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Kinslow CJ, Rae A, Kumar P, Grinband J, Gill BJA, McKhann GM, Sisti MB, Bruce JN, Canoll P, Iwamoto F, Yu JB, Kachnic LA, Cheng SK, Wang TJC. MGMT Promoter Methylation Predicts Survival in 1p19q-Codeleted Gliomas after Chemotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e117. [PMID: 37784660 DOI: 10.1016/j.ijrobp.2023.06.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MGMT promoter methylation (mMGMT) is predictive of response to alkylating chemotherapy in glioblastomas and used to guide treatment decisions. However, the role of MGMT promoter status in low-grade and anaplastic gliomas remains unclear due to molecular heterogeneity and the lack of sufficiently large datasets. We recently found that MGMT promoter methylation predicts progression-free survival in 1p19q-codeleted gliomas after alkylating chemotherapy in a meta-analysis of three prospective cohorts. There were not enough deaths to determine the effect on overall survival. Here, we query a large national database to determine the association between MGMT promoter methylation and overall survival in patients with 1p19q-codeleted gliomas. MATERIALS/METHODS We identified all patients with newly diagnosed gliomas in the National Cancer Database (NCDB) from 2010-2016 with 1p19q-codeletion and information on MGMT promoter methylation status. The cohort was stratified based on receipt of chemotherapy. Multivariable Cox proportional hazards regression modeling was used to assess the effect of MGMT promoter methylation status on overall survival after adjusting for age, sex, race, co-morbidity, grade, extent of resection, chemotherapy, and radiotherapy. RESULTS We identified 530 eligible patients, 373 (70.4%) of whom received chemotherapy in their initial course of treatment. The MGMT promoter was methylated in 400 (75.5%) patients. For all patients, unmethylated MGMT (uMGMT) was associated with poorer survival compared to mMGMT (75% survival time [75%ST] 45 months vs. not reached, P = .003, adjusted hazard ratio [aHR] 2.36 [95% confidence interval (95% CI) 1.53-3.62]). uMGMT was associated with poorer survival in patients who received chemotherapy (75%ST 22 vs. 66 months, P<.001, aHR 2.55 [95% CI 1.60-4.06]) but not in patients who did not receive chemotherapy (75%ST 110 months vs. not reached, P = 0.7, HR 1.24 [95% CI 0.40-3.81]). CONCLUSION To our knowledge, this is the first study to demonstrate an association between overall survival and MGMT promoter status in 1p19q-codeleted gliomas. MGMT promoter status should be used as a stratification factor in future clinical trials of 1p19q-codeleted gliomas that use overall survival as an endpoint.
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Affiliation(s)
- C J Kinslow
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - A Rae
- Oregon Health & Sciences University, Portland, OR
| | - P Kumar
- Columbia University, New York, NY
| | - J Grinband
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | | | - G M McKhann
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY
| | - M B Sisti
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY
| | - J N Bruce
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY
| | - P Canoll
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | | | - J B Yu
- Saint Francis Radiation Oncology, Hartford, CT
| | | | - S K Cheng
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
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Bowden SG, Gill BJA, Englander ZK, Horenstein CI, Zanazzi G, Chang PD, Samanamud J, Lignelli A, Bruce JN, Canoll P, Grinband J. Local Glioma Cells Are Associated with Vascular Dysregulation. AJNR Am J Neuroradiol 2018; 39:507-514. [PMID: 29371254 DOI: 10.3174/ajnr.a5526] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 11/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Malignant glioma is a highly infiltrative malignancy that causes variable disruptions to the structure and function of the cerebrovasculature. While many of these structural disruptions have known correlative histopathologic alterations, the mechanisms underlying vascular dysfunction identified by resting-state blood oxygen level-dependent imaging are not yet known. The purpose of this study was to characterize the alterations that correlate with a blood oxygen level-dependent biomarker of vascular dysregulation. MATERIALS AND METHODS Thirty-two stereotactically localized biopsies were obtained from contrast-enhancing (n = 16) and nonenhancing (n = 16) regions during open surgical resection of malignant glioma in 17 patients. Preoperative resting-state blood oxygen level-dependent fMRI was used to evaluate the relationships between radiographic and histopathologic characteristics. Signal intensity for a blood oxygen level-dependent biomarker was compared with scores of tumor infiltration and microvascular proliferation as well as total cell and neuronal density. RESULTS Biopsies corresponded to a range of blood oxygen level-dependent signals, ranging from relatively normal (z = -4.79) to markedly abnormal (z = 8.84). Total cell density was directly related to blood oxygen level-dependent signal abnormality (P = .013, R2 = 0.19), while the neuronal labeling index was inversely related to blood oxygen level-dependent signal abnormality (P = .016, R2 = 0.21). The blood oxygen level-dependent signal abnormality was also related to tumor infiltration (P = .014) and microvascular proliferation (P = .045). CONCLUSIONS The relationship between local, neoplastic characteristics and a blood oxygen level-dependent biomarker of vascular function suggests that local effects of glioma cell infiltration contribute to vascular dysregulation.
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Affiliation(s)
- S G Bowden
- From the Department of Neurological Surgery (S.G.B.), Oregon Health & Science University, Portland, Oregon.,The Gabriele Bartoli Brain Tumor Research Laboratory (S.G.B., B.J.A.G., Z.K.E., J.S., J.N.B., P.C.)
| | - B J A Gill
- The Gabriele Bartoli Brain Tumor Research Laboratory (S.G.B., B.J.A.G., Z.K.E., J.S., J.N.B., P.C.).,Departments of Neurological Surgery (B.J.A.G., Z.K.E., J.N.B., P.C.)
| | - Z K Englander
- The Gabriele Bartoli Brain Tumor Research Laboratory (S.G.B., B.J.A.G., Z.K.E., J.S., J.N.B., P.C.).,Departments of Neurological Surgery (B.J.A.G., Z.K.E., J.N.B., P.C.)
| | - C I Horenstein
- Department of Radiology (C.I.H.), North Shore University Hospital, Long Island, New York
| | - G Zanazzi
- Pathology and Cell Biology (G.Z., P.C.)
| | - P D Chang
- Department of Radiology (P.D.C.), University of California, San Francisco, California
| | - J Samanamud
- The Gabriele Bartoli Brain Tumor Research Laboratory (S.G.B., B.J.A.G., Z.K.E., J.S., J.N.B., P.C.)
| | - A Lignelli
- Radiology (A.L., J.G.), Columbia University Medical Center, New York, New York
| | - J N Bruce
- The Gabriele Bartoli Brain Tumor Research Laboratory (S.G.B., B.J.A.G., Z.K.E., J.S., J.N.B., P.C.).,Departments of Neurological Surgery (B.J.A.G., Z.K.E., J.N.B., P.C.)
| | - P Canoll
- The Gabriele Bartoli Brain Tumor Research Laboratory (S.G.B., B.J.A.G., Z.K.E., J.S., J.N.B., P.C.).,Departments of Neurological Surgery (B.J.A.G., Z.K.E., J.N.B., P.C.).,Pathology and Cell Biology (G.Z., P.C.)
| | - J Grinband
- Radiology (A.L., J.G.), Columbia University Medical Center, New York, New York
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Chang PD, Malone HR, Bowden SG, Chow DS, Gill BJA, Ung TH, Samanamud J, Englander ZK, Sonabend AM, Sheth SA, McKhann GM, Sisti MB, Schwartz LH, Lignelli A, Grinband J, Bruce JN, Canoll P. A Multiparametric Model for Mapping Cellularity in Glioblastoma Using Radiographically Localized Biopsies. AJNR Am J Neuroradiol 2017; 38:890-898. [PMID: 28255030 DOI: 10.3174/ajnr.a5112] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 12/09/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The complex MR imaging appearance of glioblastoma is a function of underlying histopathologic heterogeneity. A better understanding of these correlations, particularly the influence of infiltrating glioma cells and vasogenic edema on T2 and diffusivity signal in nonenhancing areas, has important implications in the management of these patients. With localized biopsies, the objective of this study was to generate a model capable of predicting cellularity at each voxel within an entire tumor volume as a function of signal intensity, thus providing a means of quantifying tumor infiltration into surrounding brain tissue. MATERIALS AND METHODS Ninety-one localized biopsies were obtained from 36 patients with glioblastoma. Signal intensities corresponding to these samples were derived from T1-postcontrast subtraction, T2-FLAIR, and ADC sequences by using an automated coregistration algorithm. Cell density was calculated for each specimen by using an automated cell-counting algorithm. Signal intensity was plotted against cell density for each MR image. RESULTS T2-FLAIR (r = -0.61) and ADC (r = -0.63) sequences were inversely correlated with cell density. T1-postcontrast (r = 0.69) subtraction was directly correlated with cell density. Combining these relationships yielded a multiparametric model with improved correlation (r = 0.74), suggesting that each sequence offers different and complementary information. CONCLUSIONS Using localized biopsies, we have generated a model that illustrates a quantitative and significant relationship between MR signal and cell density. Projecting this relationship over the entire tumor volume allows mapping of the intratumoral heterogeneity in both the contrast-enhancing tumor core and nonenhancing margins of glioblastoma and may be used to guide extended surgical resection, localized biopsies, and radiation field mapping.
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Affiliation(s)
- P D Chang
- From the Departments of Radiology (P.D.C., L.H.S., A.L., J.G.)
| | - H R Malone
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.).,Gabriele Bartoli Brain Tumor Laboratory and the Irving Cancer Research Center (H.R.M., S.G.B., B.J.A.G., T.H.U., J.S., Z.K.E., A.M.S., J.N.B., P.C.), New York, New York
| | - S G Bowden
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.).,Gabriele Bartoli Brain Tumor Laboratory and the Irving Cancer Research Center (H.R.M., S.G.B., B.J.A.G., T.H.U., J.S., Z.K.E., A.M.S., J.N.B., P.C.), New York, New York
| | - D S Chow
- Department of Radiology (D.S.C.), University of San Francisco School of Medicine, San Francisco, California
| | - B J A Gill
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.).,Gabriele Bartoli Brain Tumor Laboratory and the Irving Cancer Research Center (H.R.M., S.G.B., B.J.A.G., T.H.U., J.S., Z.K.E., A.M.S., J.N.B., P.C.), New York, New York
| | - T H Ung
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.).,Gabriele Bartoli Brain Tumor Laboratory and the Irving Cancer Research Center (H.R.M., S.G.B., B.J.A.G., T.H.U., J.S., Z.K.E., A.M.S., J.N.B., P.C.), New York, New York
| | - J Samanamud
- Gabriele Bartoli Brain Tumor Laboratory and the Irving Cancer Research Center (H.R.M., S.G.B., B.J.A.G., T.H.U., J.S., Z.K.E., A.M.S., J.N.B., P.C.), New York, New York
| | - Z K Englander
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.).,Gabriele Bartoli Brain Tumor Laboratory and the Irving Cancer Research Center (H.R.M., S.G.B., B.J.A.G., T.H.U., J.S., Z.K.E., A.M.S., J.N.B., P.C.), New York, New York
| | - A M Sonabend
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.).,Gabriele Bartoli Brain Tumor Laboratory and the Irving Cancer Research Center (H.R.M., S.G.B., B.J.A.G., T.H.U., J.S., Z.K.E., A.M.S., J.N.B., P.C.), New York, New York
| | - S A Sheth
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.)
| | - G M McKhann
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.)
| | - M B Sisti
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.)
| | - L H Schwartz
- From the Departments of Radiology (P.D.C., L.H.S., A.L., J.G.)
| | - A Lignelli
- From the Departments of Radiology (P.D.C., L.H.S., A.L., J.G.)
| | - J Grinband
- From the Departments of Radiology (P.D.C., L.H.S., A.L., J.G.)
| | - J N Bruce
- Neurological Surgery (H.R.M., S.G.B., B.J.A.G., T.H.U., Z.K.E., A.M.S., S.A.S., G.M.M., M.B.S., J.N.B.) .,Gabriele Bartoli Brain Tumor Laboratory and the Irving Cancer Research Center (H.R.M., S.G.B., B.J.A.G., T.H.U., J.S., Z.K.E., A.M.S., J.N.B., P.C.), New York, New York
| | - P Canoll
- Pathology and Cell Biology (P.C.), College of Physicians and Surgeons at Columbia University, New York, New York .,Gabriele Bartoli Brain Tumor Laboratory and the Irving Cancer Research Center (H.R.M., S.G.B., B.J.A.G., T.H.U., J.S., Z.K.E., A.M.S., J.N.B., P.C.), New York, New York
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