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Fairclough S, Chumas P, Goodden J, Maguire M, Mathew RK. Motor seizures confer overall survival benefit in who grade 2 glioma. Epilepsia 2024; 65:1679-1686. [PMID: 38506645 DOI: 10.1111/epi.17956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The prevalence of epilepsy in World Health Organization (WHO) grade 2 glioma is high, with seizures being the presenting symptom in 60%-90%. We explore the epidemiology of seizures in this patient population in a regional neurosurgical center. METHODS Electronic health records of patients with histologically-proven WHO grade 2 glioma (n = 228) were reviewed between 1997 and 2021, with data collected including patient demographics, epilepsy prevalence, and seizure semiology. The influence of seizure type on overall survival was calculated using a Cox proportional hazards model. RESULTS Overall, 197 of 228 patients (86.4%) were diagnosed with epilepsy-either at presentation or during the course of their disease. Male patients were more likely than female patients to be diagnosed with epilepsy (91.1% vs 77.1%, p = .003) and, in those with epilepsy, more likely to experience at least one focal to bilateral tonic-clonic seizure (69.4% vs 54.1%, p = .05). Patients with left-sided tumors were twice as likely to have experienced a focal to bilateral tonic-clonic seizure (p = .02, odds ratio [OR] = .47). Predominantly experiencing seizures with motor activity appeared to confer better overall survival, with a 65% decrease in the risk of death 10 years post diagnosis (hazard ratio [HR] = .35, p = .02). This is despite accounting for previously described prognostic markers including tumor histology/genetics, time from diagnosis to surgery, and the extent of tumor resection. SIGNIFICANCE Motor seizure activity is a frequent feature in WHO grade 2 glioma and appears to confer a survival benefit regardless of histology or surgical factors. Seizures due to dominant hemisphere tumors may be more likely to propagate and cause bilateral tonic-clonic activity.
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Affiliation(s)
- Sam Fairclough
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - John Goodden
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - Melissa Maguire
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Ryan K Mathew
- School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
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2
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Wang Z, Li L, Wang Z, Chen X, Zhang Z. The clinical, radiological, and surgical characteristics of anterior perforated substance glioma: a retrospective study. Chin Neurosurg J 2023; 9:36. [PMID: 38111070 PMCID: PMC10729556 DOI: 10.1186/s41016-023-00349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/23/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND To explore the clinical, radiological, and surgical characteristics of anterior perforated substance (APS) gliomas. METHODS Twenty patients with APS glioma who were treated with surgery between March 2019 and January 2022 from Tiantan hospital were retrospectively reviewed. The clinical, histological and radiological data were collected. RESULTS Twenty patients, including 7 males (55%) and 13 females (45%), with a mean age at diagnosis of 37.9 years (range, 28-53 years) underwent operative intervention for APS. Headaches and dizziness were the most common preoperative symptoms in the majority patients (14, 70%). Based on radiological features of MRI, the APS was classified into two subtypes, type A and type B. Seven patients (40%) in type A indicated a clear tumor margin, while 13 patients (60%) in type B showed an ill-defined margin. The surgical approach including frontal, temporal, and coronal frontal incisions for type A and type B tumors, respectively. Three patients in type A received total resection, while one patient in type B were total resected. Pathologically, 12 cases (60%, 12/20) were diagnosed as astrocytoma and 8 cases (20%, 8/20) were oligodendroglioma. Meanwhile, 17 cases (85%, 17/20) had MGMT promotor methylation. CONCLUSION In this study, we performed the first systematic research of patients with APS glioma. Most of patients with APS presented headaches and dizziness symptoms. The APS glioma was further divided into two major radiological subtypes with relevant different surgical approaches. The APS glioma in type A were more likely to receive total resection.
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Affiliation(s)
- Zhiliang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Beijing, 100070, People's Republic of China
| | - Lianwang Li
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Beijing, 100070, People's Republic of China
| | - Xuzhu Chen
- Department of Radiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Beijing, 100070, People's Republic of China.
| | - Zhong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Beijing, 100070, People's Republic of China.
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3
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Soldatelli JS, Oliveira IMDE, Kneubil MC, Henriques JAP. Gliomas molecular markers: importance in treatment, prognosis and applicability in brazilian health system. AN ACAD BRAS CIENC 2022; 94:e20211075. [PMID: 35766600 DOI: 10.1590/0001-3765202220211075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022] Open
Abstract
Gliomas represent 80% of all primary malignant brain tumors in adults. In view of this public health problem, the early detection through sensitive and specific molecular tumor markers analysis can help to improve gliomas diagnosis and prognosis as well as their staging, assessment of therapeutic response and detection of recurrence. Therefore, this review focuses in current gliomas tumor markers, IDH-1/2, 1p/19q, MGMT, ATRX, TERT, H3, EGFR, BRAF and Ki67 used in clinic worldwide and their importance to early detection, glioma histological and molecular classification as well as in predicting patient's therapeutic response. In addition, we present what are the steps in the requesting process for this type of examination in the Brazilian Public Health System (SUS) scope, which attends most of the Brazilian population. Thereby, this article is useful in demonstrating which markers are used in the clinical practice for glioma patients and can be performed in the SUS through partnerships/agreements between specialized health centers and clinical analysis laboratories. It is hoped that this work clarifies, the necessary subsidies to carry out the research of tumor markers in all institutions that serve SUS users, providing a service with equal conditions.
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Affiliation(s)
- Jéssica S Soldatelli
- Universidade Federal do Rio Grande do Sul, UFRGS, Instituto de Biociências, Departamento de Biofísica, Av. Bento Gonçalves, 9500, Agronomia, 91501-970 Porto Alegre, RS, Brazil
| | - Iuri M DE Oliveira
- Universidade Federal do Rio Grande do Sul, UFRGS, Instituto de Biociências, Departamento de Biofísica, Av. Bento Gonçalves, 9500, Agronomia, 91501-970 Porto Alegre, RS, Brazil
| | - Maximiliano C Kneubil
- Universidade de Caxias do Sul, UCS, Instituto de Biotecnologia/Divisão de Cirurgia de Mama, Hospital Geral, Rua Francisco Getúlio Vargas, 1130, Petrópolis 95070-560 Caxias do Sul, RS, Brazil
| | - João Antonio P Henriques
- Universidade Federal do Rio Grande do Sul, UFRGS, Instituto de Biociências, Departamento de Biofísica, Av. Bento Gonçalves, 9500, Agronomia, 91501-970 Porto Alegre, RS, Brazil.,Universidade do Vale do Taquari, UNIVATES, Programa de Pós Graduação em Biotecnologia e em Ciências Médicas, Av. Avelino Talini, 171, Universitáriom 95914-014 Lajeado, RS, Brazil
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4
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Quantitative Analysis of the MGMT Methylation Status of Glioblastomas in Light of the 2021 WHO Classification. Cancers (Basel) 2022; 14:cancers14133149. [PMID: 35804921 PMCID: PMC9264886 DOI: 10.3390/cancers14133149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Glioblastomas with methylation of the promoter region of the O(6)-methylguanine-DNA methyltransferase (MGMT) gene exhibit increased sensitivity to alkylating chemotherapy. Quantitative assessment of the MGMT promoter methylation status might provide additional prognostic information. The aim of our study was to determine a quantitative methylation threshold for better survival among patients with glioblastomas. Methods: We included consecutive patients ≥18 years treated at our department between 11/2010 and 08/2018 for a glioblastoma, IDH wildtype, undergoing quantitative MGMT promoter methylation analysis. The primary endpoint was overall survival. Results: A total of 321 patients were included. Median overall survival was 12.6 months. Kaplan−Meier and adjusted Cox regression analysis showed better survival for the groups with 16−30%, 31−60%, and 61−100% methylation. In contrast, survival in the group with 1−15% methylation was similar to those with unmethylated promoter regions. A secondary analysis confirmed this threshold. Conclusions: Better survival is observed in patients with glioblastomas with ≥16% methylation of the MGMT promoter region than with <16% methylation. Survival with tumors with 1−15% methylation is similar to with unmethylated tumors. Above 16% methylation, we found no additional benefit with increasing methylation.
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Draaisma K, Tesileanu CMS, de Heer I, Klein M, Smits M, Reijneveld JC, Clement PM, De Vos F, Wick A, Mulholland P, Taphoorn M, Weller M, Chinot OL, Kros JM, Verschuere T, Coens C, Golfinopoulos V, Gorlia T, Idbaih A, Robe PA, van den Bent MJ, French PJ. Prognostic significance of DNA methylation profiles at MRI enhancing tumor recurrence: a report from the EORTC 26091 TAVAREC trial. Clin Cancer Res 2022; 28:2440-2448. [PMID: 35294545 DOI: 10.1158/1078-0432.ccr-21-3725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/19/2021] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Despite recent advances in the molecular characterization of gliomas, it remains unclear which patients benefit most from which second line treatments. The TAVAREC trial was a randomized, open-label phase 2 trial assessing the benefit of the addition of the angiogenesis inhibitor bevacizumab to treatment with temozolomide in patients with a first enhancing recurrence of WHO grade 2 or 3 glioma without 1p/19q codeletion. We evaluated the prognostic significance of genome wide DNA methylation profiles and copy number variations on the TAVAREC trial samples. EXPERIMENTAL DESIGN IDH-mutation status was determined via Sanger sequencing and immunohistochemistry. DNA methylation analysis was performed using the MethylationEPIC BeadChip (Illumina) from which 1p/19q codeletion, MGMT promoter methylation (MGMT-STP27) and homozygous deletion of CDKN2A/B were determined. DNA-methylation classes were determined according to classifiers developed in Heidelberg and TCGA ("Heidelberg" and "TCGA" classifier respectively). RESULTS DNA methylation profiles of 122 samples were successfully determined. As expected, most samples were IDH-mutant (89/122) and MGMT promotor methylated (89/122). Methylation classes were prognostic for time to progression. However, Heidelberg methylation classes determined at time of diagnosis were no longer prognostic following enhancing recurrence of the tumor. In contrast, TCGA methylation classes of primary samples remained prognostic also following enhancing recurrence. Homozygous deletions in CDKN2A/B were found in 10/87 IDH-mutated samples and were prognostically unfavorable at recurrence. CONCLUSIONS DNA methylome Heidelberg classification at time of diagnosis is no longer of prognostic value at the time of enhancing recurrence. CDKN2A/B deletion status was predictive of survival from progression of IDH-mutated tumors.
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Affiliation(s)
- Kaspar Draaisma
- Erasmus MC Cancer Institute, Rotterdam, Rotterdam, Netherlands
| | | | | | - Martin Klein
- Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Filip De Vos
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Antje Wick
- University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Michael Weller
- University Hospital and University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Thierry Gorlia
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | - Pierre A Robe
- University Medical Center Utrecht, Utrecht, Utrecht, Netherlands
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6
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Lam K, Eldred BSC, Kevan B, Pianka S, Eldred BA, Zapanta Rinonos S, Yong WH, Liau LM, Nghiemphu PL, Cloughesy TF, Green RM, Lai A. Prognostic value of O 6-methylguanine-DNA methyltransferase methylation in isocitrate dehydrogenase mutant gliomas. Neurooncol Adv 2022; 4:vdac030. [PMID: 35386566 PMCID: PMC8982195 DOI: 10.1093/noajnl/vdac030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Patients with isocitrate dehydrogenase (IDH) mutant gliomas have been associated with longer survival time than those that are IDH wild-type. Previous studies have shown the prognostic value of O 6 -methylguanine-DNA methyltransferase (MGMT) promoter methylation for glioblastoma multiforme (GBM), which are predominantly IDH wild-type. Little is known of the prognostic value of MGMT methylation status for IDH mutant gliomas. Methods We retrospectively identified IDH mutant gliomas patients between 2011 and 2020 that were tested for MGMT promoter methylation. We generated Kaplan-Meier estimator curves and performed Cox proportional hazard models for overall survival (OS) and progression-free survival (PFS) to compare the outcomes of MGMT promoter methylated versus MGMT unmethylated patients. Results Of 419 IDH mutant gliomas with MGMT promoter methylation testing, we identified 54 GBMs, 223 astrocytomas, and 142 oligodendrogliomas. 62.3% patients had MGMT methylated tumors while 37.7% were MGMT unmethylated. On Kaplan-Meier analysis, median OS for all MGMT methylated patients was 17.7 years and 14.6 years for unmethylated patients. Median PFS for all MGMT methylated patients was 7.0 years and for unmethylated patients 5.2 years. After univariate subgroup analysis, MGMT methylation is only prognostic for OS and PFS in GBM, and for OS in anaplastic oligodendroglioma and anaplastic oligodendroglioma for OS. In multivariate analysis, MGMT unmethylated GBM patients carry a higher risk of death (HR 7.72, 95% CI 2.10-28.33) and recurrence (HR 3.85, 95% CI 1.35-10.96). Conclusions MGMT promoter methylation is associated with better OS and PFS for IDH mutant GBM. MGMT promoter methylation testing for other IDH mutant glioma subtypes may not provide additional information on prognostication.
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Affiliation(s)
- Keng Lam
- Department of Neurology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Blaine S C Eldred
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Bryan Kevan
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Sean Pianka
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Brittany A Eldred
- Department of Strategic Communications, Sonoma State University, Rohnert Park, California, USA
| | | | - William H Yong
- Department of Pathology and Laboratory Medicine, University of California, Irvine, California, USA
| | - Linda M Liau
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Phioanh L Nghiemphu
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Timothy F Cloughesy
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Richard M Green
- Department of Neurology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Albert Lai
- Department of Neurology, University of California, Los Angeles, California, USA,Corresponding Author: Albert Lai, MD, PhD, Department of Neurology, University of California, 635 Charles E. Young Drive South, NRB Room 555C, Los Angeles, CA 90095, USA ()
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7
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Nakasu S, Nakasu Y. Malignant Progression of Diffuse Low-grade Gliomas: A Systematic Review and Meta-analysis on Incidence and Related Factors. Neurol Med Chir (Tokyo) 2022; 62:177-185. [PMID: 35197400 PMCID: PMC9093671 DOI: 10.2176/jns-nmc.2021-0313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Malignant progression of diffuse low-grade glioma (LGG) is a critical event affecting patient survival; however, the incidence and related factors have been inconsistent in literature. According to the PRISMA guidelines, we systematically reviewed articles from 2009, meta-analyzed the incidence of malignant progression, and clarified factors related to the transformation. Forty-one articles were included in this study (n = 7,122; n, number of patients). We identified two definitions of malignant progression: histologically proven (Htrans) and clinically defined (Ctrans). The malignant progression rate curves of Htrans and Ctrans were almost in parallel when constructed from the results of meta-regression by the mean follow-up time. The true transformation rate was supposed to lie between the two curves, approximately 40% at the 10-year mean follow-up. Risk of malignant progression was evaluated using hazard ratio (HR). Pooled HRs were significantly higher in tumors with a larger pre- and postoperative tumor volume, lower degree of resection, and notable preoperative contrast enhancement on magnetic resonance imaging than in others. Oligodendroglial histology and IDH mutation (IDHm) with 1p/19q codeletion (Codel) also significantly reduced the HRs. Using Kaplan-Meier curves from eight studies with molecular data, we extracted data and calculated the 10-year malignant progression-free survival (10yMPFS). The 10yMPFS in patients with IDHm without Codel was 30.4% (95% confidence interval [95% CI]: 22.2-39.0) in Htrans and 38.3% (95% CI: 32.3-44.3) in Ctrans, and that with IDHm with Codel was 71.7% (95% CI: 61.7-79.5) in Htrans and 62.5% (95% CI: 55.9-68.5) in Ctrans. The effect of adjuvant radiotherapy or chemotherapy could not be determined.
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Affiliation(s)
- Satoshi Nakasu
- Division of Neurosurgery, Omi Medical Center.,Department of Neurosurgery, Shiga University of Medical Science
| | - Yoko Nakasu
- Department of Neurosurgery, Shiga University of Medical Science.,Division of Neurosurgery, Shizuoka Cancer Center
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8
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Teske N, Karschnia P, Weller J, Siller S, Dorostkar MM, Herms J, von Baumgarten L, Tonn JC, Thon N. Extent, pattern, and prognostic value of MGMT promotor methylation: does it differ between glioblastoma and IDH-wildtype/TERT-mutated astrocytoma? J Neurooncol 2021; 156:317-327. [PMID: 34902093 PMCID: PMC8816375 DOI: 10.1007/s11060-021-03912-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022]
Abstract
Introduction The cIMPACT-NOW update 6 first introduced glioblastoma diagnosis based on the combination of IDH-wildtype (IDHwt) status and TERT promotor mutation (pTERTmut). In glioblastoma as defined by histopathology according to the WHO 2016 classification, MGMT promotor status is associated with outcome. Whether this is also true in glioblastoma defined by molecular markers is yet unclear.
Methods We searched the institutional database for patients with: (1) glioblastoma defined by histopathology; and (2) IDHwt astrocytoma with pTERTmut. MGMT promotor methylation was analysed using methylation-specific PCR and Sanger sequencing of CpG sites within the MGMT promotor region.
Results We identified 224 patients with glioblastoma diagnosed based on histopathology, and 54 patients with IDHwt astrocytoma with pTERTmut (19 astrocytomas WHO grade II and 38 astrocytomas WHO grade III). There was no difference in the number of MGMT methylated tumors between the two cohorts as determined per PCR, and also neither the number nor the pattern of methylated CpG sites differed as determined per Sanger sequencing. Progression-free (PFS) and overall survival (OS) was similar between the two cohorts when treated with radio- or chemotherapy. In both cohorts, higher numbers of methylated CpG sites were associated with favourable outcome. Conclusions Extent and pattern of methylated CpG sites are similar in glioblastoma and IDHwt astrocytoma with pTERTmut. In both tumor entities, higher numbers of methylated CpG sites appear associated with more favourable outcome. Evaluation in larger prospective cohorts is warranted.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany. .,Department of Neurosurgery, Division of Neuro-Oncology, Ludwig-Maximilians-University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Sebastian Siller
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Mario M Dorostkar
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Jochen Herms
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Joerg Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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9
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Karschnia P, Weller J, Blobner J, Stoecklein VM, Dorostkar MM, Rejeski K, Forbrig R, Niyazi M, von Baumgarten L, Dietrich J, Tonn JC, Thon N. Subventricular zone involvement is associated with worse outcome in glioma WHO grade 2 depending on molecular markers. Sci Rep 2021; 11:20045. [PMID: 34625590 PMCID: PMC8501091 DOI: 10.1038/s41598-021-97714-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023] Open
Abstract
Neural stem cells within the subventricular zone were identified as cells of origin driving growth of high-grade gliomas, and anatomical involvement of the subventricular zone has been associated with an inferior clinical outcome. Whether the association between poor outcome and subventricular zone involvement also applies to glioma of lower grades is unclear. We therefore analysed a retrospective cohort of 182 patients with glioma grade 2 (according to the WHO 2016 classification) including 78 individuals (43%) with subventricular zone involvement. Patients with and without subventricular zone involvement did not differ in regard to demographics, histopathology, and molecular markers. Notably, subventricular zone involvement was a negative prognostic marker for malignant progression and overall survival on uni- and multivariate analysis. When patients were stratified according to the cIMPACT-NOW update 6, subventricular zone involvement was negatively associated with outcome in IDH-wildtype astrocytomas and 1p19q-codeleted oligodendrogliomas but not in IDH-mutant astrocytomas. Collectively, subventricular zone involvement may represent a risk factor for worse outcome in glioma WHO grade 2 depending on the molecular tumor signature. The present data confirm the relevance of molecular glioma classifications as proposed by the cIMPACT-NOW update 6. These findings warrant evaluation in prospective cohorts.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany. .,Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Jonathan Weller
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Jens Blobner
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Mario M Dorostkar
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
| | - Kai Rejeski
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Medicine III, Ludwig-Maximilians-University, Munich, Germany
| | - Robert Forbrig
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Neuroradiology, Ludwig-Maximilians-University, Munich, Germany
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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10
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Qiu H, Tian W, He Y, Li J, He C, Li Y, Liu N, Li J. Integrated Analysis Reveals Prognostic Value and Immune Correlates of CD86 Expression in Lower Grade Glioma. Front Oncol 2021; 11:654350. [PMID: 33954112 PMCID: PMC8089378 DOI: 10.3389/fonc.2021.654350] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/29/2021] [Indexed: 12/17/2022] Open
Abstract
Background CD86 has great potential to be a new target of immunotherapy by regulating cancer immune response. However, it remains unclear whether CD86 is a friend or foe in lower-grade glioma (LGG). Methods The prognostic value of CD86 expression in pan-cancer was analyzed using Cox regression and Kaplan-Meier analysis with data from the cancer genome atlas (TCGA). Cancer types where CD86 showed prognostic value in overall survival and disease-specific survival were identified for further analyses. The Chinese Glioma Genome Atlas (CGGA) dataset were utilized for external validation. Quantitative real-time PCR (qRT-PCR), Western blot (WB), and Immunohistochemistry (IHC) were conducted for further validation using surgical samples from Jiangsu Province hospital. The correlations between CD86 expression and tumor immunity were analyzed using the Estimation of Stromal and Immune cells in Malignant Tumours using Expression data (ESTIMATE) algorithm, Tumor IMmune Estimation Resource (TIMER) database, and expressions of immune checkpoint molecules. Gene Set Enrichment Analysis (GSEA) was performed using clusterprofiler r package to reveal potential pathways. Results Pan-cancer survival analysis established CD86 expression as an unfavorable prognostic factor in tumor progression and survival for LGG. CD86 expression between Grade-II and Grade-III LGG was validated using qRT-PCR and WB. Additionally, CD86 expression in LGG with unmethylated O(6)-methylguanine-DNA-methyltransferase (MGMT) promoter was significantly higher than those with methylated MGMT (P<0.05), while in LGG with codeletion of 1p/19q it was significantly downregulated as opposed to those with non-codeletion (P<2.2*10-16). IHC staining validated that CD86 expression was correlated with MGMT status and X1p/19q subtypes, which was independent of tumor grade. Multivariate regression validated that CD86 expression acts as an unfavorable prognostic factor independent of clinicopathological factors in overall survival of LGG patients. Analysis of tumor immunity and GSEA revealed pivotal role of CD86 in immune response for LGG. Conclusions Integrated analysis shows that CD86 is an unfavorable prognostic biomarker in LGG patients. Targeting CD86 may become a novel approach for immunotherapy of LGG.
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Affiliation(s)
- Huaide Qiu
- Department of Rehabilitation Medicine, Jiangsu Shengze Hospital Affiliated to Nanjing Medical University, Suzhou, China.,Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Tian
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yikang He
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Rehabilitation Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jiahui Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chuan He
- Department of Rehabilitation Medicine, Jiangsu Shengze Hospital Affiliated to Nanjing Medical University, Suzhou, China
| | - Yongqiang Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ning Liu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianan Li
- Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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