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Targeted detection of genetic alterations reveal the prognostic impact of H3K27M and MAPK pathway aberrations in paediatric thalamic glioma.
- Source :
-
Acta neuropathologica communications [Acta Neuropathol Commun] 2016 Aug 31; Vol. 4 (1), pp. 93. Date of Electronic Publication: 2016 Aug 31. - Publication Year :
- 2016
-
Abstract
- Paediatric brain tumours arising in the thalamus present significant diagnostic and therapeutic challenges to physicians due to their sensitive midline location. As such, genetic analysis for biomarkers to aid in the diagnosis, prognosis and treatment of these tumours is needed. Here, we identified 64 thalamic gliomas with clinical follow-up and characterized targeted genomic alterations using newly optimized droplet digital and NanoString-based assays. The median age at diagnosis was 9.25 years (range, 0.63-17.55) and median survival was 6.43 (range, 0.01-27.63) years. Our cohort contained 42 and 22 tumours reviewed as low and high grade gliomas, respectively. Five (12 %) low grade and 11 (50 %) high grade gliomas were positive for the H3F3A/HIST1H3B K27M (H3K27M) mutation. Kaplan-Meier survival analysis revealed significantly worse overall survival for patients harbouring the H3K27M mutation versus H3F3A/HIST1H3B wild type (H3WT) samples (log-rank p < 0.0001) with a median survival of 1.02 vs. 9.12 years. Mitogen-activated protein kinase (MAPK) pathway activation via BRAF or FGFR1 hotspot mutations or fusion events were detected in 44 % of patients, and was associated with long-term survival in the absence of H3K27M (log-rank p < 0.0001). Multivariate analysis demonstrated H3K27M status and high grade histology to be the most significant independent predictors of poor overall survival with hazard ratios of 6.945 and 7.721 (p < 0.0001), respectively. In contrast, MAPK pathway activation is a predictor of favourable patient outcome, although not independent of other clinical factors. Importantly, we show that low grade malignancies may harbour H3K27M mutations and that these tumours show a dismal survival compared to low grade H3WT cases. Our data strongly supports the inclusion of targeted genetic testing in childhood thalamic tumours to most accurately stratify patients into appropriate risk groups.
- Subjects :
- Adolescent
Biomarkers, Tumor genetics
Brain Neoplasms pathology
Brain Neoplasms surgery
Child
Child, Preschool
Female
Follow-Up Studies
Glioma pathology
Glioma surgery
Humans
Infant
Kaplan-Meier Estimate
Male
Multivariate Analysis
Mutation
Neoplasm Grading
Prognosis
Proportional Hazards Models
Brain Neoplasms genetics
Glioma genetics
MAP Kinase Signaling System genetics
Thalamus pathology
Thalamus surgery
Subjects
Details
- Language :
- English
- ISSN :
- 2051-5960
- Volume :
- 4
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Acta neuropathologica communications
- Publication Type :
- Academic Journal
- Accession number :
- 27577993
- Full Text :
- https://doi.org/10.1186/s40478-016-0353-0