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Stewart IJ, Howard JT, Poltavskiy E, Dore M, Amuan ME, Ocier K, Walker LE, Alcover KC, Pugh MJ. Traumatic Brain Injury and Subsequent Risk of Brain Cancer in US Veterans of the Iraq and Afghanistan Wars. JAMA Netw Open 2024; 7:e2354588. [PMID: 38358743 PMCID: PMC10870183 DOI: 10.1001/jamanetworkopen.2023.54588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024] Open
Abstract
Importance While brain cancer is rare, it has a very poor prognosis and few established risk factors. To date, epidemiologic work examining the potential association of traumatic brain injury (TBI) with the subsequent risk of brain cancer is conflicting. Further data may be useful. Objective To examine whether a history of TBI exposure is associated with the subsequent development of brain cancer. Design, Setting, and Participants A retrospective cohort study was conducted from October 1, 2004, to September 20, 2019, and data analysis was performed between January 1 and June 26, 2023. The median follow-up for the cohort was 7.2 (IQR, 4.1-10.1) years. Veterans Affairs (VA) and Department of Defense (DoD) administrative data on 1 919 740 veterans from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium were included. Exposure The main exposure of interest was TBI severity (categorized as mild, moderate or severe [moderate/severe], and penetrating). Main Outcomes and Measures The outcome of interest was the development of brain cancer based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes in either the DoD/VA medical records or from the National Death Index. Results After 611 107 exclusions (predominately for no encounter during the study period), a cohort including 1 919 740 veterans was included, most of whom were male (80.25%) and non-Hispanic White (63.11%). Median age at index date was 31 (IQR, 25-42) years. The cohort included 449 880 individuals with TBI (mild, 385 848; moderate/severe, 46 859; and penetrating, 17 173). Brain cancer occurred in 318 individuals without TBI (0.02%), 80 with mild TBI (0.02%), 17 with moderate/severe TBI (0.04%), and 10 or fewer with penetrating TBI (≤0.06%). After adjustment, moderate/severe TBI (adjusted hazard ratio [AHR], 1.90; 95% CI, 1.16-3.12) and penetrating TBI (AHR, 3.33; 95% CI, 1.71-6.49), but not mild TBI (AHR, 1.14; 95% CI, 0.88-1.47), were associated with the subsequent development of brain cancer. Conclusions and Relevance In this cohort study of veterans of the Iraq and Afghanistan wars, moderate/severe TBI and penetrating TBI, but not mild TBI, were associated with the subsequent development of brain cancer.
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Affiliation(s)
- Ian J. Stewart
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
- Military Cardiovascular Outcomes Research Program, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Jeffrey T. Howard
- Miltary & Health Research Foundation, Laurel, Maryland
- Department of Public Health, University of Texas, San Antonio
| | | | - Michael Dore
- Department of Medicine, Duke University, Durham, North Carolina
| | - Megan E. Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Krista Ocier
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Lauren E. Walker
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
| | - Karl C. Alcover
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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2
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Shah DS, Sanan A, Morell AA, Eichberg DG, Shah AH, Luther E, Lu VM, Elarjani T, Higgins DMO, Patel NV, Jagid JR, Ivan ME, Komotar RJ. Traumatic brain injury and subsequent brain tumor development: a systematic review of the literature. Neurosurg Rev 2022; 45:3003-3018. [PMID: 35641842 DOI: 10.1007/s10143-022-01819-y] [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: 03/10/2022] [Revised: 04/29/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022]
Abstract
The role of prior head trauma in stimulating brain tumor development has been previously described in the literature but continues to be debated. The goal of this study was to conduct a systematic review interrogating the contemporary literature to delineate any possible relationship between traumatic brain injury and brain tumor development. A systematic review exploring development of post-TBI brain tumor was conducted by searching electronic databases. Abstracts from articles were read and selected for full-text review according to criteria previously established in the scientific literature. Relevant full-text articles were divided into case reports and single-arm studies and epidemiological studies. Of 1070 resultant articles, 18 case reports and single-arm studies (level of evidence of IV and V) with 45 patients were included. The most common cause of TBI was traffic accidents. The average period between TBI and subsequent tumor diagnosis was 12.8 years. Meningiomas represented the largest share of tumors, followed by gliomas. Most post-TBI brain tumors developed in the frontal and temporal lobes. Fifteen epidemiological studies were also interrogated from a variety of countries (level of evidence of III). Case-control studies were more common than cohort studies. There were 9 of 15 studies proposed a possible relationship between history of head trauma and development of brain tumor. The relationship between head trauma and neoplastic growth continues to be heavily debated. There are certainly case reports and epidemiological studies in the literature that suggest a correlational relationship between the two. However, there is no concrete evidence of a causal relationship between TBI and brain tumors. More research is needed to definitively delineate the extent of any such relationship.
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Affiliation(s)
- Darsh S Shah
- Department of Neurological Surgery, Dell Medical School, University of Texas at Austin, 501 Red River St., Austin, TX, 78712, USA.
| | - Akshat Sanan
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Alexis A Morell
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | | | - Nitesh V Patel
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Jonathan R Jagid
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
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3
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Abstract
Traumatic brain injury (TBI) was first proposed as a potential risk factor for developing a glioma in the 1800s, and conditions for establishing a causal relationship between brain injury and gliomas have since been proposed. Given the medical and legal ramifications, the current literature was reviewed to better understand this possible association. Articles that examined the relationship between TBI and glioma formation in adults and were published in English between 1978 and 2022 were reviewed. There were 19 case reports of 25 patients and 16 observational studies. The case reports describe glioma formation at the precise site of prior brain injury in continuity with traumatic scar; the observational studies report conflicting findings, but they largely demonstrate no association. Most of the observational studies are limited by their retrospective nature, but we identified one prospective cohort study which found a positive association. Altogether, we suggest that glioma formation after TBI is a rare occurrence that warrants further study.
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4
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Cheng S, McLaughlin JR, Brown MC, Al-Sawaihey H, Rutka J, Bouffet E, Hawkins C, Cairney AE, Ranger A, Fleming AJ, Johnston D, Greenberg M, Malkin D, Hung RJ. Childhood head trauma and the risk of childhood brain tumours: A case-control study in Ontario, Canada. Int J Cancer 2021; 150:795-801. [PMID: 34520575 DOI: 10.1002/ijc.33805] [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: 03/02/2021] [Revised: 07/07/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022]
Abstract
Head trauma in early childhood has been hypothesized as a potential risk factor for childhood brain tumours (CBTs). However, head trauma has not been extensively studied in the context of CBTs and existing studies have yielded conflicting results. A population-based and hospital-based case-control study of children 0 to 15 years with newly diagnosed CBTs from 1997 to 2003 recruited across Ontario through paediatric oncology centres was conducted. Controls were frequency-matched with cases by age, sex and geographical region. The association was assessed based on multivariable logistic regressions, accounting for child's age, sex, ethnicity, highest level of maternal education and maternal pack-years of smoking during the pregnancy. Analyses were conducted separately based on age of first head trauma, sex and histology. A latency period analysis was conducted. Overall, based on 280 cases and 919 controls, CBTs were not significantly associated with previous history of head trauma (OR 1.34, 95% CI 0.96, 1.86), head trauma severity, number of head injuries, or head or neck X-rays or computed tomography (CT) examinations. Results were consistent across sexes and histological subtypes. However, head trauma within the first year of life was significantly associated with CBTs (OR 2.00, 95% CI 1.01, 3.98), but the association diminished when adjusted for X-ray or CT occurring during the same time period (OR 1.62, 95% CI 0.75, 3.49), albeit limited sample size. Overall, no association was observed between head trauma and CBTs among all children, while head trauma occurring within first year of life may warrant further investigation in future research.
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Affiliation(s)
- Sierra Cheng
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - John R McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M Catherine Brown
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Hamad Al-Sawaihey
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - James Rutka
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia Hawkins
- Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Adrianna Ranger
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Adam J Fleming
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Donna Johnston
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Mark Greenberg
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - David Malkin
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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5
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Lan YL, Zhu Y, Chen G, Zhang J. The Promoting Effect of Traumatic Brain Injury on the Incidence and Progression of Glioma: A Review of Clinical and Experimental Research. J Inflamm Res 2021; 14:3707-3720. [PMID: 34377008 PMCID: PMC8350857 DOI: 10.2147/jir.s325678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/23/2021] [Indexed: 12/16/2022] Open
Abstract
The role of traumatic brain injury in the development of glioma is highly controversial since first presented. This is not unexpected because traumatic brain injuries are overwhelmingly more common than glioma. However, the causes of post-traumatic glioma have been long discussed and still warrant further research. In this review, we have presented an overview of previous cohort studies and case–control studies. We have summarized the roles of microglial cells, macrophages, astrocytes, and stem cells in post-traumatic glioma formation and development, and reviewed various carcinogenic factors involved during traumatic brain injury, especially those reported in experimental studies indicating a relationship with glioma progression. Besides, traumatic brain injury and glioma share several common pathways, including inflammation and oxidative stress; however, the exact mechanism underlying this co-occurrence is yet to be discovered. In this review, we have summarized current epidemiological studies, clinical reports, pathophysiological research, as well as investigations evaluating the probable causes of co-occurrence and treatment possibilities. More efforts should be directed toward elucidating the relationship between traumatic brain injury and glioma, which could likely lead to promising pharmacological interventions towards designing therapeutic strategies.
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Affiliation(s)
- Yu-Long Lan
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.,Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.,Department of Neurosurgery, Shenzhen People's Hospital, Shenzhen, People's Republic of China
| | - Yongjian Zhu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Gao Chen
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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6
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McElvenny DM, Davis A, Dixon K, Alexander C, Gupta G, Nixon I, Crawford JO. Systematic review of the epidemiology of a single physical trauma and cancer. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408621993757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background A systematic review of single physical trauma and cancer was carried out, with a meta-analysis where deemed appropriate. Methods A comprehensive search of the literature including databases such as Medline and Embase identified 1529 potentially relevant papers for inclusion. A further 89 potentially relevant studies were identified from bibliographies. After review of titles and abstracts and then full papers, a total of 77 studies were included in the broader review of trauma and cancer, and 31 of these studies considered single physical trauma and cancer. The searches were carried out in June 2016. Results Although physical trauma as a cause of cancer has been an issue of clinical interest for decades, the epidemiological evidence was sparse. Only for traumatic brain injury and brain cancer was there considered a sufficient number of epidemiological studies for a meta-analysis. A random effects meta-relative risk for glioma from cohort studies was 0.96 (95% CI: 0.49 to 1.88) and 1.53 (95% CI: 1.02 to 2.27) for case-control studies. The equivalent results for meningioma were 1.22 (95% CI: 0.85 to 1.76) and 1.88 (95% CI: 0.84 to 1.49) respectively. Conclusions Further work is required to clarify whether physical trauma has a role in cancer development, perhaps by exploiting trauma registries.
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Affiliation(s)
- Damien M McElvenny
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Alice Davis
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
| | - Ken Dixon
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
| | - Carla Alexander
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
| | - Girish Gupta
- University Department of Dermatology, NHS Lothian, Edinburgh, UK
| | - Ioanna Nixon
- NHS Greater Glasgow & Clyde, Glasgow, UK
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Joanne O Crawford
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
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7
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Almahariq F, Raguž M, Dlaka D, Marčinković P, Kaštelančić A, Orešković D, Chudy D. Glioblastoma multiforme developed in site of motor cortex stimulation. Neurochirurgie 2020; 66:284-286. [PMID: 32589902 DOI: 10.1016/j.neuchi.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Affiliation(s)
- F Almahariq
- Department of Neurosurgery, University Hospital Dubrava, avenija Gojka Šuska 6, 10 000 Zagreb, Croatia; Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10 000 Zagreb, Croatia
| | - M Raguž
- Department of Neurosurgery, University Hospital Dubrava, avenija Gojka Šuska 6, 10 000 Zagreb, Croatia; Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10 000 Zagreb, Croatia.
| | - D Dlaka
- Department of Neurosurgery, University Hospital Dubrava, avenija Gojka Šuska 6, 10 000 Zagreb, Croatia; Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10 000 Zagreb, Croatia
| | - P Marčinković
- Department of Neurosurgery, University Hospital Dubrava, avenija Gojka Šuska 6, 10 000 Zagreb, Croatia; Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10 000 Zagreb, Croatia
| | - A Kaštelančić
- Department of Neurosurgery, University Hospital Dubrava, avenija Gojka Šuska 6, 10 000 Zagreb, Croatia
| | - D Orešković
- Department of Neurosurgery, University Hospital Dubrava, avenija Gojka Šuska 6, 10 000 Zagreb, Croatia; Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10 000 Zagreb, Croatia
| | - D Chudy
- Department of Neurosurgery, University Hospital Dubrava, avenija Gojka Šuska 6, 10 000 Zagreb, Croatia; Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10 000 Zagreb, Croatia; Department of Surgery, School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia
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8
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Juškys R, Chomanskis Ž. Glioblastoma Following Traumatic Brain Injury: Case Report and Literature Review. Cureus 2020; 12:e8019. [PMID: 32528758 PMCID: PMC7282376 DOI: 10.7759/cureus.8019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The association between traumatic brain injury and brain cancer is a matter of debate. The available literature is sparse and yields conflicting results. Even though there is a pathophysiological rationale for post-traumatic intracranial cancerogenesis, the direct link still has not been proven. Here we present a case of a patient who developed glioblastoma multiforme four years following the traumatic intracerebral hemorrhage. In addition, we provide a brief review of the relevant literature.
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Affiliation(s)
- Raimondas Juškys
- Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, Vilnius, LTU
| | - Žilvinas Chomanskis
- Department of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, LTU
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9
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Fyllingen EH, Hansen TI, Jakola AS, Håberg AK, Salvesen Ø, Solheim O. Does risk of brain cancer increase with intracranial volume? A population-based case control study. Neuro Oncol 2019; 20:1225-1230. [PMID: 29554311 DOI: 10.1093/neuonc/noy043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Glioma is the most common primary brain tumor and is believed to arise from glial stem cells. Despite large efforts, there are limited established risk factors. It has been suggested that tissue with more stem cell divisions may exhibit higher risk of cancer due to chance alone. Assuming a positive correlation between the number of stem cell divisions in an organ and size of the same organ, we hypothesized that variation in intracranial volume, as a proxy for brain size, may be linked to risk of high-grade glioma. Methods Intracranial volume was calculated from pretreatment 3D T1-weighted MRI brain scans from 124 patients with high-grade glioma and 995 general population-based controls. Binomial logistic regression analyses were performed to ascertain the effect of intracranial volume and sex on the likelihood that participants had high-grade glioma. Results An increase in intracranial volume of 100 mL was associated with an odds ratio of high-grade glioma of 1.69 (95% CI: 1.44‒1.98; P < 0.001). After adjusting for intracranial volume, female sex emerged as a risk factor for high-grade glioma (odds ratio for male sex = 0.56, 95% CI: 0.33‒0.93; P = 0.026). Conclusions Intracranial volume is strongly associated with risk of high-grade glioma. After correcting for intracranial volume, risk of high-grade glioma was higher in women. The development of glioma is correlated to brain size and may to a large extent be a stochastic event related to the number of cells at risk.
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Affiliation(s)
- Even Hovig Fyllingen
- Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tor Ivar Hansen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Asgeir Store Jakola
- Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,National Competence Centre for Ultrasound and Image Guided Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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10
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Molinaro AM, Taylor JW, Wiencke JK, Wrensch MR. Genetic and molecular epidemiology of adult diffuse glioma. Nat Rev Neurol 2019; 15:405-417. [PMID: 31227792 PMCID: PMC7286557 DOI: 10.1038/s41582-019-0220-2] [Citation(s) in RCA: 409] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 12/24/2022]
Abstract
The WHO 2007 glioma classification system (based primarily on tumour histology) resulted in considerable interobserver variability and substantial variation in patient survival within grades. Furthermore, few risk factors for glioma were known. Discoveries over the past decade have deepened our understanding of the molecular alterations underlying glioma and have led to the identification of numerous genetic risk factors. The advances in molecular characterization of glioma have reframed our understanding of its biology and led to the development of a new classification system for glioma. The WHO 2016 classification system comprises five glioma subtypes, categorized by both tumour morphology and molecular genetic information, which led to reduced misclassification and improved consistency of outcomes within glioma subtypes. To date, 25 risk loci for glioma have been identified and several rare inherited mutations that might cause glioma in some families have been discovered. This Review focuses on the two dominant trends in glioma science: the characterization of diagnostic and prognostic tumour markers and the identification of genetic and other risk factors. An overview of the many challenges still facing glioma researchers is also included.
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Affiliation(s)
- Annette M Molinaro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Jennie W Taylor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - John K Wiencke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Margaret R Wrensch
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA, USA
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11
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Georgakis MK, Dessypris N, Papadakis V, Tragiannidis A, Bouka E, Hatzipantelis E, Moschovi M, Papakonstantinou E, Polychronopoulou S, Sgouros S, Stiakaki E, Pourtsidis A, Psaltopoulou T, Petridou ET. Perinatal and early life risk factors for childhood brain tumors: Is instrument-assisted delivery associated with higher risk? Cancer Epidemiol 2019; 59:178-184. [PMID: 30818125 DOI: 10.1016/j.canep.2019.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The childhood peak of brain tumors suggests that early-life exposures might have a role in their etiology. Hence, we examined in the Greek National Registry for Childhood Hematological Malignancies and Solid tumors (NARECHEM-ST) whether perinatal and early-life risk factors influence the risk of childhood brain tumors. METHODS In a nationwide case-control study, we included 203 cases (0-14 years) with a diagnosis of brain tumor in NARECHEM-ST (2010-2016) and 406 age-, sex-, and center-matched hospital controls. Information was collected via interviews with the guardians and we analyzed the variables of interest in multivariable conditional logistic regression models. RESULTS Instrument-assisted delivery was associated with higher (OR: 7.82, 95%CI: 2.18-28.03), whereas caesarean delivery with lower (OR: 0.67, 95%CI: 0.45-0.99) risk of childhood brain tumors, as compared to spontaneous vaginal delivery. Maternal alcohol consumption during pregnancy (OR: 2.35, 95%CI: 1.45-3.81) and history of living in a farm (OR: 4.98, 2.40-10.32) increased the odds of childhood brain tumors. Conversely, higher birth order was associated with lower risk (OR for 2nd vs. 1st child: 0.60, 95%CI: 0.40-0.89 and OR for 3rd vs. 1st: 0.34, 95%CI: 0.18-0.63). Birth weight, gestational age, parental age, history of infertility, smoking during pregnancy, allergic diseases, and maternal diseases during pregnancy showed no significant associations. CONCLUSIONS Perinatal and early-life risk factors, and specifically indicators of brain trauma, exposure to toxic agents and immune system maturation, might be involved in the pathogenesis of childhood brain tumors. Larger studies should aim to replicate our findings and examine associations with tumor subtypes.
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Affiliation(s)
- Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Papadakis
- Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Athanasios Tragiannidis
- Second Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel Hatzipantelis
- Second Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Maria Moschovi
- Haematology-Oncology Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | - Sophia Polychronopoulou
- Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Spyridon Sgouros
- Department of Neurosurgery, "Mitera" Childrens Hospital, Athens, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, University Hospital of Heraklion, Heraklion, Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden.
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12
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The Pathophysiology of Post-Traumatic Glioma. Int J Mol Sci 2018; 19:ijms19082445. [PMID: 30126222 PMCID: PMC6121393 DOI: 10.3390/ijms19082445] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/27/2022] Open
Abstract
Malignant glioma is a brain tumor with a very high mortality rate resulting from the specific morphology of its infiltrative growth and poor early detection rates. The causes of one of its very specific types, i.e., post-traumatic glioma, have been discussed for many years, with some studies providing evidence for mechanisms where the reaction to an injury may in some cases lead to the onset of carcinogenesis in the brain. In this review of the available literature, we discuss the consequences of breaking the blood–brain barrier and consequences of the influx of immune-system cells to the site of injury. We also analyze the influence of inflammatory mediators on the expression of genes controlling the process of apoptosis and the effect of chemical mutagenic factors on glial cells in the brain. We present the results of experimental studies indicating a relationship between injury and glioma development. However, epidemiological studies on post-traumatic glioma, of which only a few confirm the conclusions of experimental research, indicate that any potential relationship between injury and glioma, if any, is indirect.
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13
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Ferenczi EA, Saadi A, Bhattacharyya S, Berkowitz AL. Glioblastoma arising within sites of encephalomalacia from cerebrovascular insult: two cases and a review of the literature. J Clin Neurosci 2018; 50:110-115. [PMID: 29422364 DOI: 10.1016/j.jocn.2018.01.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/08/2018] [Indexed: 12/31/2022]
Abstract
Glioblastoma is the most common primary parenchymal brain malignancy, with median survival of less than one year. While there are likely multiple predisposing genetic and environmental factors in glioblastoma formation, chronic inflammation resulting from non-traumatic vascular brain injury is one proposed risk factor for oncogenesis. Here, we report two instances of glioblastoma arising within areas of encephalomalacia caused by remote vascular insults (one following aneurysmal subarachnoid hemorrhage and one following ischemic infarction), review the literature associating glioblastoma with prior brain injury, and discuss potential mechanisms for malignant transformation in injured brain tissue.
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Affiliation(s)
- Emily A Ferenczi
- Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Altaf Saadi
- National Clinical Scholars Program, University of California Los Angeles, 10940 Wilshire Blvd, Los Angeles, CA 90045, USA
| | - Shamik Bhattacharyya
- Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Aaron L Berkowitz
- Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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14
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Tyagi V, Theobald J, Barger J, Bustoros M, Bayin NS, Modrek AS, Kader M, Anderer EG, Donahue B, Fatterpekar G, Placantonakis DG. Traumatic brain injury and subsequent glioblastoma development: Review of the literature and case reports. Surg Neurol Int 2016; 7:78. [PMID: 27625888 PMCID: PMC5009580 DOI: 10.4103/2152-7806.189296] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/28/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Previous reports have proposed an association between traumatic brain injury (TBI) and subsequent glioblastoma (GBM) formation. METHODS We used literature searches and radiographic evidence from two patients to assess the possibility of a link between TBI and GBM. RESULTS Epidemiological studies are equivocal on a possible link between brain trauma and increased risk of malignant glioma formation. We present two case reports of patients with GBM arising at the site of prior brain injury. CONCLUSION The hypothesis that TBI may predispose to gliomagenesis is disputed by several large-scale epidemiological studies, but supported by some. Radiographic evidence from two cases presented here suggest that GBM formed at the site of brain injury. We propose a putative pathogenesis model that connects post-traumatic inflammation, stem and progenitor cell transformation, and gliomagenesis.
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Affiliation(s)
- Vineet Tyagi
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Jason Theobald
- Department of Neurosurgery, NYU School of Medicine, Brooklyn, New York, USA
| | - James Barger
- Department of Neurosurgery, NYU School of Medicine, Brooklyn, New York, USA
| | - Mark Bustoros
- Department of Neurosurgery, NYU School of Medicine, Brooklyn, New York, USA
| | - N Sumru Bayin
- Department of Neurosurgery, NYU School of Medicine, Brooklyn, New York, USA; Kimmel Center for Stem Cell Biology, NYU School of Medicine, Brooklyn, New York, USA
| | - Aram S Modrek
- Department of Neurosurgery, NYU School of Medicine, Brooklyn, New York, USA
| | - Michael Kader
- Department of Neurosurgery, NYU School of Medicine, Brooklyn, New York, USA
| | - Erich G Anderer
- Division of Neurosurgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Bernadine Donahue
- Department of Radiation Oncology, NYU School of Medicine, Brooklyn, New York, USA; Maimonides Cancer Center, Brooklyn, New York, USA
| | - Girish Fatterpekar
- Department of Radiology, NYU School of Medicine, Brooklyn, New York, USA
| | - Dimitris G Placantonakis
- Department of Neurosurgery, NYU School of Medicine, Brooklyn, New York, USA; Kimmel Center for Stem Cell Biology, NYU School of Medicine, Brooklyn, New York, USA; Brain Tumor Center, NYU School of Medicine, Brooklyn, New York, USA
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