
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173
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Fritzsche FS, Regelsberger J, Schmidt NO, Müller J, Buhk JH, Diemert A, Westphal M, Martens T. Maternal Aneurysmal Subarachnoid Hemorrhage During Pregnancy as an Interdisciplinary Task. Z Geburtshilfe Neonatol 2017; 221:276-282. [PMID: 29041013 DOI: 10.1055/s-0043-119363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Maternal aneurysmal subarachnoid hemorrhage (aSAH) during pregnancy presents a challenge regarding treatment and management. Due to the limited number of cases there are no treatment guidelines available. Thus, treatment is usually done on a case-by-case basis. Here we report on four cases of aSAH during pregnancy, describing the different management strategies and suggesting a possible treatment algorithm. Patients treated between 2003 and 2013 in our center were included in this retrospective study. Clinical data focused on time management concerning gestation week (GW), microsurgical or endovascular treatment, and outcome of the patients and the fetuses. Results were compared to the present literature on this issue. Mean age was 30.8 years, initial Hunt & Hess (H&H) grade ranged from III to V. All patients suffered from aSAH during the 3rd trimester of pregnancy. In the four cases, two emergency Caesarean sections (CS) were performed. Two aneurysms were occluded by microsurgical clipping and one was treated endovascularly. One patient died before definitive treatment of the aneurysm could be achieved, whereas fetal mortality was 0%. The mean follow-up was 83 months. aSAH during pregnancy needs individualized interdisciplinary management. Efforts must focus on the mother so that a delay in the best available treatment for the pregnant patient is avoided. Therefore treatment modality should be primarily determined by the aneurysm itself. However, timing in terms of delivery of the fetus and aneurysm treatment is a crucial point.
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Affiliation(s)
| | - Jan Regelsberger
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - Nils Ole Schmidt
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - Jakob Müller
- Klinik und Poliklinik für Anästhesiologie, Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg Eppendorf
| | - Jan Hendrik Buhk
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinik Hamburg-Eppendorf
| | - Anke Diemert
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - Manfred Westphal
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - Tobias Martens
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
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174
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Abboud T, Mende KC, Jung R, Czorlich P, Vettorazzi E, Priefler M, Kluge S, Westphal M, Regelsberger J. Prognostic Value of Early S100 Calcium Binding Protein B and Neuron-Specific Enolase in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Pilot Study. World Neurosurg 2017; 108:669-675. [PMID: 28943424 DOI: 10.1016/j.wneu.2017.09.074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND This prospective study was undertaken to investigate the value of early S100 calcium binding protein B (S100B) and neuron-specific enolase (NSE) in prognosticating outcome in patients with poor-grade aneurysmal subarachnoid hemorrhage and to develop a statistical model and cutoff values for clinical practice. METHODS Between 2012 and 2014, patients with poor-grade subarachnoid hemorrhage (Hunt and Hess grade 3-5) who were admitted within 24 hours after hemorrhage were prospectively enrolled. Serum NSE and S100B levels were assayed once daily during the first 3 days after hemorrhage. Patient characteristics, Glasgow Coma Scale score, Hunt and Hess grade, and Fisher grade at admission were recorded. Glasgow Outcome Scale (GOS) score was obtained at 6 months and dichotomized as poor (score 1-3) or good (score 4-5). Logistic regression and receiver operating characteristic curve were used to assess the value of S100B and NSE in predicting outcome, and cutoff values were calculated using conditional interference trees. RESULTS The study included 52 patients. Hunt and Hess grade was 3 in 23 patients, 4 in 15 patients, and 5 in 14 patients. S100B range was 0.07-5.62 μg/L (mean 0.87 μg/L ± 1.06). NSE range was 5.7-94.2 μg/L (mean 16.1 μg/L ± 10.5). At 6-month follow-up, 23 patients (44.2%) had a poor outcome, and 29 patients (55.8%) had a good outcome. Both S100B at day 1 (P = 0.004; cutoff 0.202 μg/L) and NSE at day 1 (P = 0.047; cutoff 9.4 μg/L) predicted good outcome with a specificity of 100%. The specificity of mean S100B in detecting patients with poor outcome reached 100% (P = 0.003) when combined with mean NSE levels. CONCLUSIONS S100B and NSE measured during the first 3 days after hemorrhage showed, separately and combined, a significant predictive value in prognosticating clinical outcome in patients with poor-grade subarachnoid hemorrhage. A multicenter study with a large patient cohort is necessary to validate the above-mentioned cutoff values for clinical practice.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Medical Centre Göttingen, Göttingen, Germany.
| | - Klaus Christian Mende
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Roman Jung
- Department of Clinical Chemistry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Priefler
- Department of Intensive Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Felsberg J, Hentschel B, Kaulich K, Gramatzki D, Zacher A, Malzkorn B, Kamp M, Sabel M, Simon M, Westphal M, Schackert G, Tonn JC, Pietsch T, von Deimling A, Loeffler M, Reifenberger G, Weller M. Epidermal Growth Factor Receptor Variant III (EGFRvIII) Positivity in EGFR-Amplified Glioblastomas: Prognostic Role and Comparison between Primary and Recurrent Tumors. Clin Cancer Res 2017; 23:6846-6855. [DOI: 10.1158/1078-0432.ccr-17-0890] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/25/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
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Czorlich P, Dreimann M, Emami P, Westphal M, Lefering R, Hoffmann M. Body Mass Index >35 as Independent Predictor of Mortality in Severe Traumatic Brain Injury. World Neurosurg 2017; 107:515-521. [PMID: 28823658 DOI: 10.1016/j.wneu.2017.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Severe traumatic brain injury (TBI) has a major influence on polytrauma outcome. The aim of this study was to evaluate the impact of body mass index (BMI) on mortality and early neurologic outcome in patients suffering from severe TBI with a special focus on obesity classes II and III (BMI ≥35). METHODS A retrospective cohort analysis of patients suffering from a leading, at least severe TBI and registered in the TraumaRegister DGU was conducted. Patients alive on admission with full status documentation on Glasgow Coma Scale, height, and weight were classified into 4 BMI subgroups. Early neurologic outcome was classified using the Glasgow Outcome Scale. RESULTS A total of 1634 patients met the inclusion criteria. Lowest mortality was documented for BMI group 1 (15.2%, BMI 25.0-29.9918.5). Highest mortality was found in BMI group 5 (25.6%, BMI ≥35). BMI ≥35 was an independent predictor of mortality with an odds ratio of 3.15 (95% confidence interval [1.06-9.36], P = 0.039). Further independent mortality predictors were >65 years of age, a Glasgow Coma Scale of ≤13, an Abbreviated Injury Scalehead ≥5, prehospital cardiopulmonary resuscitation, and a prehospital blood pressure of <90 mm Hg. In terms of good early neurologic outcomes, no differences were recorded between the BMI groups (range 59.0%-62.6%, P = 0.087). CONCLUSIONS In this study a BMI ≥35 is an independent predictor of mortality and is associated with an inferior early functional neurologic outcome.
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Affiliation(s)
- Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Marc Dreimann
- Division of Spine Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pedram Emami
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Michael Hoffmann
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, and Clinic for Orthopedics, Holstein, Germany
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177
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Mohme M, Riethdorf S, Dreimann M, Werner S, Maire CL, Joosse SA, Bludau F, Mueller V, Neves RPL, Stoecklein NH, Lamszus K, Westphal M, Pantel K, Wikman H, Eicker SO. Circulating Tumour Cell Release after Cement Augmentation of Vertebral Metastases. Sci Rep 2017; 7:7196. [PMID: 28775319 PMCID: PMC5543076 DOI: 10.1038/s41598-017-07649-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/28/2017] [Indexed: 12/21/2022] Open
Abstract
Cement augmentation via percutaneous vertebroplasty or kyphoplasty for treatment of spinal metastasis is a well-established treatment option. We assessed whether elevated intrametastatic pressure during cement augmentation results in an increased dissemination of tumour cells into the vascular circulation. We prospectively collected blood from patients with osteolytic spinal column metastases and analysed the prevalence of circulating tumour cells (CTCs) at three time-points: preoperatively, 20 minutes after cement augmentation, and 3–5 days postoperatively. Enrolling 21 patients, including 13 breast- (61.9%), 5 lung- (23.8%), and one (4.8%) colorectal-, renal-, and prostate-carcinoma patient each, we demonstrate a significant 1.8-fold increase of EpCAM+/K+ CTCs in samples taken 20 minutes post-cement augmentation (P < 0.0001). Despite increased mechanical CTC dissemination due to cement augmentation, follow-up blood draws demonstrated that no long-term increase of CTCs was present. Array-CGH analysis revealed a specific profile of the CTC collected 20 minutes after cement augmentation. This is the first study to report that peripheral CTCs are temporarily increased due to vertebral cement augmentation procedures. Our findings provide a rationale for the development of new prophylactic strategies to reduce the increased release of CTC after cement augmentation of osteolytic spinal metastases.
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Affiliation(s)
- Malte Mohme
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Sabine Riethdorf
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Dreimann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Werner
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Cecile L Maire
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Simon A Joosse
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Frederic Bludau
- Department for Trauma Surgery, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Centre Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Rui P L Neves
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Dusseldorf, Dusseldorf, Germany
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Dusseldorf, Dusseldorf, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Pantel
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Harriet Wikman
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sven O Eicker
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Abstract
OBJECTIVESpinal tumors account for 2%–4% of all tumors of the central nervous system and can be intramedullary, intradural extramedullary, or extradural. In the past, wide approaches were used to obtain safe access to these tumors, as complete resection is the goal in treating most tumor entities. To reduce surgical complications due to large skin incisions and destabilizing laminectomies, minimally invasive approaches were established. In this study, the authors share their experience with mini-open approaches to intradural tumor pathologies.METHODSThe authors retrospectively reviewed cases involving patients with intramedullary and intradural extramedullary lesions treated between 2009 and 2016. They present their surgical mini-open approach to the spinal cord as well as unique characteristics, key steps, and postsurgical complications for specific tumor subgroups (meningioma, neuroma, and intramedullary tumors).RESULTSA total of 245 intradural tumors were surgically treated during the study period. Of these lesions, 151 were intradural extramedullary meningiomas (n = 79) or neuromas (n = 72). Nine (12.5%) of the neuromas were dumbbell neuromas. Ninety-four tumors were intramedullary. The mean age of the patients was 51.4 years, and 53.9% were female. The mean duration of follow-up was 46.0 months.All meningiomas and neuromas could be resected using a mini-open keyhole approach, but only 5.3% of the intramedullary lesions could be accessed using this technique. Of the 94 patients with intramedullary tumors, 76.6% required a laminotomy, 7.4% required a hemilaminectomy, and 10.6% required a 2-level laminectomy. Only 2 of the patients with intramedullary tumors needed stabilization for progressive cervical kyphosis during follow-up. None of the other patients developed spinal instability after undergoing surgery via the mini-open (keyhole/interlaminar) approach. There were significantly more surgery-associated complications in the large exposure group than in the patients treated with the mini-open approach (19.1% vs 9.6%, p < 0.01).CONCLUSIONSIntradural extramedullary and in selected cases intramedullary pathologies may safely be resected using a mini-open interlaminar approach. Avoiding laminectomy, laminotomy, and even hemilaminectomy preserves spinal stability and significantly reduces comorbidities, while still allowing for complete resection of these tumors.
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Weller M, van den Bent M, Tonn JC, Stupp R, Preusser M, Cohen-Jonathan-Moyal E, Henriksson R, Le Rhun E, Balana C, Chinot O, Bendszus M, Reijneveld JC, Dhermain F, French P, Marosi C, Watts C, Oberg I, Pilkington G, Baumert BG, Taphoorn MJB, Hegi M, Westphal M, Reifenberger G, Soffietti R, Wick W. Evidence-based management of adult patients with diffuse glioma - Authors' reply. Lancet Oncol 2017; 18:e430-e431. [PMID: 28759377 DOI: 10.1016/s1470-2045(17)30515-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Michael Weller
- Department of Neurology, Brain Tumour Centre, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland.
| | | | - Jörg C Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Roger Stupp
- Department of Oncology, Brain Tumour Centre, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Elizabeth Cohen-Jonathan-Moyal
- Département de Radiotherapie, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Roger Henriksson
- Regional Cancer Centre Stockholm-Gotland and Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Emilie Le Rhun
- Neuro-Oncology, Department of Neurosurgery, University Hospital, Lille, France
| | - Carmen Balana
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Olivier Chinot
- Department of Neuro-Oncology, Aix-Marseille Université, Assistance Publique-Hopitaux de Marseille, Centre Hospitalo-Universitaire Timone, Marseilles, France
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumour Centre Amsterdam, Vrije Universiteit Medical Centre, Amsterdam, Netherlands
| | - Frederic Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Pim French
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Christine Marosi
- Department of Medicine, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Colin Watts
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Ingela Oberg
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals Foundation Trust, Cambridge, UK
| | | | - Brigitta G Baumert
- Department of Radiation Oncology, MediClin Robert Janker Clinic and Clinical Cooperation Unit Neurooncology, University of Bonn Medical Centre, Bonn, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Centre and Medical Centre Haaglanden, The Hague, Netherlands
| | - Monika Hegi
- Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg, Hamburg, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf and German Cancer Consortium, Essen/Düsseldorf, Germany
| | | | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany; German Consortium of Translational Cancer Research, Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
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180
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Buhmann C, Huckhagel T, Engel K, Gulberti A, Hidding U, Poetter-Nerger M, Goerendt I, Ludewig P, Braass H, Choe CU, Krajewski K, Oehlwein C, Mittmann K, Engel AK, Gerloff C, Westphal M, Köppen JA, Moll CKE, Hamel W. Adverse events in deep brain stimulation: A retrospective long-term analysis of neurological, psychiatric and other occurrences. PLoS One 2017; 12:e0178984. [PMID: 28678830 PMCID: PMC5497949 DOI: 10.1371/journal.pone.0178984] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 05/22/2017] [Indexed: 11/18/2022] Open
Abstract
Background and objective The extent to which deep brain stimulation (DBS) can improve quality of life may be perceived as a permanent trade-off between neurological improvements and complications of therapy, comorbidities, and disease progression. Patients and methods We retrospectively investigated 123 consecutive and non-preselected patients. Indications for DBS surgery were Parkinson's disease (82), dystonia (18), tremor of different etiology (21), Huntington's disease (1) and Gilles de la Tourette syndrome (1). AEs were defined as any untoward clinical occurrence, sign or patient complaint or unintended disease if related or unrelated to the surgical procedures, implanted devices or ongoing DBS therapy. Results Over a mean/median follow-up period of 4.7 years (578 patient-years) 433 AEs were recorded in 106 of 123 patients (86.2%). There was no mortality or persistent morbidity from the surgical procedure. All serious adverse events (SAEs) that occurred within 4 weeks of surgery were reversible. Neurological AEs (193 in 85 patients) and psychiatric AEs (78 in 48 patients) were documented most frequently. AEs in 4 patients (suicide under GPI stimulation, weight gain >20 kg, impairment of gait and speech, cognitive decline >2 years following surgery) were severe or worse, at least possibly related to DBS and non reversible. In PD 23.1% of the STN-stimulated patients experienced non-reversible (or unknown reversibility) AEs that were at least possibly related to DBS in the form of impaired speech or gait, depression, weight gain, cognitive disturbances or urinary incontinence (severity was mild or moderate in 15 of 18 patients). Age and Hoehn&Yahr stage of STN-simulated PD patients, but not preoperative motor impairment or response to levodopa, showed a weak correlation (r = 0.24 and 0.22, respectively) with the number of AEs. Conclusions DBS-related AEs that were severe or worse and non-reversible were only observed in PD (4 of 82 patients; 4.9%), but not in other diseases. PD patients exhibited a significant risk for non-severe AEs most of which also represented preexisting and progressive axial and non-motor symptoms of PD. Mild gait and/or speech disturbances were rather frequent complaints under VIM stimulation. GPI stimulation for dystonia could be applied with negligible DBS-related side effects.
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Affiliation(s)
- Carsten Buhmann
- Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Torge Huckhagel
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Katja Engel
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Gulberti
- Institut für Neurophysiologie und Pathophysiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Hidding
- Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ines Goerendt
- Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Ludewig
- Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Braass
- Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Chi-un Choe
- Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Kara Krajewski
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Andreas K. Engel
- Institut für Neurophysiologie und Pathophysiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes A. Köppen
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian K. E. Moll
- Institut für Neurophysiologie und Pathophysiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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Mohme M, Sauvigny T, Grensemann J, Söffker G, Kluge S, Westphal M, Czorlich P. Irreversible Total Loss of Brain Function and Organ Donation in Patients with Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2017; 105:492-497. [PMID: 28619501 DOI: 10.1016/j.wneu.2017.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening disease with an often fatal clinical course leading to irreversible loss of brain function (ILBF) (i.e., brain death). The purpose of this study was to assess the prevalence and characteristics of patients with aSAH who became organ donors after diagnosis of ILBF. METHODS Anonymized clinical data sets of 395 patients treated for aSAH at a university medical center from January 2011 to December 2016 were retrospectively analyzed. Prevalence of consent for organ donation and clinical characteristics, including parameters for diagnosis of irreversible loss of brain function, were assessed. RESULTS After initial admission to the intensive care unit, 18.0% of patients (n = 71) died (Glasgow Outcome Scale score 1). Intracerebral hemorrhage occurred in 42.3% of patients who died, aneurysmal rebleeding occurred in 19.7%, and intraventricular hemorrhage occurred in 87.3%. In 50.7% of patients who died (n = 36), ILBF was diagnosed, and 32.4% (n = 23) of these patients became organ donors. In 55.6%, additional diagnostic electroencephalography was performed. Male patients significantly more often became organ donors than female patients (P = 0.008). ILBF with subsequent organ donation was predominantly seen in patients <60 years old. A total 85 of organs were explanted for donation, including 42 kidneys, 21 livers, 3 pancreas, 11 hearts and 8 lungs. CONCLUSIONS ILBF in the setting of fatal aSAH is a prevalent diagnosis with complex demands for neurointensive care physicians. We demonstrated the clinical characteristics and epidemiologic factors of patients with aSAH converting to organ donors.
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Affiliation(s)
- Malte Mohme
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerold Söffker
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Mende KC, Matschke J, Burkhardt T, Saeger W, Buslei R, Buchfelder M, Fahlbusch R, Westphal M, Flitsch J. Pituicytoma-An outlook on possible targeted therapies. CNS Neurosci Ther 2017; 23:620-626. [PMID: 28556544 DOI: 10.1111/cns.12709] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/30/2017] [Accepted: 05/03/2017] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Pituicytoma is a rare neoplasm of the sella region. Tumor resection is the primary treatment option, but remains subtotal due to excessive bleeding in many cases. The search for alternative or additional treatment regimens is necessary. AIMS We aimed to determine the receptor expression of pituicytoma to find alternatives or supplements to surgical therapy in the use of targeted therapies. METHODS Pituicytoma samples were collected from three institutions between 2006 and 2015 and were stained for vascular endothelial growth factors (VEGF), thyroid transcription factor (TTF1), and somatostatin receptors (SSTR 2/3/5). The stains were classified from 0=no staining to +++=strong staining. A complementary retrospective analysis of the patient charts regarding sex, age, and primary symptoms, pituitary function, and perioperative complications was performed. RESULTS Ten samples were analyzed; mean patient age was 57.8 years SD 16.3 years. Seven samples were acquired from male patients (one relapse) and three from female. All tumors stained strongly positive (+++) for VEGF-R. Six samples stained positive for TTF1. As for somatostatin receptors, three samples were slightly positive for SSTR 2; seven were negative. SSTR 3 was + in one, three were ++, three were +++, and three were 0. SSTR 5 stained +++ in 1, ++ in 5, + in 1, and 0 in three patients. CONCLUSIONS Pituicytomas were generally positive for VEGFR and showed regular expression of SSTR 3 and 5 indicating a possible treatment option through targeted therapies in cases where resection remains insufficient. Further research is necessary as to whether tumor growth can be inhibited using these pathways.
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Affiliation(s)
| | - Jakob Matschke
- Institute of Neuropathology, Hamburg University Medical Center, Hamburg, Germany
| | - Till Burkhardt
- Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany
| | - Wolfgang Saeger
- Institute of Neuropathology, Hamburg University Medical Center, Hamburg, Germany
| | - Rolf Buslei
- Department of Neuropathology, University of Erlangen, Erlangen, Germany
| | | | - Rudolf Fahlbusch
- International Neuroscience Institute Hannover GmbH, Hannover, Germany
| | - Manfred Westphal
- Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany
| | - Jörg Flitsch
- Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany
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Gramatzki D, Witt H, Hentschel B, Pajtler KW, Schackert G, Westphal M, Herrlinger U, Pietsch T, Loeffler M, Reifenberger G, Pfister SM, Tonn J, Weller M. Clinical and molecular subgroups of ependymoma in adulthood: An analysis of the German Glioma Network. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2038 Background: Ependymoma is a subtype of glioma that is rare in adults. Its classification has remained entirely morphological until recently, and surgery and radiotherapy remain the mainstays of treatment. Here we characterized DNA methylation profiles and their clinical correlates in the prospectively assembled cohort of the German Glioma Network. Methods: The GGN cohort was screened for patients diagnosed with myxopapillary ependymoma, subependymoma, classic ependymoma and anaplastic ependymoma for whom clinical data and remaining tumor tissue were available. Tumors were subjected to DNA methylation profiling using the Illumina Infinium HumanMethylation450 BeadChip platform. Molecular data were correlated with morphological tumor and clinical patient characteristics. Results: One hundred and twenty-two ependymoma patients with available tumor tissue were identified. Each adult tumor could be assigned to one of the previously defined methylation classes of ependymoma. Molecular entities of ependymal brain tumors display distinct copy-number variations. PF-EPN-B and ST-EPN-RELA tumors tend to have a worse prognosis than other ependymal subtypes in adults. Conclusions: Molecular classification of adult ependymal methylation subclasses should be implemented in routine diagnostics. Patients with PF-EPN-B and ST-EPN-RELA subtypes might benefit from early treatment beyond surgery.
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Affiliation(s)
- Dorothee Gramatzki
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hendrik Witt
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Bettina Hentschel
- Institute for Medical Informatics, Statistics and Epidemology, Leipzig University, Leipzig, Germany
| | - Kristian W. Pajtler
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Technical University Dresden, Dresden, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University of Hamburg, Hamburg, Germany
| | - Ulrich Herrlinger
- Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemology, Leipzig University, Leipzig, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich-Heine University, Heidelberg, Germany
| | - Stefan M. Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Joerg Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
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Weller M, Sill M, Hentschel B, Felsberg J, Jones DTW, Gramatzki D, Kaulich K, Happold C, Tonn J, Herrlinger U, Schackert G, Westphal M, Capper D, Kumar R, Hemminki K, Pietsch T, Loeffler M, Pfister SM, von Deimling A, Reifenberger G. Clinical and molecular features associated with long-term survival of elderly patients with glioblastoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2013 Background: Glioblastomas in elderly patients are associated with particularly poor outcome, with only few patients demonstrating long-term survival (LTS). Methods: To better characterize clinical and molecular correlates of LTS in elderly glioblastoma patients, we searched the German Glioma Network (GGN) database for patients aged 71 years or more with histological confirmation of glioblastoma and survival of at least two years after diagnosis. Results: Of 2071 glioblastoma patients enrolled in the GGN from 2004-2012, 425 patients were aged 71 years or more; of these, 27 patients (6.4%) survived for 2 years or more (median survival: 37.1 months, 95% confidence interval: 30.0-44.2 months). A comparison of these 27 patients with the 398 patients who survived shorter than 2 years (median survival: 6.2, 95% confidence interval: 5.2-7.2 months) revealed more intensive up-front treatment and a trend towards higher initial Karnofsky performance score as distinguishing clinical factors. Molecular analyses additionally showed more frequent O6-methylguanine-DNA methyltransferase ( MGMT) promoter methylation in the LTS patients. Isocitrate dehydrogenase (IDH) mutation was restricted to single patients and the frequency of telomerase reverse transcriptase ( TERT) promoter mutation did not differ between groups. Genome-wide DNA copy number and methylation profiling using 450k microarray analysis performed for 16 LTS patients and 40 control patients revealed limited differential DNA methylation and no specific copy number profiles linked to LTS. Conclusions: Collectively, our findings confirm that LTS is rare in elderly patients with glioblastoma and that clinical and tumor-associated molecular factors linked to LTS resemble those in standard age patients, except for less common IDH mutation.
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Affiliation(s)
- Michael Weller
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Martin Sill
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bettina Hentschel
- Institute for Medical Informatics, Statistics and Epidemology, Leipzig University, Leipzig, Germany
| | - Joerg Felsberg
- Department of Neuropathology, Heinrich-Heine University, Düsseldorf, Germany
| | - David T. W. Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Dorothee Gramatzki
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Kerstin Kaulich
- Department of Neuropathology, Heinrich-Heine University, Düsseldorf, Germany
| | - Caroline Happold
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Joerg Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ulrich Herrlinger
- Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Technical University Dresden, Dresden, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University of Hamburg, Hamburg, Germany
| | - David Capper
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Rajiv Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemology, Leipzig University, Leipzig, Germany
| | - Stefan M. Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich-Heine University, Heidelberg, Germany
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185
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Weller M, van den Bent M, Tonn JC, Stupp R, Preusser M, Cohen-Jonathan-Moyal E, Henriksson R, Le Rhun E, Balana C, Chinot O, Bendszus M, Reijneveld JC, Dhermain F, French P, Marosi C, Watts C, Oberg I, Pilkington G, Baumert BG, Taphoorn MJB, Hegi M, Westphal M, Reifenberger G, Soffietti R, Wick W. European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas. Lancet Oncol 2017; 18:e315-e329. [PMID: 28483413 DOI: 10.1016/s1470-2045(17)30194-8] [Citation(s) in RCA: 691] [Impact Index Per Article: 98.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/29/2016] [Accepted: 01/13/2017] [Indexed: 12/14/2022]
Abstract
The European Association for Neuro-Oncology guideline provides recommendations for the clinical care of adult patients with astrocytic and oligodendroglial gliomas, including glioblastomas. The guideline is based on the 2016 WHO classification of tumours of the central nervous system and on scientific developments since the 2014 guideline. The recommendations focus on pathological and radiological diagnostics, and the main treatment modalities of surgery, radiotherapy, and pharmacotherapy. In this guideline we have also integrated the results from contemporary clinical trials that have changed clinical practice. The guideline aims to provide guidance for diagnostic and management decisions, while limiting unnecessary treatments and costs. The recommendations are a resource for professionals involved in the management of patients with glioma, for patients and caregivers, and for health-care providers in Europe. The implementation of this guideline requires multidisciplinary structures of care, and defined processes of diagnosis and treatment.
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Affiliation(s)
- Michael Weller
- Department of Neurology, Brain Tumour Centre, University Hospital and University of Zurich, Zurich, Switzerland.
| | | | - Jörg C Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Roger Stupp
- Department of Oncology, Brain Tumour Centre, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Elizabeth Cohen-Jonathan-Moyal
- Département de Radiotherapie, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Roger Henriksson
- Regional Cancer Centre Stockholm-Gotland and Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Emilie Le Rhun
- Neuro-Oncology, Department of Neurosurgery, University Hospital, Lille, France
| | - Carmen Balana
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Olivier Chinot
- Department of Neuro-Oncology, Aix-Marseille Université, Assistance Publique-Hopitaux de Marseille, Centre Hospitalo-Universitaire Timone, Marseilles, France
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumour Centre Amsterdam, Vrije Universiteit Medical Centre, Amsterdam, Netherlands
| | - Frederick Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Pim French
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Christine Marosi
- Department of Medicine, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Colin Watts
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Ingela Oberg
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals Foundation Trust, Cambridge, UK
| | | | - Brigitta G Baumert
- Department of Radiation Oncology, MediClin Robert Janker Clinic and Clinical Cooperation Unit Neurooncology, University of Bonn Medical Centre, Bonn, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Centre and Medical Centre Haaglanden, The Hague, Netherlands
| | - Monika Hegi
- Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg, Hamburg, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf and German Cancer Consortium (DKTK), Essen/Düsseldorf, Germany
| | | | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany; German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
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186
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Neidert MC, Kowalewski DJ, Wolpert F, Stevanovic S, Rammensee H, Lamszus K, Westphal M, Regli L, Weller M, Eisele G. P06.05 The natural HLA ligandome of glioblastoma stem-like cells: Antigen discovery for T-cell based immunotherapy. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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187
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Gramatzki D, Kickingereder P, Hentschel B, Felsberg J, Herrlinger U, Schackert G, Tonn JC, Westphal M, Sabel M, Schlegel U, Wick W, Pietsch T, Reifenberger G, Loeffler M, Bendszus M, Weller M. Limited role for extended maintenance temozolomide for newly diagnosed glioblastoma. Neurology 2017; 88:1422-1430. [PMID: 28298550 DOI: 10.1212/wnl.0000000000003809] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 01/18/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore an association with survival of modifying the current standard of care for patients with newly diagnosed glioblastoma of surgery followed by radiotherapy plus concurrent and 6 cycles of maintenance temozolomide chemotherapy (TMZ/RT → TMZ) by extending TMZ beyond 6 cycles. METHODS The German Glioma Network cohort was screened for patients with newly diagnosed glioblastoma who received TMZ/RT → TMZ and completed ≥6 cycles of maintenance chemotherapy without progression. Associations of clinical patient characteristics, molecular markers, and residual tumor determined by magnetic resonance imaging after 6 cycles of TMZ with progression-free survival (PFS) and overall survival (OS) were analyzed with the log-rank test. Multivariate analyses using the Cox proportional hazards model were performed to assess associations of prolonged TMZ use with outcome. RESULTS Sixty-one of 142 identified patients received at least 7 maintenance TMZ cycles (median 11, range 7-20). Patients with extended maintenance TMZ treatment had better PFS (20.5 months, 95% confidence interval [CI] 17.7-23.3, vs 17.2 months, 95% CI 10.2-24.2, p = 0.035) but not OS (32.6 months, 95% CI 28.9-36.4, vs 33.2 months, 95% CI 25.3-41.0, p = 0.126). However, there was no significant association of prolonged TMZ chemotherapy with PFS (hazard ratio [HR] = 0.8, 95% CI 0.4-1.6, p = 0.559) or OS (HR = 1.6, 95% CI 0.8-3.3, p = 0.218) adjusted for age, extent of resection, Karnofsky performance score, presence of residual tumor, O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status, or isocitrate dehydrogenase (IDH) mutation status. CONCLUSION These data may not support the practice of prolonging maintenance TMZ chemotherapy beyond 6 cycles. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in patients with newly diagnosed glioblastoma, prolonged TMZ chemotherapy does not significantly increase PFS or OS.
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Affiliation(s)
- Dorothee Gramatzki
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany.
| | - Philipp Kickingereder
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Bettina Hentschel
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Jörg Felsberg
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Ulrich Herrlinger
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Gabriele Schackert
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Jörg-Christian Tonn
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Manfred Westphal
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Michael Sabel
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Uwe Schlegel
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Wick
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Torsten Pietsch
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Guido Reifenberger
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Markus Loeffler
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Martin Bendszus
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Michael Weller
- From the Department of Neurology and Brain Tumor Center (D.G., M.W.), University Hospital Zurich and University of Zurich, Switzerland; Department of Neuroradiology (P.K., M.B.), University Hospital of Heidelberg; Institute for Medical Informatics, Statistics and Epidemiology (B.H., M.L.), University of Leipzig; Departments of Neuropathology (J.F., G.R.) and Neurosurgery (M.S.), Heinrich-Heine University Düsseldorf; Division of Neurooncology (U.H.), Department of Neurology, University Medical Center Bonn; Department of Neurosurgery (G.S.), University of Dresden; Department of Neurosurgery (J.-C.T.), Ludwig Maximilians University Munich; Department of Neurosurgery (M.W.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Neurology (U.S.), Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum; Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, and Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg; Department of Neuropathology (T.P.), DGNN Brain Tumor Reference Center, University of Bonn Medical School; and German Cancer Consortium (G.R.), German Cancer Research Center Heidelberg, Partner Site Essen/Düsseldorf, Düsseldorf, Germany
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188
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Sahm F, Schrimpf D, Stichel D, Jones DTW, Hielscher T, Schefzyk S, Okonechnikov K, Koelsche C, Reuss DE, Capper D, Sturm D, Wirsching HG, Berghoff AS, Baumgarten P, Kratz A, Huang K, Wefers AK, Hovestadt V, Sill M, Ellis HP, Kurian KM, Okuducu AF, Jungk C, Drueschler K, Schick M, Bewerunge-Hudler M, Mawrin C, Seiz-Rosenhagen M, Ketter R, Simon M, Westphal M, Lamszus K, Becker A, Koch A, Schittenhelm J, Rushing EJ, Collins VP, Brehmer S, Chavez L, Platten M, Hänggi D, Unterberg A, Paulus W, Wick W, Pfister SM, Mittelbronn M, Preusser M, Herold-Mende C, Weller M, von Deimling A. DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol 2017; 18:682-694. [PMID: 28314689 DOI: 10.1016/s1470-2045(17)30155-9] [Citation(s) in RCA: 497] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The WHO classification of brain tumours describes 15 subtypes of meningioma. Nine of these subtypes are allotted to WHO grade I, and three each to grade II and grade III. Grading is based solely on histology, with an absence of molecular markers. Although the existing classification and grading approach is of prognostic value, it harbours shortcomings such as ill-defined parameters for subtypes and grading criteria prone to arbitrary judgment. In this study, we aimed for a comprehensive characterisation of the entire molecular genetic landscape of meningioma to identify biologically and clinically relevant subgroups. METHODS In this multicentre, retrospective analysis, we investigated genome-wide DNA methylation patterns of meningiomas from ten European academic neuro-oncology centres to identify distinct methylation classes of meningiomas. The methylation classes were further characterised by DNA copy number analysis, mutational profiling, and RNA sequencing. Methylation classes were analysed for progression-free survival outcomes by the Kaplan-Meier method. The DNA methylation-based and WHO classification schema were compared using the Brier prediction score, analysed in an independent cohort with WHO grading, progression-free survival, and disease-specific survival data available, collected at the Medical University Vienna (Vienna, Austria), assessing methylation patterns with an alternative methylation chip. FINDINGS We retrospectively collected 497 meningiomas along with 309 samples of other extra-axial skull tumours that might histologically mimic meningioma variants. Unsupervised clustering of DNA methylation data clearly segregated all meningiomas from other skull tumours. We generated genome-wide DNA methylation profiles from all 497 meningioma samples. DNA methylation profiling distinguished six distinct clinically relevant methylation classes associated with typical mutational, cytogenetic, and gene expression patterns. Compared with WHO grading, classification by individual and combined methylation classes more accurately identifies patients at high risk of disease progression in tumours with WHO grade I histology, and patients at lower risk of recurrence among WHO grade II tumours (p=0·0096) from the Brier prediction test). We validated this finding in our independent cohort of 140 patients with meningioma. INTERPRETATION DNA methylation-based meningioma classification captures clinically more homogenous groups and has a higher power for predicting tumour recurrence and prognosis than the WHO classification. The approach presented here is potentially very useful for stratifying meningioma patients to observation-only or adjuvant treatment groups. We consider methylation-based tumour classification highly relevant for the future diagnosis and treatment of meningioma. FUNDING German Cancer Aid, Else Kröner-Fresenius Foundation, and DKFZ/Heidelberg Institute of Personalized Oncology/Precision Oncology Program.
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Affiliation(s)
- Felix Sahm
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Damian Stichel
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Schefzyk
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Konstantin Okonechnikov
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Koelsche
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David E Reuss
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dominik Sturm
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, Haematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Peter Baumgarten
- Neurological Institute (Edinger-Institute), Goethe University, Frankfurt, Germany
| | - Annekathrin Kratz
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristin Huang
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Sill
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hayley P Ellis
- Brain Tumour Research Group, Institute of Clinical Neurosciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Kathreena M Kurian
- Brain Tumour Research Group, Institute of Clinical Neurosciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Ali Fuat Okuducu
- Department of Pathology, University Hospital Nürnberg, Nürnberg, Germany
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Matthias Schick
- Genomics and Proteomics Core Facility, Micro-Array Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, Micro-Array Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Mawrin
- Department of Neuropathology, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | | | - Ralf Ketter
- Department of Neurosurgery, Saarland University, Homburg, Germany
| | - Matthias Simon
- Department of Neurosurgery, Evangelische Krankenhaus Bielefeld, Bielefeld, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Albert Becker
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Arend Koch
- Department of Neuropathology, Charité Medical University, Berlin, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Elisabeth J Rushing
- Department of Neuropathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - V Peter Collins
- Department of Molecular Histopathology, University of Cambridge, Cambridge, UK
| | - Stefanie Brehmer
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Lukas Chavez
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Platten
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany; Neurology Clinic, University Hospital Mannheim, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, Haematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Mittelbronn
- Neurological Institute (Edinger-Institute), Goethe University, Frankfurt, Germany
| | - Matthias Preusser
- Department of Medicine I, CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | | | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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189
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Au K, Ram Z, Zadeh G, Aldape K, Balogun J, Barani I, DiMeco F, Goel A, Khu K, Lang FF, Lund-Johansen M, Maldaun M, Tabatabai G, Tonn JC, Westphal M. Proceedings of the WFNS Neuro-Oncology Committee Workshop Rome 2015. Surg Neurol Int 2017; 7:S963-S975. [PMID: 28217379 PMCID: PMC5295139 DOI: 10.4103/2152-7806.195563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/02/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Karolyn Au
- Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Zvi Ram
- Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Gelareh Zadeh
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Canada
| | - Kenneth Aldape
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Igor Barani
- University of California, San Francisco, California
| | - Francesco DiMeco
- Instituto Neurologico C Besta, Milan, Italy, and Johns Hopkins Medical School, Baltimore, USA
| | - Atul Goel
- King Edward Memorial Hospital, Mumbai, India
| | - Kathleen Khu
- Philippine General Hospital, University of the Philippines, Manila, Philippines, USA
| | | | | | | | - Ghazaleh Tabatabai
- University Hospital Tübingen and Eberhard Karls University of Tübingen, Tübingen, Germany
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190
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Czorlich P, Sauvigny T, Ricklefs F, Abboud T, Nierhaus A, Vettorazzi E, Reuter DA, Regelsberger J, Westphal M, Schmidt NO. Impact of dexamethasone in patients with aneurysmal subarachnoid haemorrhage. Eur J Neurol 2017; 24:645-651. [DOI: 10.1111/ene.13265] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/11/2017] [Indexed: 11/27/2022]
Affiliation(s)
- P. Czorlich
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - T. Sauvigny
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - F. Ricklefs
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - T. Abboud
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - A. Nierhaus
- Department of Intensive Care Medicine; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - E. Vettorazzi
- Department of Medical Biometry and Epidemiology; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - D. A. Reuter
- Department of Anaesthesiology; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - J. Regelsberger
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - M. Westphal
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
| | - N. O. Schmidt
- Department of Neurosurgery; University Medical Center Hamburg − Eppendorf; Hamburg Germany
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191
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Cohen-Pfeffer JL, Gururangan S, Lester T, Lim DA, Shaywitz AJ, Westphal M, Slavc I. Intracerebroventricular Delivery as a Safe, Long-Term Route of Drug Administration. Pediatr Neurol 2017; 67:23-35. [PMID: 28089765 DOI: 10.1016/j.pediatrneurol.2016.10.022] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/07/2016] [Accepted: 10/30/2016] [Indexed: 01/19/2023]
Abstract
Intrathecal delivery methods have been used for many decades to treat a broad range of central nervous system disorders. A literature review demonstrated that intracerebroventricular route is an established and well-tolerated method for prolonged central nervous system drug delivery in pediatric and adult populations. Intracerebroventricular devices were present in patients from one to 7156 days. The number of punctures per device ranged from 2 to 280. Noninfectious complication rates per patient (range, 1.0% to 33.0%) were similar to infectious complication rates (0.0% to 27.0%). Clinician experience and training and the use of strict aseptic techniques have been shown to reduce the frequency of complications.
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Affiliation(s)
| | | | | | - Daniel A Lim
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | | | - Manfred Westphal
- Department of Neurosurgery, University Clinic Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
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192
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Cloughesy T, Finocchiaro G, Belda-Iniesta C, Recht L, Brandes AA, Pineda E, Mikkelsen T, Chinot OL, Balana C, Macdonald DR, Westphal M, Hopkins K, Weller M, Bais C, Sandmann T, Bruey JM, Koeppen H, Liu B, Verret W, Phan SC, Shames DS. Randomized, Double-Blind, Placebo-Controlled, Multicenter Phase II Study of Onartuzumab Plus Bevacizumab Versus Placebo Plus Bevacizumab in Patients With Recurrent Glioblastoma: Efficacy, Safety, and Hepatocyte Growth Factor and O6-Methylguanine–DNA Methyltransferase Biomarker Analyses. J Clin Oncol 2017; 35:343-351. [DOI: 10.1200/jco.2015.64.7685] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Bevacizumab regimens are approved for the treatment of recurrent glioblastoma in many countries. Aberrant mesenchymal-epithelial transition factor (MET) expression has been reported in glioblastoma and may contribute to bevacizumab resistance. The phase II study GO27819 investigated the monovalent MET inhibitor onartuzumab plus bevacizumab (Ona + Bev) versus placebo plus bevacizumab (Pla + Bev) in recurrent glioblastoma. Methods At first recurrence after chemoradiation, bevacizumab-naïve patients with glioblastoma were randomly assigned 1:1 to receive Ona (15 mg/kg, once every 3 weeks) + Bev (15 mg/kg, once every 3 weeks) or Pla + Bev until disease progression. The primary end point was progression-free survival by response assessment in neuro-oncology criteria. Secondary end points were overall survival, objective response rate, duration of response, and safety. Exploratory biomarker analyses correlated efficacy with expression levels of MET ligand hepatocyte growth factor, O6-methylguanine–DNA methyltransferase promoter methylation, and glioblastoma subtype. Results Among 129 patients enrolled (Ona + Bev, n = 64; Pla + Bev, n = 65), baseline characteristics were balanced. The median progression-free survival was 3.9 months for Ona + Bev versus 2.9 months for Pla + Bev (hazard ratio, 1.06; 95% CI, 0.72 to 1.56; P = .7444). The median overall survival was 8.8 months for Ona + Bev and 12.6 months for Pla + Bev (hazard ratio, 1.45; 95% CI, 0.88 to 2.37; P = .1389). Grade ≥ 3 adverse events were reported in 38.5% of patients who received Ona + Bev and 35.9% of patients who received Pla + Bev. Exploratory biomarker analyses suggested that patients with high expression of hepatocyte growth factor or unmethylated O6-methylguanine–DNA methyltransferase may benefit from Ona + Bev. Conclusion There was no evidence of further clinical benefit with the addition of onartuzumab to bevacizumab compared with bevacizumab plus placebo in unselected patients with recurrent glioblastoma in this phase II study; however, further investigation into biomarker subgroups is warranted.
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Affiliation(s)
- Timothy Cloughesy
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Gaetano Finocchiaro
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Cristóbal Belda-Iniesta
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Lawrence Recht
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Alba A. Brandes
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Estela Pineda
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Tom Mikkelsen
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Olivier L. Chinot
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Carmen Balana
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - David R. Macdonald
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Manfred Westphal
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Kirsten Hopkins
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Michael Weller
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Carlos Bais
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Thomas Sandmann
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Jean-Marie Bruey
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Hartmut Koeppen
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Bo Liu
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - Wendy Verret
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - See-Chun Phan
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
| | - David S. Shames
- Timothy Cloughesy, University of California, Los Angeles; Lawrence Recht, Stanford Cancer Center, Stanford; Carlos Bais, Thomas Sandmann, Jean-Marie Bruey, Hartmut Koeppen, Bo Liu, Wendy Verret, See-Chun Phan, and David S. Shames, Genentech, South San Francisco, CA; Tom Mikkelsen, Henry Ford Hospital, Detroit, MI; Gaetano Finocchiaro, Istituto Neurologico Carlo Besta, Milan; Alba A. Brandes, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurologic
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193
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Mohme M, Maire CL, Riecken K, Zapf S, Aranyossy T, Westphal M, Lamszus K, Fehse B. Optical Barcoding for Single-Clone Tracking to Study Tumor Heterogeneity. Mol Ther 2017; 25:621-633. [PMID: 28109958 DOI: 10.1016/j.ymthe.2016.12.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 11/29/2022] Open
Abstract
Intratumoral heterogeneity has been identified as one of the strongest drivers of treatment resistance and tumor recurrence. Therefore, investigating the complex clonal architecture of tumors over time has become a major challenge in cancer research. We developed a new fluorescent "optical barcoding" technique that allows fast tracking, identification, and quantification of live cell clones in vitro and in vivo using flow cytometry (FC). We optically barcoded two cell lines derived from malignant glioma, an exemplary heterogeneous brain tumor. In agreement with mathematical combinatorics, we demonstrate that up to 41 clones can unambiguously be marked using six fluorescent proteins and a maximum of three colors per clone. We show that optical barcoding facilitates sensitive, precise, rapid, and inexpensive analysis of clonal composition kinetics of heterogeneous cell populations by FC. We further assessed the quantitative contribution of multiple clones to glioblastoma growth in vivo and we highlight the potential to recover individual viable cell clones by fluorescence-activated cell sorting. In summary, we demonstrate that optical barcoding is a powerful technique for clonal cell tracking in vitro and in vivo, rendering this approach a potent tool for studying the heterogeneity of complex tissues, in particular, cancer.
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Affiliation(s)
- Malte Mohme
- Laboratory for Brain Tumor Biology, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Cecile L Maire
- Laboratory for Brain Tumor Biology, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Kristoffer Riecken
- Research Department Cell and Gene Therapy, Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Svenja Zapf
- Laboratory for Brain Tumor Biology, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Tim Aranyossy
- Research Department Cell and Gene Therapy, Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Manfred Westphal
- Laboratory for Brain Tumor Biology, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Katrin Lamszus
- Laboratory for Brain Tumor Biology, Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Boris Fehse
- Research Department Cell and Gene Therapy, Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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194
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Abstract
The receptor for epidermal growth factor (EGFR) is a prime target for cancer therapy across a broad variety of tumor types. As it is a tyrosine kinase, small molecule tyrosine kinase inhibitors (TKIs) targeting signal transduction, as well as monoclonal antibodies against the EGFR, have been investigated as anti-tumor agents. However, despite the long-known enigmatic EGFR gene amplification and protein overexpression in glioblastoma, the most aggressive intrinsic human brain tumor, the potential of EGFR as a target for this tumor type has been unfulfilled. This review analyses the attempts to use TKIs and monoclonal antibodies against glioblastoma, with special consideration given to immunological approaches, the use of EGFR as a docking molecule for conjugates with toxins, T-cells, oncolytic viruses, exosomes and nanoparticles. Drug delivery issues associated with therapies for intracerebral diseases, with specific emphasis on convection enhanced delivery, are also discussed.
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Affiliation(s)
- Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Cecile L. Maire
- 0000 0001 2180 3484grid.13648.38Department of Neurosurgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Katrin Lamszus
- 0000 0001 2180 3484grid.13648.38Department of Neurosurgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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195
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Dührsen L, Matschke J, Westphal M. A 55-Year-Old Woman with Year-Long Headache and Dizziness. Brain Pathol 2016; 27:111-112. [PMID: 28032421 DOI: 10.1111/bpa.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Lasse Dührsen
- Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany
| | - Jakob Matschke
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany
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196
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Abboud T, Rustom J, Bester M, Czorlich P, Vittorazzi E, Pinnschmidt HO, Westphal M, Regelsberger J. Morphology of Ruptured and Unruptured Intracranial Aneurysms. World Neurosurg 2016; 99:610-617. [PMID: 28017741 DOI: 10.1016/j.wneu.2016.12.053] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In addition to size and location, the morphology of intracranial aneurysms has been proposed to predict rupture. This study was undertaken to compare morphologic features between ruptured and unruptured aneurysms and identify those associated with greater risk of rupture. METHODS Between 2010 and 2014, 301 patients with subarachnoid hemorrhage and 204 with unruptured aneurysms were admitted to our hospital. Two investigators reviewed 3-dimensional angiograms of all aneurysms. Risk factors for rupture were identified. Morphology was classified into single-sac aneurysms with smooth margin, single-sac aneurysms with irregular margin, aneurysms with a daughter sac, and multilobulated aneurysms. The value of morphology in predicting rupture was tested with the use of logistic regression. RESULTS A total of 420 aneurysms met the inclusion criteria. Multilobulated aneurysm was the most frequent finding among ruptured aneurysms, followed by single sac with irregular margin, aneurysm with daughter sac, and single sac with smooth margin (44.9%, 25.9%, 18%, and 11.2%, respectively). Among unruptured aneurysms, single sac with smooth margin was the most frequent finding, followed by single sac with irregular margin, multilobulated aneurysm, and aneurysm with daughter sac (38.1%, 29.8%, 20.9%, and 11.2%, respectively). Morphology was an independent predictor of rupture (receiver operating characteristic-area under the curve 0.693, P < 0.001). Risk of rupture increased by factor of 3 (5, 95% confidence interval [CI] 1.6-5.3) from single sac with regular margin to irregular margin, by factor of 5.5 (5, 95% CI 2.8-11.0) to daughter sac, and by factor of 7.3 (5, 95% CI 4.1-13.1) to multilobulated aneurysm. CONCLUSIONS Morphology might have an independent predictive value of aneurysm rupture. Risk of rupture might increase according to extent of morphologic change. Prospective studies will be necessary to evaluate the influence of aneurysm morphology on natural history.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Jihad Rustom
- Department of Internal Medicine, Klinikum Itzehoe, Itzehoe, Germany
| | - Maxim Bester
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vittorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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197
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Gramatzki D, Kickingereder P, Hentschel B, Herrlinger U, Schackert G, Tonn JC, Westphal M, Sabel M, Schlegel U, Wick W, Reifenberger G, Löffler M, Bendszus M, Weller M. DRES-13. EXTENDED TEMOZOLOMIDE FOR NEWLY DIAGNOSED GLIOBLASTOMA: AN ANALYSIS OF THE GERMAN GLIOMA NETWORK. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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198
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Dührsen L, Borchert P, Bolar D, Fiehler J, Westphal M, Sedlacik J, Schmidt NO. NIMG-38. MAPPING OF BRAIN TUMOR OXYGEN METABOLISM IN NATIVE MRI. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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199
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Reifenberger G, Sill M, Hentschel B, Felsberg J, Jones DT, Gramatzki D, Kaulich K, Tonn JC, Herrlinger U, Schackert G, Westphal M, Sabel M, Capper D, Kumar R, Hemminki K, Pietsch T, Loeffler M, Pfister SM, Deimling AV, Weller M. MPTH-23. LONG-TERM SURVIVAL WITH GLIOBLASTOMA IN THE ELDERLY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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200
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Sauvigny T, Brückner K, Dührsen L, Heese O, Westphal M, Stodieck SRG, Martens T. Neuropsychological performance and seizure control after subsequent anteromesial temporal lobe resection following selective amygdalohippocampectomy. Epilepsia 2016; 57:1789-1797. [DOI: 10.1111/epi.13567] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Sauvigny
- Department of Neurological Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Katja Brückner
- Department of Neurology and Epileptology; Epilepsy Center Hamburg-Alsterdorf; Hamburg Germany
| | - Lasse Dührsen
- Department of Neurological Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Oliver Heese
- Department of Neurosurgery; Helios Medical Center Schwerin; Schwerin Germany
| | - Manfred Westphal
- Department of Neurological Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Stefan R. G. Stodieck
- Department of Neurology and Epileptology; Epilepsy Center Hamburg-Alsterdorf; Hamburg Germany
| | - Tobias Martens
- Department of Neurological Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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