1
|
Liu Z, Xu X, Zhang W, Zhang L, Wen M, Gao J, Yang J, Kan Y, Yang X, Wen Z, Chen S, Cao X. A fusion model integrating magnetic resonance imaging radiomics and deep learning features for predicting alpha-thalassemia X-linked intellectual disability mutation status in isocitrate dehydrogenase-mutant high-grade astrocytoma: a multicenter study. Quant Imaging Med Surg 2024; 14:251-263. [PMID: 38223098 PMCID: PMC10784047 DOI: 10.21037/qims-23-807] [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: 06/05/2023] [Accepted: 10/24/2023] [Indexed: 01/16/2024]
Abstract
Background The mutational status of alpha-thalassemia X-linked intellectual disability (ATRX) is an important indicator for the treatment and prognosis of high-grade gliomas, but reliable ATRX testing currently requires invasive procedures. The objective of this study was to develop a clinical trait-imaging fusion model that combines preoperative magnetic resonance imaging (MRI) radiomics and deep learning (DL) features with clinical variables to predict ATRX status in isocitrate dehydrogenase (IDH)-mutant high-grade astrocytoma. Methods A total of 234 patients with IDH-mutant high-grade astrocytoma (120 ATRX mutant type, 114 ATRX wild type) from 3 centers were retrospectively analyzed. Radiomics and DL features from different regions (edema, tumor, and the overall lesion) were extracted to construct multiple imaging models by combining different features in different regions for predicting ATRX status. An optimal imaging model was then selected, and its features and linear coefficients were used to calculate an imaging score. Finally, a fusion model was developed by combining the imaging score and clinical variables. The performance and application value of the fusion model were evaluated through the comparison of receiver operating characteristic curves, the construction of a nomogram, calibration curves, decision curves, and clinical application curves. Results The overall hybrid model constructed with radiomics and DL features from the overall lesion was identified as the optimal imaging model. The fusion model showed the best prediction performance with an area under curve of 0.969 in the training set, 0.956 in the validation set, and 0.949 in the test set as compared to the optimal imaging model (0.966, 0.916, and 0.936, respectively) and clinical model (0.677, 0.641, 0.772, respectively). Conclusions The clinical trait-imaging fusion model based on preoperative MRI could effectively predict the ATRX mutation status of individuals with IDH-mutant high-grade astrocytoma and has the potential to help patients through the development of a more effective treatment strategy before treatment.
Collapse
Affiliation(s)
- Zhi Liu
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xinyi Xu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wang Zhang
- College of Computer & Information Science, Southwest University, Chongqing, China
| | - Liqiang Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming Wen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jueni Gao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Yang
- Department of Endocrinology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yubo Kan
- School of Medical and Life Sciences Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xing Yang
- Department of Radiology, Chongqing United Medical Imaging Center, Chongqing, China
| | - Zhipeng Wen
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shanxiong Chen
- College of Computer & Information Science, Southwest University, Chongqing, China
| | - Xu Cao
- School of Medical and Life Sciences Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
2
|
Gong X, Kuang S, Deng D, Wu J, Zhang L, Liu C. Differences in survival prognosticators between children and adults with H3K27M-mutant diffuse midline glioma. CNS Neurosci Ther 2023; 29:3863-3875. [PMID: 37311690 PMCID: PMC10651973 DOI: 10.1111/cns.14307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS H3K27M-mutant diffuse midline glioma (DMG) is a rare and aggressive central nervous system tumor. The biological behavior, clinicopathological characteristics, and prognostic factors of DMG have not yet been completely uncovered, especially in adult patients. This study aims to investigate the clinicopathological characteristics and identify prognostic factors of H3K27M-mutant DMG in pediatric and adult patients, respectively. METHODS A total of 171 patients with H3K27M-mutant DMG were included in the study. The clinicopathological characteristics of the patients were analyzed and stratified based on age. The Cox proportional hazard model was used to determine the independent prognostic factors in pediatric and adult subgroups. RESULTS The median overall survival (OS) for the entire cohort was 9.0 months. Significant differences were found in some clinicopathological characteristics between children and adults. The median OS was also significantly different between the pediatric and adult subgroups, with 7.1 months for children and 12.3 months for adults (p < 0.001). In the overall population, the multivariate analysis identified adult patients, single lesion, concurrent chemoradiotherapy/radiotherapy, and intact ATRX expression as independent favorable prognostic factors. In the age-stratified subgroups, the prognostic factors varied between children and adults, with intact ATRX expression and single lesion being independent favorable prognostic factors in adults, while infratentorial localization was significantly associated with worse prognosis in children. CONCLUSIONS The differences in clinicopathological features and prognostic factors between pediatric and adult patients with H3K27M-mutant DMG suggest the need for further clinical and molecular stratification based on age.
Collapse
Affiliation(s)
- Xuan Gong
- Departments of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaChina
| | - Shuwen Kuang
- Departments of OncologyXiangya Hospital, Central South UniversityChangshaChina
| | - Dongfeng Deng
- Departments of OncologyXiangya Hospital, Central South UniversityChangshaChina
| | - Jun Wu
- Departments of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Longbo Zhang
- Departments of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Chao Liu
- National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaChina
- Departments of OncologyXiangya Hospital, Central South UniversityChangshaChina
| |
Collapse
|
3
|
Yoda RA, Cimino PJ. Classification and Grading of Central Nervous System Tumors According to the World Health Organization 5th Edition. Semin Neurol 2023; 43:833-844. [PMID: 37949117 DOI: 10.1055/s-0043-1776793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The World Health Organization (WHO) released the 5th edition of its classification of central nervous system (CNS) tumors in 2021. Advances in the landscape of molecular tumor pathophysiology prompted major revisions to the previous edition released in 2016, some of which were first introduced by the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy-Not Official WHO (cIMPACT-NOW). The 2021 classification system integrates newly gained molecular insights to guide changes in tumor taxonomy and nomenclature, introduces several new types of tumors, and expands the use of molecular testing for diagnosis and grading, with a particular impact on adult-type and pediatric-type gliomas, ependymomas, and embryonal tumors. These updates aim to promote clear and accurate diagnoses, yield more reliable prognostic information, and enable the selection of optimal therapies. Familiarity with these changes will be of great importance for clinicians involved in the management of CNS tumor patients.
Collapse
Affiliation(s)
- Rebecca A Yoda
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Patrick J Cimino
- Neuropathology Unit, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
4
|
Kumari K, Dandapath I, Singh J, Rai HIS, Kaur K, Jha P, Malik N, Chosdol K, Mallick S, Garg A, Suri A, Sharma MC, Sarkar C, Suri V. Molecular Characterization of IDH Wild-type Diffuse Astrocytomas: The Potential of cIMPACT-NOW Guidelines. Appl Immunohistochem Mol Morphol 2022; 30:410-417. [PMID: 35708480 DOI: 10.1097/pai.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
IDH wild-type (wt) grade 2/3 astrocytomas are a heterogenous group of tumors with disparate clinical and molecular profiles. cIMPACT-NOW recommendations incorporated in the new 2021 World Health Organization (WHO) Classification of Central Nervous System (CNS) Tumors urge minimal molecular criteria to identify a subset that has an aggressive clinical course similar to IDH -wt glioblastomas (GBMs). This paper describes the use of a panel of molecular markers to reclassify IDH -wt grade 2/3 diffuse astrocytic gliomas (DAGs) and study median overall survival concerning for to IDH -wt GBMs in the Indian cohort. IDH -wt astrocytic gliomas (grades 2, 3, and 4) confirmed by IDHR132H immunohistochemistry and IDH1/2 gene sequencing, 1p/19q non-codeleted with no H3F3A mutations were included. TERT promoter mutation by Sanger sequencing, epidermal growth factor receptor amplification, and whole chromosome 7 gain and chromosome 10 loss by fluorescence in situ hybridization was assessed and findings correlated with clinical and demographic profiles. The molecular profile of 53 IDH -wt DAGs (grade 2: 31, grade 3: 22) was analyzed. Eleven cases (grade 2: 8, grade 3: 3) (20.75%) were reclassified as IDH -wt GBMs, WHO grade 4 ( TERT promoter mutation in 17%, epidermal growth factor receptor amplification in 5.5%, and whole chromosome 7 gain and chromosome 10 loss in 2%). Molecular GBMs were predominantly frontal (54.5%) with a mean age of 36 years and median overall survival equivalent to IDH -wt GBMs (18 vs. 19 mo; P =0.235). Among grade 2/3 DAGs not harboring these alterations, significantly better survival was observed for grade 2 versus grade 3 DAGs (25 vs. 16 mo; P =0.002). Through the incorporation of a panel of molecular markers, a subset of IDH -wt grade 2 DAGs can be stratified into molecular grade 4 tumors with prognostic and therapeutic implications. However, IDH -wt grade 3 DAGs behave like GBMs irrespective of molecular profile.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ajay Garg
- Neuroradiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | | | | | | |
Collapse
|
5
|
Pladevall-Morera D, Castejón-Griñán M, Aguilera P, Gaardahl K, Ingham A, Brosnan-Cashman JA, Meeker AK, Lopez-Contreras AJ. ATRX-Deficient High-Grade Glioma Cells Exhibit Increased Sensitivity to RTK and PDGFR Inhibitors. Cancers (Basel) 2022; 14:cancers14071790. [PMID: 35406561 PMCID: PMC8997088 DOI: 10.3390/cancers14071790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
High-grade glioma, including anaplastic astrocytoma and glioblastoma (GBM) patients, have a poor prognosis due to the lack of effective treatments. Therefore, the development of new therapeutic strategies to treat these gliomas is urgently required. Given that high-grade gliomas frequently harbor mutations in the SNF2 family chromatin remodeler ATRX, we performed a screen to identify FDA-approved drugs that are toxic to ATRX-deficient cells. Our findings reveal that multi-targeted receptor tyrosine kinase (RTK) and platelet-derived growth factor receptor (PDGFR) inhibitors cause higher cellular toxicity in high-grade glioma ATRX-deficient cells. Furthermore, we demonstrate that a combinatorial treatment of RTKi with temozolomide (TMZ)-the current standard of care treatment for GBM patients-causes pronounced toxicity in ATRX-deficient high-grade glioma cells. Our findings suggest that combinatorial treatments with TMZ and RTKi may increase the therapeutic window of opportunity in patients who suffer high-grade gliomas with ATRX mutations. Thus, we recommend incorporating the ATRX status into the analyses of clinical trials with RTKi and PDGFRi.
Collapse
Affiliation(s)
- David Pladevall-Morera
- Department of Cellular and Molecular Medicine, DNRF Center for Chromosome Stability and Center for Healthy Aging, University of Copenhagen, 2200 Copenhagen, Denmark; (D.P.-M.); (M.C.-G.); (P.A.); (K.G.); (A.I.)
| | - María Castejón-Griñán
- Department of Cellular and Molecular Medicine, DNRF Center for Chromosome Stability and Center for Healthy Aging, University of Copenhagen, 2200 Copenhagen, Denmark; (D.P.-M.); (M.C.-G.); (P.A.); (K.G.); (A.I.)
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Sevilla, Universidad Pablo de Olavide, 41013 Seville, Spain
| | - Paula Aguilera
- Department of Cellular and Molecular Medicine, DNRF Center for Chromosome Stability and Center for Healthy Aging, University of Copenhagen, 2200 Copenhagen, Denmark; (D.P.-M.); (M.C.-G.); (P.A.); (K.G.); (A.I.)
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Sevilla, Universidad Pablo de Olavide, 41013 Seville, Spain
| | - Karina Gaardahl
- Department of Cellular and Molecular Medicine, DNRF Center for Chromosome Stability and Center for Healthy Aging, University of Copenhagen, 2200 Copenhagen, Denmark; (D.P.-M.); (M.C.-G.); (P.A.); (K.G.); (A.I.)
| | - Andreas Ingham
- Department of Cellular and Molecular Medicine, DNRF Center for Chromosome Stability and Center for Healthy Aging, University of Copenhagen, 2200 Copenhagen, Denmark; (D.P.-M.); (M.C.-G.); (P.A.); (K.G.); (A.I.)
| | - Jacqueline A. Brosnan-Cashman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (J.A.B.-C.); (A.K.M.)
| | - Alan K. Meeker
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (J.A.B.-C.); (A.K.M.)
| | - Andres J. Lopez-Contreras
- Department of Cellular and Molecular Medicine, DNRF Center for Chromosome Stability and Center for Healthy Aging, University of Copenhagen, 2200 Copenhagen, Denmark; (D.P.-M.); (M.C.-G.); (P.A.); (K.G.); (A.I.)
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Sevilla, Universidad Pablo de Olavide, 41013 Seville, Spain
- Correspondence:
| |
Collapse
|
6
|
Morgan KM, Danish S, Xiong Z. Diffuse astrocytoma with mosaic IDH1-R132H-mutant immuno-phenotype and low subclonal allele frequency. Intractable Rare Dis Res 2022; 11:43-45. [PMID: 35261853 PMCID: PMC8898389 DOI: 10.5582/irdr.2022.01019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
Abstract
Molecular alterations found in gliomas are now considered entity-defining features. The World Health Organization (WHO) classification system currently classifies the vast majority of gliomas utilizing an integrated genotype-phenotype approach. We present a case of diffuse astrocytoma with a mosaic isocitrate dehydrogenase (IDH)1-R132H-mutant immunophenotype and low subclonal allele frequency. A 35-year-old patient with a history of IDH1-R132H mutated diffuse astrocytoma in 20014 presented to the hospital again in 2019. MRI examination showed a non-enhancing abnormal signal in the periphery of her previous surgical cavity. Histopathological examination revealed that the tumor was hypercellular and without high grade histopathological features. The neoplastic cells were immunohistologically positive for GFAP, Olig2, and ATRX. However, only some scattered tumor cells were positive for IDH1-R132H. Cytogenetic studies revealed a lack of chromosomal 1p/19q co-deletion. Further next-generation sequencing (NGS) demonstrated a low-level IDH1-R132H mutation and allele frequency. Based on these findings, the diagnosis of diffuse astrocytoma with mosaic IDH1- R132H-mutant immunophenotype and low subclonal allele frequency (WHO grade II) was generated. This case indicates that gliomas may have heterogeneous molecular profile and the intra-tumoral molecular heterogeneity highlights the need to further characterize the molecular profile for glioma classification and clinical management.
Collapse
Affiliation(s)
- Katherine M. Morgan
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Shabbar Danish
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Zhenggang Xiong
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Address correspondence to:Zhenggang Xiong, Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, LMB, Suite 110, 234 Goodman Street, Cincinnati, OH 45219, USA. E-mail:
| |
Collapse
|
7
|
Carlos-Escalante JA, Gómez-Flores-Ramos L, Bian X, Perdomo-Pantoja A, de Andrade KC, Mejía-Pérez SI, Cacho-Díaz B, González-Barrios R, Reynoso-Noverón N, Soto-Reyes E, Sánchez-Correa TE, Guerra-Calderas L, Yan C, Chen Q, Castro-Hernández C, Vidal-Millán S, Taja-Chayeb L, Gutiérrez O, Álvarez-Gómez RM, Gómez-Amador JL, Ostrosky-Wegman P, Mohar-Betancourt A, Herrera-Montalvo LA, Corona T, Meerzaman D, Wegman-Ostrosky T. Landscape of Germline Genetic Variants in AGT, MGMT, and TP53 in Mexican Adult Patients with Astrocytoma. Cell Mol Neurobiol 2021; 41:1285-1297. [PMID: 32535722 DOI: 10.1007/s10571-020-00901-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/06/2020] [Indexed: 12/20/2022]
Abstract
Astrocytoma is the most common type of primary brain tumor. The risk factors for astrocytoma are poorly understood; however, germline genetic variants account for 25% of the risk of developing gliomas. In this study, we assessed the risk of astrocytoma associated with variants in AGT, known by its role in angiogenesis, TP53, a well-known tumor suppressor and the DNA repair gene MGMT in a Mexican population. A case-control study was performed in 49 adult Mexican patients with grade II-IV astrocytoma. Sequencing of exons and untranslated regions of AGT, MGMT, and TP53 from was carried in an Ion Torrent platform. Individuals with Mexican Ancestry from the 1000 Genomes Project were used as controls. Variants found in our cohort were then assessed in a The Cancer Genome Atlas astrocytoma pan-ethnic validation cohort. Variants rs1926723 located in AGT (OR 2.74, 1.40-5.36 95% CI), rs7896488 in MGMT (OR 3.43, 1.17-10.10 95% CI), and rs4968187 in TP53 (OR 2.48, 1.26-4.88 95% CI) were significantly associated with the risk of astrocytoma after multiple-testing correction. This is the first study where the AGT rs1926723 variant, TP53 rs4968187, and MGMT rs7896488 were found to be associated with the risk of developing an astrocytoma.
Collapse
Affiliation(s)
| | | | - Xiaopeng Bian
- Computational Genomics and Bioinformatics Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, NIH, Rockville, MD, 20850, USA
| | | | - Kelvin César de Andrade
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, 20850, USA
| | - Sonia Iliana Mejía-Pérez
- Departamento de Enseñanza, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", 13269, Mexico City, Mexico
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", 14269, Mexico City, Mexico
| | - Bernardo Cacho-Díaz
- Unidad de Neurociencia, Instituto Nacional de Cancerología, 14080, Mexico City, Mexico
| | | | - Nancy Reynoso-Noverón
- Dirección de Investigación, Instituto Nacional de Cancerología, 14080, Mexico City, Mexico
| | - Ernesto Soto-Reyes
- Departamento de Ciencias Naturales, Universidad Autónoma Metropolitana-Cuajimalpa, 05370, Mexico City, Mexico
| | - Thalía Estefanía Sánchez-Correa
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", 14269, Mexico City, Mexico
| | - Lissania Guerra-Calderas
- Departamento de Ciencias Naturales, Universidad Autónoma Metropolitana-Cuajimalpa, 05370, Mexico City, Mexico
| | - Chunhua Yan
- Computational Genomics and Bioinformatics Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, NIH, Rockville, MD, 20850, USA
| | - Qingrong Chen
- Computational Genomics and Bioinformatics Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, NIH, Rockville, MD, 20850, USA
| | - Clementina Castro-Hernández
- Unidad de Epidemiología E Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, UNAM-INCAN, 14080, Mexico City, Mexico
| | - Silvia Vidal-Millán
- Clínica de Cáncer Hereditario, Instituto Nacional de Cancerología, 14080, Mexico City, Mexico
| | - Lucía Taja-Chayeb
- Dirección de Investigación, Instituto Nacional de Cancerología, 14080, Mexico City, Mexico
| | - Olga Gutiérrez
- Dirección de Investigación, Instituto Nacional de Cancerología, 14080, Mexico City, Mexico
| | | | - Juan Luis Gómez-Amador
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", 14269, Mexico City, Mexico
| | - Patricia Ostrosky-Wegman
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, 04510, Mexico City, Mexico
| | - Alejandro Mohar-Betancourt
- Unidad de Epidemiología E Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, UNAM-INCAN, 14080, Mexico City, Mexico
| | - Luis Alonso Herrera-Montalvo
- Unidad de Epidemiología E Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, UNAM-INCAN, 14080, Mexico City, Mexico
- Dirección General, Instituto Nacional de Medicina Genómica, 14610, Mexico City, Mexico
| | - Teresa Corona
- Laboratorio Clínico de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez", 14269, Mexico City, Mexico
| | - Daoud Meerzaman
- Computational Genomics and Bioinformatics Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, NIH, Rockville, MD, 20850, USA
| | - Talia Wegman-Ostrosky
- Dirección de Investigación, Instituto Nacional de Cancerología, 14080, Mexico City, Mexico.
| |
Collapse
|
8
|
Yao J, Wang L, Ge H, Yin H, Piao Y. Diffuse midline glioma with H3 K27M mutation of the spinal cord: A series of 33 cases. Neuropathology 2021; 41:183-190. [PMID: 33599007 DOI: 10.1111/neup.12714] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 12/23/2022]
Abstract
We investigated the risk factors for diffuse midline gliomas of the spinal cord (DMGSCs). Seventy patients with spinal cord gliomas in two hospitals were analyzed retrospectively. Sixty-nine patients that underwent surgery achieved partial or gross total removal. The patients were subdivided into some groups, based on age, WHO grade, tumor location within the cord, tumor size, and molecular profile: immunohistochemical expression of p53 and ATRX, and mutational status of Histone 3 (H3), and BRAF. Thirty-three patients had an H3 K27M mutation (47%). Some clinical characteristics were significantly different between H3 K27M mutant and H3 wild-type tumors. The main risk factors for DMGSCs were male sex, glioblastomas, and ≤ 2 spinal cord segments. The median survival period of patients with H3 K27M mutant tumors was significantly shorter than those with H3 wild-type tumors (17.0 ± 3.7 months vs censored, P < 0.0001). In the DMGSC subgroup, patients with thoracic cord tumors had a significantly better prognosis than those with cervical cord tumors (31.0 ± 6.0 vs 10.0 ± 4.8 months). Patients > 45 years of age survived significantly longer than patients < 19 years (P = 0.001). In conclusion, H3 K27M mutation significantly predicts a worse outcome of spinal cord gliomas. Anatomical location and age are the main risk factors for DMGSCs.
Collapse
Affiliation(s)
- Jingjing Yao
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Leiming Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haijing Ge
- Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hongfang Yin
- Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yueshan Piao
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
9
|
Becker AP, Sells BE, Haque SJ, Chakravarti A. Tumor Heterogeneity in Glioblastomas: From Light Microscopy to Molecular Pathology. Cancers (Basel) 2021; 13:761. [PMID: 33673104 PMCID: PMC7918815 DOI: 10.3390/cancers13040761] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/24/2022] Open
Abstract
One of the main reasons for the aggressive behavior of glioblastoma (GBM) is its intrinsic intra-tumor heterogeneity, characterized by the presence of clonal and subclonal differentiated tumor cell populations, glioma stem cells, and components of the tumor microenvironment, which affect multiple hallmark cellular functions in cancer. "Tumor Heterogeneity" usually encompasses both inter-tumor heterogeneity (population-level differences); and intra-tumor heterogeneity (differences within individual tumors). Tumor heterogeneity may be assessed in a single time point (spatial heterogeneity) or along the clinical evolution of GBM (longitudinal heterogeneity). Molecular methods may detect clonal and subclonal alterations to describe tumor evolution, even when samples from multiple areas are collected in the same time point (spatial-temporal heterogeneity). In GBM, although the inter-tumor mutational landscape is relatively homogeneous, intra-tumor heterogeneity is a striking feature of this tumor. In this review, we will address briefly the inter-tumor heterogeneity of the CNS tumors that yielded the current glioma classification. Next, we will take a deeper dive in the intra-tumor heterogeneity of GBMs, which directly affects prognosis and response to treatment. Our approach aims to follow technological developments, allowing for characterization of intra-tumor heterogeneity, beginning with differences on histomorphology of GBM and ending with molecular alterations observed at single-cell level.
Collapse
Affiliation(s)
- Aline P. Becker
- Comprehensive Cancer Center, Ohio State University, Columbus, OH 43210, USA; (S.J.H.); (A.C.)
| | | | - S. Jaharul Haque
- Comprehensive Cancer Center, Ohio State University, Columbus, OH 43210, USA; (S.J.H.); (A.C.)
| | - Arnab Chakravarti
- Comprehensive Cancer Center, Ohio State University, Columbus, OH 43210, USA; (S.J.H.); (A.C.)
| |
Collapse
|
10
|
Burford C, Laxton R, Sidhu Z, Aizpurua M, King A, Bodi I, Ashkan K, Al-Sarraj S. ATRX immunohistochemistry can help refine 'not elsewhere classified' categorisation for grade II/III gliomas. Br J Neurosurg 2019; 33:536-540. [PMID: 31018710 DOI: 10.1080/02688697.2019.1600657] [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] [Indexed: 02/05/2023]
Abstract
Purpose: The 2016 WHO tumour classification highlights the role of IDH1/2 gene mutation and 1p/19q co-deletion in classifying grade II/III gliomas. A recent cIMPACT-NOW update proposes the use of the term 'Not Elsewhere Classified' (NEC) for IDH-mutant, non co-deleted tumours. Here we show how the incorporation of ATRX immunohistochemistry can be used to better delineate the NEC group. Methods: Clinical data was collected for 112 patients (59% male) treated at our unit. Mutations in IDH1/2 genes were detected by pyrosequencing or immunohistochemistry, 1p/19q co-deletion was assessed with fluorescence in situ hybridisation and ATRX status was determined using immunohistochemical techniques. Tumours were grouped on the basis of molecular markers and outcomes compared. Results: The mean age of diagnosis was 42.6 years (20-73 years). There were 88 oligodendrogliomas (II = 47, III = 41), 18 diffuse astrocytomas (II = 9, III = 9) and 6 oligoastrocytomas (II = 4, III = 2). The majority of gliomas (87.5%) had mutations in IDH1/2. 1p/19q co-deletion was significantly associated with oligodendroglial morphology (p = < 0.001) and was mutually exclusive with ATRX mutation. Classification on the basis of molecular information showed a significant different in survival between the groups. Conclusions: ATRX immunohistochemisty is a useful adjunct which can be used with IDH mutation status, 1p/19q co-deletion and histological findings to further define tumour groups. More work is needed to understand the molecular profiles and prognostic implications for non co-deletion, ATRX preserved cases.
Collapse
Affiliation(s)
- C Burford
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London , London , UK
| | - R Laxton
- Department of Neuropathology, King's College Hospital , London , UK
| | - Z Sidhu
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London , London , UK
| | - M Aizpurua
- Department of Neuropathology, King's College Hospital , London , UK
| | - A King
- Department of Neuropathology, King's College Hospital , London , UK
| | - I Bodi
- Department of Neuropathology, King's College Hospital , London , UK
| | - K Ashkan
- Department of Neurosurgery, King's College Hospital , London , UK
| | - S Al-Sarraj
- Department of Neuropathology, King's College Hospital , London , UK
| |
Collapse
|
11
|
Aberrant ATRX protein expression is associated with poor overall survival in NF1-MPNST. Oncotarget 2018; 9:23018-23028. [PMID: 29796169 PMCID: PMC5955415 DOI: 10.18632/oncotarget.25195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/06/2018] [Indexed: 12/14/2022] Open
Abstract
Malignant Peripheral Nerve Sheath Tumors (MPNSTs) are aggressive soft tissue sarcomas that can occur sporadically or in the setting of the Neurofibromatosis type 1 (NF1) cancer predisposition syndrome. These tumors carry a dismal overall survival. Previous work in our lab had identified ATRX chromatin remodeler (ATRX), previously termed, Alpha Thalassemia/Mental Retardation Syndrome X Linked as a gene mutated in a subset of MPNSTs. Given the great need for novel biomarkers and therapeutic targets for MPNSTs, we sought to determine the expression of ATRX in a larger subset of sporadic and NF1 associated MPNSTs (NF1-MPNSTs). We performed immunohistochemistry (IHC) on 74 MPNSTs (43 NF1-associated and 31 sporadic), 21 plexiform neurofibromas, and 9 atypical neurofibromas. Using this approach, we have demonstrated that 58% (43/74) of MPNSTs have aberrant ATRX expression (<80% nuclear expression) compared to only 7% (2/30) of benign (plexiform and atypical) neurofibromas. Second, we demonstrated that 65% (28/43) of NF1-MPNSTs displayed aberrant ATRX expression as did 48% (15/31) of sporadic MPNSTs. Finally, we show that aberrant ATRX expression was associated with a significantly decreased overall survival for patients with NF1-MPNST (median OS of 17.9 months for aberrant expression and median OS not met (>120 months) for intact expression, p = 0.0276). In summary, we demonstrate that ATRX is aberrantly expressed in the majority of NF1-MPNSTs, but not plexiform or atypical neurofibromas. Additionally, aberrant ATRX expression is associated with decreased overall survival in NF1-MPNST, but not sporadic MPNST and may serve as a prognostic marker for patients with NF1-MPNST.
Collapse
|
12
|
Immunohistochemical ATRX expression is not a surrogate for 1p19q codeletion. Brain Tumor Pathol 2018; 35:106-113. [DOI: 10.1007/s10014-018-0312-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
|
13
|
Li Y, Liu X, Qian Z, Sun Z, Xu K, Wang K, Fan X, Zhang Z, Li S, Wang Y, Jiang T. Genotype prediction of ATRX mutation in lower-grade gliomas using an MRI radiomics signature. Eur Radiol 2018; 28:2960-2968. [DOI: 10.1007/s00330-017-5267-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/25/2017] [Accepted: 12/20/2017] [Indexed: 12/24/2022]
|
14
|
Nandakumar P, Mansouri A, Das S. The Role of ATRX in Glioma Biology. Front Oncol 2017; 7:236. [PMID: 29034211 PMCID: PMC5626857 DOI: 10.3389/fonc.2017.00236] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/14/2017] [Indexed: 02/03/2023] Open
Abstract
The current World Health Organization classification of CNS tumors has made a tremendous leap from past editions by incorporating molecular criteria in addition to the pre-existing histological parameters. The revised version has had a particular impact on the classification of diffuse low-grade gliomas and their high-grade variants. The ATRX status is one of the critical markers that define the molecular classification of gliomas. In this review, we will first provide an overview of the role of ATRX in regular cell biology. Furthermore, the role of ATRX in tumorigenesis, specifically gliomas, is comprehensively elucidated. The possible correlation of ATRX status with other genetic/epigenetic modifications is also presented. We conclude by discussing some of the challenges associated with incorporating ATRX status assessment into routine clinical practice while also exploring opportunities for future diagnostics/therapeutics in gliomas based on ATRX status.
Collapse
Affiliation(s)
- Pravanya Nandakumar
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Alireza Mansouri
- Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States.,Division of Neuro-Oncology, Johns Hopkins University, Baltimore, MD, United States
| | - Sunit Das
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumour Centre, Hospital for Sick Kids, University of Toronto, Toronto, ON, Canada
| |
Collapse
|