Novel, improved grading system(s) for IDH-mutant astrocytic gliomas.

Details

Serval ID
serval:BIB_2EA465E71CB2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Novel, improved grading system(s) for IDH-mutant astrocytic gliomas.
Journal
Acta neuropathologica
Author(s)
Shirahata M., Ono T., Stichel D., Schrimpf D., Reuss D.E., Sahm F., Koelsche C., Wefers A., Reinhardt A., Huang K., Sievers P., Shimizu H., Nanjo H., Kobayashi Y., Miyake Y., Suzuki T., Adachi J.I., Mishima K., Sasaki A., Nishikawa R., Bewerunge-Hudler M., Ryzhova M., Absalyamova O., Golanov A., Sinn P., Platten M., Jungk C., Winkler F., Wick A., Hänggi D., Unterberg A., Pfister S.M., Jones DTW, van den Bent M., Hegi M., French P., Baumert B.G., Stupp R., Gorlia T., Weller M., Capper D., Korshunov A., Herold-Mende C., Wick W., Louis D.N., von Deimling A.
ISSN
1432-0533 (Electronic)
ISSN-L
0001-6322
Publication state
Published
Issued date
07/2018
Peer-reviewed
Oui
Volume
136
Number
1
Pages
153-166
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
According to the 2016 World Health Organization Classification of Tumors of the Central Nervous System (2016 CNS WHO), IDH-mutant astrocytic gliomas comprised WHO grade II diffuse astrocytoma, IDH-mutant (AII <sub>IDHmut</sub> ), WHO grade III anaplastic astrocytoma, IDH-mutant (AAIII <sub>IDHmut</sub> ), and WHO grade IV glioblastoma, IDH-mutant (GBM <sub>IDHmut</sub> ). Notably, IDH gene status has been made the major criterion for classification while the manner of grading has remained unchanged: it is based on histological criteria that arose from studies which antedated knowledge of the importance of IDH status in diffuse astrocytic tumor prognostic assessment. Several studies have now demonstrated that the anticipated differences in survival between the newly defined AII <sub>IDHmut</sub> and AAIII <sub>IDHmut</sub> have lost their significance. In contrast, GBM <sub>IDHmut</sub> still exhibits a significantly worse outcome than its lower grade IDH-mutant counterparts. To address the problem of establishing prognostically significant grading for IDH-mutant astrocytic gliomas in the IDH era, we undertook a comprehensive study that included assessment of histological and genetic approaches to prognosis in these tumors. A discovery cohort of 211 IDH-mutant astrocytic gliomas with an extended observation was subjected to histological review, image analysis, and DNA methylation studies. Tumor group-specific methylation profiles and copy number variation (CNV) profiles were established for all gliomas. Algorithms for automated CNV analysis were developed. All tumors exhibiting 1p/19q codeletion were excluded from the series. We developed algorithms for grading, based on molecular, morphological and clinical data. Performance of these algorithms was compared with that of WHO grading. Three independent cohorts of 108, 154 and 224 IDH-mutant astrocytic gliomas were used to validate this approach. In the discovery cohort several molecular and clinical parameters were of prognostic relevance. Most relevant for overall survival (OS) was CDKN2A/B homozygous deletion. Other parameters with major influence were necrosis and the total number of CNV. Proliferation as assessed by mitotic count, which is a key parameter in 2016 CNS WHO grading, was of only minor influence. Employing the parameters most relevant for OS in our discovery set, we developed two models for grading these tumors. These models performed significantly better than WHO grading in both the discovery and the validation sets. Our novel algorithms for grading IDH-mutant astrocytic gliomas overcome the challenges caused by introduction of IDH status into the WHO classification of diffuse astrocytic tumors. We propose that these revised approaches be used for grading of these tumors and incorporated into future WHO criteria.
Keywords
Adolescent, Adult, Aged, Algorithms, Astrocytoma/genetics, Astrocytoma/mortality, Astrocytoma/pathology, Brain Neoplasms/genetics, Brain Neoplasms/mortality, Brain Neoplasms/pathology, Cyclin-Dependent Kinase Inhibitor p16/genetics, Cyclin-Dependent Kinase Inhibitor p16/metabolism, Female, Gene Expression Regulation, Neoplastic/genetics, Humans, Isocitrate Dehydrogenase/genetics, Ki-67 Antigen/metabolism, Male, Middle Aged, Models, Biological, Mutation/genetics, Neoplasm Grading, Neoplasm Proteins/genetics, Neoplasm Proteins/metabolism, World Health Organization, Young Adult, Astrocytoma, CDKN2A/B, Glioblastoma, Grading, IDH
Pubmed
Web of science
Create date
08/05/2018 19:00
Last modification date
04/10/2019 5:08
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