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Chai R, Zhang K, Wang K, Li G, Huang R, Zhao Z, Liu Y, Chen J. A novel gene signature based on five glioblastoma stem-like cell relevant genes predicts the survival of primary glioblastoma. J Cancer Res Clin Oncol 2018; 144:439-447. [PMID: 29299749 DOI: 10.1007/s00432-017-2572-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/27/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Primary glioblastoma (pGBM) is the most common and lethal type of neoplasms in the central nervous system, while the existing biomarkers, lacking consideration on the stemness changes of GBM cells, are not specific enough to predict the complex prognosis respectively. We aimed to build a high-efficiency prediction gene signature related to GBM cell stemness and investigate its prognostic value in primary glioblastoma. METHODS Differentially expressed genes were screened in GSE23806 database. The selected genes were then verified by univariate Cox regression in 591 patients from four enormous independent databases, including the Chinese Glioma Genome Atlas (CGGA), TCGA, REMBRANDT and GSE16011. Finally, the intersected genes were included to build the gene signature. GO analysis and GSEA were carried out to explore the bioinformatic implication. RESULTS The novel five-gene signature was used to identify high- and low-risk groups in the four databases, and the high-risk group showed notably poorer prognosis (P < 0.05). Gene ontology (GO) terms including "immune response", "apoptotic process", and "angiogenesis" were picked out by GO analysis and GSEA, which revealed that the gene signature was highly possibly related to the stemness of GSCs and predicting the prognosis of GBM effectively. CONCLUSION We built a gene signature with five glioblastoma stem-like cell (GSC) relevant genes, and predicted the survival in four independent databases effectively, which is possibly related to the stemness of GSCs in pGBM. Several GO terms were investigated to be correlated to the signature. The signature can predict the prognosis of glioblastoma efficiently.
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Affiliation(s)
- Ruichao Chai
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China.,Chinese Glioma Cooperative Group (CGCG), Beijing, China
| | - Kenan Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Chinese Glioma Cooperative Group (CGCG), Beijing, China
| | - Kuanyu Wang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Chinese Glioma Cooperative Group (CGCG), Beijing, China
| | - Guanzhang Li
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Chinese Glioma Cooperative Group (CGCG), Beijing, China
| | - Ruoyu Huang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Chinese Glioma Cooperative Group (CGCG), Beijing, China
| | - Zheng Zhao
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China.,Chinese Glioma Cooperative Group (CGCG), Beijing, China
| | - Yanwei Liu
- Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Glioma Cooperative Group (CGCG), Beijing, China
| | - Jing Chen
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China. .,Chinese Glioma Cooperative Group (CGCG), Beijing, China.
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Opoku-Darko M, Amuah JE, Kelly JJP. Surgical Resection of Anterior and Posterior Butterfly Glioblastoma. World Neurosurg 2017; 110:e612-e620. [PMID: 29162526 DOI: 10.1016/j.wneu.2017.11.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/08/2017] [Accepted: 11/11/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence suggests a survival benefit for patients with glioblastoma who undergo maximal safe surgical resection. Not all glioblastomas are amenable to surgical resection and anatomic location is one potentially limiting factor. Glioblastomas that invade the corpus callosum and cross midline to the contralateral hemisphere-butterfly glioblastomas (bGBMs)-are one subgroup of tumors traditionally deemed inoperable. METHODS We evaluate the management of bGBMs at our institution to assess whether surgical resection is feasible, safe, and more effective than biopsy. We retrospectively reviewed our institutional brain tumor registry for all adult patients treated for glioblastoma (World Health Organization grade IV) between 2004 and 2016 to identify all bGBMs. RESULTS Survival between biopsy and resection was assessed using the Kaplan-Meier model. Twenty-nine (3.8%) of 764 newly diagnosed GBMs were identified as bGBM. Of these, 9 patients (31.0%) underwent surgical resection and 20 patients (69.0%) underwent biopsy. Five patients (55.6%) in the surgical resection group had 98% extent of resection or greater. Median survival of our entire cohort of patients was 3.3 months. Median survival was higher in the surgical resection groups (7.8 vs. 2.8 months; P = 0.0019). Increased age is independently associated with increased risk of death, and adjuvant therapy is independently associated with prolonged survival. CONCLUSIONS Surgical resection of butterfly glioblastoma prolongs survival without increased risk of permanent neurologic deficit. Both anterior and posterior bGBMs can be resected safely.
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Affiliation(s)
| | - Joseph E Amuah
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - John J P Kelly
- Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada; The Arne Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada.
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Stensjøen AL, Berntsen EM, Mikkelsen VE, Torp SH, Jakola AS, Salvesen Ø, Solheim O. Does Pretreatment Tumor Growth Hold Prognostic Information for Patients with Glioblastoma? World Neurosurg 2017; 101:686-694.e4. [PMID: 28300718 DOI: 10.1016/j.wneu.2017.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Glioblastomas are highly aggressive and heterogeneous tumors, both in terms of patient outcome and molecular profile. Magnetic resonance imaging of tumor growth could potentially reveal new insights about tumor biology noninvasively. The aim of this exploratory retrospective study was to investigate the prognostic potential of pretreatment growth rate of glioblastomas, after controlling for known prognostic factors. METHODS A growth model derived from clinical pretreatment postcontrast T1-weighted magnetic resonance imaging images was used to divide 106 glioblastoma patients into 2 groups. The "faster growth" group had tumors growing faster than expected based on their volume at diagnosis, whereas the "slower growth" group had tumors growing slower than expected. Associations between tumor growth and survival were examined by the use of multivariable Cox regression and logistic regression. RESULTS None of the known prognostic factors were significantly associated with tumor growth. An extended multivariable Cox model showed that during the first 12 months of follow-up, there was no significant difference in survival between faster and slower growing tumors. Beyond 12 months' follow-up, however, there was a significant, independent survival benefit in having a tumor with slower pretreatment growth. In a multiple logistic regression model including patients receiving both radiotherapy and chemotherapy (n = 82), slower pre-treatment growth of the tumor was shown to be a significant predictor of 2-year survival (odds ratio 4.4). CONCLUSIONS Pretreatment glioblastoma growth harbors prognostic information. Patients with slower growing tumors have higher odds of survival beyond 2 years, adjusted for other prognostic factors.
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Affiliation(s)
- Anne Line Stensjøen
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Radiology, St. Olav's University Hospital, Trondheim, Norway.
| | - Erik Magnus Berntsen
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Radiology, St. Olav's University Hospital, Trondheim, Norway
| | - Vilde E Mikkelsen
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Sverre H Torp
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Pathology and Medical Genetics, St. Olav's University Hospital, Trondheim, Norway
| | - Asgeir S Jakola
- Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Øyvind Salvesen
- Department of Public Health and General Practice, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ole Solheim
- Department of Neuroscience, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; National Competence Centre for Ultrasound and Image Guided Therapy, St. Olav's University Hospital, Trondheim, Norway
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Li F, Li Y, Zhang K, Li Y, He P, Liu Y, Yuan H, Lu H, Liu J, Che S, Li Z, Bie L. FBLN4 as candidate gene associated with long-term and short-term survival with primary glioblastoma. Onco Targets Ther 2017; 10:387-395. [PMID: 28144153 PMCID: PMC5248947 DOI: 10.2147/ott.s117165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Glioblastoma multiforme (GBM) is the most common malignant and lethal type of primary central nervous system tumor in humans. In spite of its high lethality, a small percentage of patients have a relatively good prognosis, with median survival times of 36 months or longer. The identification of clinical subsets of GBM associated with distinct molecular genetic profiles has made it possible to design therapies tailored to treat individual patients. Methods We compared microarray data sets from long-term survivors (LTSs) and short-term survivors (STSs) to screen for prognostic biomarkers in GBM patients using the WebArrayDB platform. We focused on FBLN4, IGFBP-2, and CHI3L1, all members of a group of 10 of the most promising, differentially regulated gene candidates. Using formalin-fixed paraffin-embedded GBM samples, we corroborated the relationship between these genes and patient outcomes using methylation-specific polymerase chain reaction (PCR) for MGMT methylation status and quantitative reverse transcription PCR for expression of these genes. Results Expression levels of the mRNAs of these 3 genes were higher in the GBM samples than in normal brain samples and these 3 genes were significantly upregulated in STSs compared to the levels in LTS samples (P<0.01). Furthermore, Kaplan–Meier analysis showed that the expression patterns of FBLN4 and IGFBP-2 serve as independent prognostic indicators for overall survival (P<0.01 and P<0.05, respectively). Conclusion To our knowledge, this is the first report describing FBLN4 as a prognostic factor for GBM patient survival, demonstrating that increased GBM survival time correlates with decreased FBLN4 expression. Understanding FBLN4 expression patterns could aid in the creation of powerful tools to predict clinical prognoses of GBM patients.
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Affiliation(s)
- Fubin Li
- Department of Neurosurgery of the First Clinical Hospital
| | - Yiping Li
- Department of Neurosurgery of the First Clinical Hospital
| | - Kewei Zhang
- Department of Neurosurgery of the First Clinical Hospital
| | - Ye Li
- Department of Neurosurgery of the First Clinical Hospital
| | - Ping He
- Department of Neurosurgery of the First Clinical Hospital
| | - Yujia Liu
- Department of Neurosurgery of the First Clinical Hospital
| | - Hongyan Yuan
- Department of Immunology, Norman Bethune College of Medicine
| | - Honghua Lu
- Department of Neurosurgery of the First Clinical Hospital
| | - Jinxiang Liu
- Department of Neurosurgery of the First Clinical Hospital
| | - Songtian Che
- Department of Neurosurgery of the Second Clinical Hospital
| | - Zhenju Li
- Department of Neurosurgery of the Fourth Clinical Hospital, Jilin University, Changchun, People's Republic of China
| | - Li Bie
- Department of Neurosurgery of the First Clinical Hospital; Department of Pathology and Laboratory Medicine, School of Medicine, University of California - Irvine, Irvine, CA, USA
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Inhibition of radiation-induced glioblastoma invasion by genetic and pharmacological targeting of MDA-9/Syntenin. Proc Natl Acad Sci U S A 2016; 114:370-375. [PMID: 28011764 DOI: 10.1073/pnas.1616100114] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Glioblastoma multiforme (GBM) is an intractable tumor despite therapeutic advances, principally because of its invasive properties. Radiation is a staple in therapeutic regimens, although cells surviving radiation can become more aggressive and invasive. Subtraction hybridization identified melanoma differentiation-associated gene 9 [MDA-9/Syntenin; syndecan-binding protein (SDCBP)] as a differentially regulated gene associated with aggressive cancer phenotypes in melanoma. MDA-9/Syntenin, a highly conserved double-PDZ domain-containing scaffolding protein, is robustly expressed in human-derived GBM cell lines and patient samples, with expression increasing with tumor grade and correlating with shorter survival times and poorer response to radiotherapy. Knockdown of MDA-9/Syntenin sensitizes GBM cells to radiation, reducing postradiation invasion gains. Radiation induces Src and EGFRvIII signaling, which is abrogated through MDA-9/Syntenin down-regulation. A specific inhibitor of MDA-9/Syntenin activity, PDZ1i (113B7), identified through NMR-guided fragment-based drug design, inhibited MDA-9/Syntenin binding to EGFRvIII, which increased following radiation. Both genetic (shmda-9) and pharmacological (PDZ1i) targeting of MDA-9/Syntenin reduced invasion gains in GBM cells following radiation. Although not affecting normal astrocyte survival when combined with radiation, PDZ1i radiosensitized GBM cells. PDZ1i inhibited crucial GBM signaling involving FAK and mutant EGFR, EGFRvIII, and abrogated gains in secreted proteases, MMP-2 and MMP-9, following radiation. In an in vivo glioma model, PDZ1i resulted in smaller, less invasive tumors and enhanced survival. When combined with radiation, survival gains exceeded radiotherapy alone. MDA-9/Syntenin (SDCBP) provides a direct target for therapy of aggressive cancers such as GBM, and defined small-molecule inhibitors such as PDZ1i hold promise to advance targeted brain cancer therapy.
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Unruh D, Schwarze SR, Khoury L, Thomas C, Wu M, Chen L, Chen R, Liu Y, Schwartz MA, Amidei C, Kumthekar P, Benjamin CG, Song K, Dawson C, Rispoli JM, Fatterpekar G, Golfinos JG, Kondziolka D, Karajannis M, Pacione D, Zagzag D, McIntyre T, Snuderl M, Horbinski C. Mutant IDH1 and thrombosis in gliomas. Acta Neuropathol 2016; 132:917-930. [PMID: 27664011 PMCID: PMC5640980 DOI: 10.1007/s00401-016-1620-7] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/16/2016] [Accepted: 09/16/2016] [Indexed: 10/21/2022]
Abstract
Mutant isocitrate dehydrogenase 1 (IDH1) is common in gliomas, and produces D-2-hydroxyglutarate (D-2-HG). The full effects of IDH1 mutations on glioma biology and tumor microenvironment are unknown. We analyzed a discovery cohort of 169 World Health Organization (WHO) grade II-IV gliomas, followed by a validation cohort of 148 cases, for IDH1 mutations, intratumoral microthrombi, and venous thromboemboli (VTE). 430 gliomas from The Cancer Genome Atlas were analyzed for mRNAs associated with coagulation, and 95 gliomas in a tissue microarray were assessed for tissue factor (TF) protein. In vitro and in vivo assays evaluated platelet aggregation and clotting time in the presence of mutant IDH1 or D-2-HG. VTE occurred in 26-30 % of patients with wild-type IDH1 gliomas, but not in patients with mutant IDH1 gliomas (0 %). IDH1 mutation status was the most powerful predictive marker for VTE, independent of variables such as GBM diagnosis and prolonged hospital stay. Microthrombi were far less common within mutant IDH1 gliomas regardless of WHO grade (85-90 % in wild-type versus 2-6 % in mutant), and were an independent predictor of IDH1 wild-type status. Among all 35 coagulation-associated genes, F3 mRNA, encoding TF, showed the strongest inverse relationship with IDH1 mutations. Mutant IDH1 gliomas had F3 gene promoter hypermethylation, with lower TF protein expression. D-2-HG rapidly inhibited platelet aggregation and blood clotting via a novel calcium-dependent, methylation-independent mechanism. Mutant IDH1 glioma engraftment in mice significantly prolonged bleeding time. Our data suggest that mutant IDH1 has potent antithrombotic activity within gliomas and throughout the peripheral circulation. These findings have implications for the pathologic evaluation of gliomas, the effect of altered isocitrate metabolism on tumor microenvironment, and risk assessment of glioma patients for VTE.
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Affiliation(s)
- Dusten Unruh
- Department of Neurosurgery, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | | | - Laith Khoury
- Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
| | - Cheddhi Thomas
- Department of Pathology, New York University, New York, NY, USA
| | - Meijing Wu
- Department of Neurosurgery, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Li Chen
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Rui Chen
- Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Yinxing Liu
- Department of Pathology, University of Kentucky, Lexington, KY, USA
| | | | - Christina Amidei
- Department of Neurosurgery, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Priya Kumthekar
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | | | | | | | | | | | - John G Golfinos
- Department of Neurosurgery, New York University, New York, NY, USA
| | | | | | - Donato Pacione
- Department of Neurosurgery, New York University, New York, NY, USA
| | - David Zagzag
- Department of Pathology, New York University, New York, NY, USA
- Department of Neurosurgery, New York University, New York, NY, USA
| | - Thomas McIntyre
- Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Matija Snuderl
- Department of Pathology, New York University, New York, NY, USA
| | - Craig Horbinski
- Department of Neurosurgery, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA.
- Department of Pathology, Northwestern University, Chicago, IL, USA.
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Bale TA, Abedalthagafi M, Bi WL, Kang YJ, Merrill P, Dunn IF, Dubuc A, Charbonneau SK, Brown L, Ligon AH, Ramkissoon SH, Ligon KL. Genomic characterization of recurrent high-grade astroblastoma. Cancer Genet 2016; 209:321-30. [PMID: 27425854 DOI: 10.1016/j.cancergen.2016.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/28/2016] [Accepted: 06/03/2016] [Indexed: 12/23/2022]
Abstract
Astroblastomas are rare primary brain tumors, diagnosed based on histologic features. Not currently assigned a WHO grade, they typically display indolent behavior, with occasional variants taking a more aggressive course. We characterized the immunohistochemical characteristics, copy number (high-resolution array comparative genomic hybridization, OncoCopy) and mutational profile (targeted next-generation exome sequencing, OncoPanel) of a cohort of seven biopsies from four patients to identify recurrent genomic events that may help distinguish astroblastomas from other more common high-grade gliomas. We found that tumor histology was variable across patients and between primary and recurrent tumor samples. No common molecular features were identified among the four tumors. Mutations commonly observed in astrocytic tumors (IDH1/2, TP53, ATRX, and PTEN) or ependymoma were not identified. However one case with rapid clinical progression displayed mutations more commonly associated with GBM (NF1(N1054H/K63)*, PIK3CA(R38H) and ERG(A403T)). Conversely, another case, originally classified as glioblastoma with nine-year survival before recurrence, lacked a GBM mutational profile. Other mutations frequently seen in lower grade gliomas (BCOR, BCORL1, ERBB3, MYB, ATM) were also present in several tumors. Copy number changes were variable across tumors. Our findings indicate that astroblastomas have variable growth patterns and morphologic features, posing significant challenges to accurate classification in the absence of diagnostically specific copy number alterations and molecular features. Their histopathologic overlap with glioblastoma will likely confound the observation of long-term GBM "survivors". Further genomic profiling is needed to determine whether these tumors represent a distinct entity and to guide management strategies.
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Affiliation(s)
- Tejus A Bale
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Malak Abedalthagafi
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Molecular Oncologic Pathology, Dana Farber Cancer Institute, Boston, MA, USA; Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yun Jee Kang
- Center for Molecular Oncologic Pathology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Parker Merrill
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ian F Dunn
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adrian Dubuc
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah K Charbonneau
- Center for Molecular Oncologic Pathology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Loreal Brown
- Center for Molecular Oncologic Pathology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Azra H Ligon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shakti H Ramkissoon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Molecular Oncologic Pathology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Keith L Ligon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Molecular Oncologic Pathology, Dana Farber Cancer Institute, Boston, MA, USA.
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Molecular Predictors of Long-Term Survival in Glioblastoma Multiforme Patients. PLoS One 2016; 11:e0154313. [PMID: 27124395 PMCID: PMC4849730 DOI: 10.1371/journal.pone.0154313] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/12/2016] [Indexed: 11/24/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common and aggressive adult primary brain cancer, with <10% of patients surviving for more than 3 years. Demographic and clinical factors (e.g. age) and individual molecular biomarkers have been associated with prolonged survival in GBM patients. However, comprehensive systems-level analyses of molecular profiles associated with long-term survival (LTS) in GBM patients are still lacking. We present an integrative study of molecular data and clinical variables in these long-term survivors (LTSs, patients surviving >3 years) to identify biomarkers associated with prolonged survival, and to assess the possible similarity of molecular characteristics between LGG and LTS GBM. We analyzed the relationship between multivariable molecular data and LTS in GBM patients from the Cancer Genome Atlas (TCGA), including germline and somatic point mutation, gene expression, DNA methylation, copy number variation (CNV) and microRNA (miRNA) expression using logistic regression models. The molecular relationship between GBM LTS and LGG tumors was examined through cluster analysis. We identified 13, 94, 43, 29, and 1 significant predictors of LTS using Lasso logistic regression from the somatic point mutation, gene expression, DNA methylation, CNV, and miRNA expression data sets, respectively. Individually, DNA methylation provided the best prediction performance (AUC = 0.84). Combining multiple classes of molecular data into joint regression models did not improve prediction accuracy, but did identify additional genes that were not significantly predictive in individual models. PCA and clustering analyses showed that GBM LTS typically had gene expression profiles similar to non-LTS GBM. Furthermore, cluster analysis did not identify a close affinity between LTS GBM and LGG, nor did we find a significant association between LTS and secondary GBM. The absence of unique LTS profiles and the lack of similarity between LTS GBM and LGG, indicates that there are multiple genetic and epigenetic pathways to LTS in GBM patients.
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Taunk NK, Moraes FY, Escorcia FE, Mendez LC, Beal K, Marta GN. External beam re-irradiation, combination chemoradiotherapy, and particle therapy for the treatment of recurrent glioblastoma. Expert Rev Anticancer Ther 2016; 16:347-58. [PMID: 26781426 DOI: 10.1586/14737140.2016.1143364] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Glioblastoma is a common aggressive primary malignant brain tumor, and is nearly universal in progression and mortality after initial treatment. Re-irradiation presents a promising treatment option for progressive disease, both palliating symptoms and potentially extending survival. Highly conformal radiation techniques such as stereotactic radiosurgery and hypofractionated radiosurgery are effective short courses of treatment that allow delivery of high doses of therapeutic radiation with steep dose gradients to protect normal tissue. Patients with higher performance status, younger age, and longer interval between primary treatment and progression represent the best candidates for re-irradiation. Multiple studies are also underway involving combinations of radiation and systemic therapy to bend the survival curve and improve the therapeutic index. In the multimodal treatment of recurrent high-grade glioma, the use of surgery, radiation, and systemic therapy should be highly individualized. Here we comprehensively review radiation therapy and techniques, along with discussion of combination treatment and novel strategies.
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Affiliation(s)
- Neil K Taunk
- a Department of Radiation Oncology , Memorial Sloan Kettering Cancer Center , New York , New York , USA
| | - Fabio Y Moraes
- b Department of Radiation Oncology , Hospital Sírio-Libanês , São Paulo , Brazil
| | - Freddy E Escorcia
- a Department of Radiation Oncology , Memorial Sloan Kettering Cancer Center , New York , New York , USA
| | - Lucas Castro Mendez
- d Department of Radiation Oncology , Instituto de Radiologia - Faculdade de Medicina da Universidade de São Paulo (FMUSP) , São Paulo , Brazil
| | - Kathryn Beal
- a Department of Radiation Oncology , Memorial Sloan Kettering Cancer Center , New York , New York , USA
| | - Gustavo N Marta
- b Department of Radiation Oncology , Hospital Sírio-Libanês , São Paulo , Brazil.,c Department of Radiation Oncology , Instituto do Câncer do Estado de São Paulo (ICESP) - Faculdade de Medicina da Universidade de São Paulo (FMUSP) , São Paulo , Brazil
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60
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Berendsen S, Varkila M, Kroonen J, Seute T, Snijders TJ, Kauw F, Spliet WGM, Willems M, Poulet C, Broekman ML, Bours V, Robe PA. Prognostic relevance of epilepsy at presentation in glioblastoma patients. Neuro Oncol 2015; 18:700-6. [PMID: 26420896 DOI: 10.1093/neuonc/nov238] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/24/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Epileptogenic glioblastomas are thought to convey a favorable prognosis, either due to early diagnosis or potential antitumor effects of antiepileptic drugs. We investigated the relationship between survival and epilepsy at presentation, early diagnosis, and antiepileptic drug therapy in glioblastoma patients. METHODS Multivariable Cox regression was applied to survival data of 647 consecutive patients diagnosed with de novo glioblastoma between 2005 and 2013 in order to investigate the association between epilepsy and survival in glioblastoma patients. In addition, we quantified the association between survival and valproic acid (VPA) treatment. RESULTS Epilepsy correlated positively with survival (HR: 0.75 (95% CI: 0.61-0.92), P < .01). This effect is independent of age, sex, performance status, type of surgery, adjuvant therapy, tumor location, and tumor volume, suggesting that this positive correlation cannot be attributed solely to early diagnosis. For patients who presented with epilepsy, the use of the antiepileptic drug VPA did not associate with survival when compared with patients who did not receive VPA treatment. CONCLUSION Epilepsy is an independent prognostic factor for longer survival in glioblastoma patients. This prognostic effect is not solely explained by early diagnosis, and survival is not associated with VPA treatment.
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Affiliation(s)
- Sharon Berendsen
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Meri Varkila
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Jérôme Kroonen
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Tatjana Seute
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Tom J Snijders
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Frans Kauw
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Wim G M Spliet
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Marie Willems
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Christophe Poulet
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Marike L Broekman
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Vincent Bours
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
| | - Pierre A Robe
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.)
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Molecular subtypes, stem cells and heterogeneity: Implications for personalised therapy in glioma. J Clin Neurosci 2015; 22:1219-26. [DOI: 10.1016/j.jocn.2015.02.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 02/14/2015] [Indexed: 01/08/2023]
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Ramakrishna R, Pisapia D. Recent Molecular Advances in Our Understanding of Glioma. Cureus 2015; 7:e287. [PMID: 26244119 PMCID: PMC4523144 DOI: 10.7759/cureus.287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/23/2015] [Indexed: 12/18/2022] Open
Abstract
Our molecular understanding of glioma has undergone a sea change over the last decade. In this review, we discuss two recent articles that employed whole genome sequencing to subclassify gliomas vis-à-vis known molecular alterations. We further discuss the relevance of these findings vis-à-vis current treatment paradigms.
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Affiliation(s)
- Rohan Ramakrishna
- Neurological Surgery, Weill Cornell Medical College ; Neurological Surgery, NewYork-Presbyterian/Weill Cornell Medical Center
| | - David Pisapia
- Pathology, Weill Cornell Medical College ; Pathology, New York Presbyterian Hospital
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63
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Amelot A, De Cremoux P, Quillien V, Polivka M, Adle-Biassette H, Lehmann-Che J, Françoise L, Carpentier AF, George B, Mandonnet E, Froelich S. IDH-Mutation Is a Weak Predictor of Long-Term Survival in Glioblastoma Patients. PLoS One 2015; 10:e0130596. [PMID: 26158269 PMCID: PMC4497660 DOI: 10.1371/journal.pone.0130596] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/21/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A very small proportion of patients diagnosed with glioblastoma (GBM) survive more than 3 years. Isocitrate dehydrogenase 1 or 2 (IDH1/2) mutations define a small subgroup of GBM patients with favourable prognosis. However, it remains controversial whether long-term survivors (LTS) are found among those IDH1/2 mutated patients. METHODS We retrospectively analyzed 207 GBM patients followed at Lariboisière Hospital (Paris) between 2005 and 2010. Clinical parameters were obtained from medical records. Mutations of IDH1/2 were analyzed in these patients, by immunohistochemistry for the R132H mutation of IDH1 and by high-resolution melting-curve analysis, followed by Sanger sequencing for IDH1 and IDH2 exon 4 mutations. Mutation rates in LTS and non-LTS groups were compared by Chi square Pearson test. RESULTS Seventeen patients with survival >3 years were identified (8.2% of the total series). The median overall survival in long-term survivors was 4.6 years. Subgroup analysis found that the median age at diagnosis was significantly higher for non long-term survivors (non-LTS) compared to LTS (60 versus 51 years, p <0.03). The difference in the rate of IDH mutation between non-LTS and LTS was statistically not significant (1.16% versus 5.9%, p = 0.144). Among LTS, 10 out of 16 tumors presented a methylation of MGMT promoter. CONCLUSIONS This study confirms that long-term survival in GBM patients is if at all only weakly correlated to IDH-mutation.
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Affiliation(s)
- Aymeric Amelot
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of Neurosurgery, Paris, France
| | - Patricia De Cremoux
- Assistance Publique-Hôpitaux de Paris (AP-HP), St-Louis Hospital, Department of Biochemistry, Molecular Oncology Unit, Paris, France
| | - Véronique Quillien
- Département de Biologie, Centre Eugène Marquis, CS 44229, Rue de la Bataille Flandres Dunkerque, 35042, Rennes Cedex, France
| | - Marc Polivka
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of pathology, Paris, France
| | - Homa Adle-Biassette
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of pathology, Paris, France
| | - Jacqueline Lehmann-Che
- Assistance Publique-Hôpitaux de Paris (AP-HP), St-Louis Hospital, Department of Biochemistry, Molecular Oncology Unit, Paris, France
| | - Laurence Françoise
- Assistance Publique-Hôpitaux de Paris (AP-HP), St-Louis Hospital, Department of Biochemistry, Molecular Oncology Unit, Paris, France
| | - Antoine F. Carpentier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Avicennes Hospital, Department of Neurology, Bobigny, France
| | - Bernard George
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of Neurosurgery, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Emmanuel Mandonnet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of Neurosurgery, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- IMNC, UMR 8165, Orsay, France
| | - Sébastien Froelich
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of Neurosurgery, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
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Chaichana KL, Jusue-Torres I, Lemos AM, Gokaslan A, Cabrera-Aldana EE, Ashary A, Olivi A, Quinones-Hinojosa A. The butterfly effect on glioblastoma: is volumetric extent of resection more effective than biopsy for these tumors? J Neurooncol 2014; 120:625-34. [PMID: 25193022 DOI: 10.1007/s11060-014-1597-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/23/2014] [Indexed: 11/24/2022]
Abstract
A subset of patients with glioblastoma (GBM) have butterfly GBM (bGBM) that involve both cerebral hemispheres by crossing the corpus callosum. The prognoses, as well as the effectiveness of surgery and adjuvant therapy, are unclear because studies are few and limited. The goals of this study were to: (1) determine if bGBM have worse outcomes than patients with non-bGBM, (2) determine if surgery is more effective than biopsy, and (3) identify factors independently associated with improved outcomes for these patients. Adult patients who underwent surgery for a newly diagnosed primary GBM at an academic tertiary-care institution between 2007 and 2012 were retrospectively reviewed and tumors were volumetrically measured. Of the 336 patients with newly diagnosed GBM who were operated on, 48 (14 %) presented with bGBM, where 29 (60 %) and 19 (40 %) underwent surgical resection and biopsy, respectively. In multivariate analysis, a bGBM was independently associated with poorer survival [HR (95 % CI) 1.848 (1.250-2.685), p < 0.003]. In matched-pair analysis, patients who underwent surgical resection had improved median survival than biopsy patients (7.0 vs. 3.5 months, p = 0.03). In multivariate analysis, increasing percent resection [HR (95 % CI) 0.987 (0.977-0.997), p = 0.01], radiation [HR (95 % CI) 0.431 (0.225-0.812), p = 0.009], and temozolomide [HR (95 % CI) 0.413 (0.212-0. 784), p = 0.007] were each independently associated with prolonged survival among patients with bGBM. This present study shows that while patients with bGBM have poorer prognoses compared to non-bGBM, these patients can also benefit from aggressive treatments including debulking surgery, maximal safe surgical resection, temozolomide chemotherapy, and radiation therapy.
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Affiliation(s)
- Kaisorn L Chaichana
- Department of Neurosurgery, Neuro-Oncology Outcomes Laboratory, The Johns Hopkins Hospital, Johns Hopkins University, 1800 Orleans Street, Zayed 6007B, Baltimore, MD, 21202, USA,
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