Research Papers: Pathology:
Combination genetic signature stratifies lower-grade gliomas better than histological grade
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Aden Ka-Yin Chan1,2,*, Yu Yao4,*, Zhenyu Zhang4, Zhifeng Shi4, Liang Chen4, Nellie Yuk-Fei Chung1,2, Joseph Shu-Ming Liu1,2, Kay Ka-Wai Li1,2, Danny Tat-Ming Chan3, Wai Sang Poon3, Ying Wang5, Liangfu Zhou4, Ho-Keung Ng1,2
1Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Shatin, Hong Kong
2Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
3Neurosurgery Division, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong
4Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
5Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai, China
*These authors have contributed equally to this work
Ho-Keung Ng, e-mail: firstname.lastname@example.org
Liangfu Zhou, e-mail: email@example.com
Keywords: Pathology Section, glioma, IDH1/2, 1p/19q, TERT, EGFR
Received: April 17, 2015 Accepted: July 30, 2015 Published: August 11, 2015
We studied if combination genetic signature potentially stratifies lower-grade gliomas better than histology by investigating 214 lower-grade gliomas for IDH1/2 and TERTp mutations, 1p/19q codeletion and EGFR amplification as to their impact on prognostication. Prognostic association of grading was independent of other prognostic variables including age, histological type, IDH1/2, 1p/19q and TERTp status. No single marker, including IDH1/2, superseded grading in prognostication, indicating grading was still a very important tool. Prognosis was most favorable in 31.7% of patients with IDH1/2 mutation and either 1p/19q codeletion or TERTp mutation (IDHmut-OT), intermediate in 45.8% of patients with IDH1/2 mutation only (IDHmut) and 16.9% of patients without any of the alterations (IDHwt), and poorest in 5.6% of patients with wild-type IDH1/2 and either TERTp mutation or EGFR amplification (IDHwt-ET). Our results suggested not all IDH1/2 wild-type lower-grade gliomas are aggressive and additional biomarkers are required to identify glioblastoma-equivalent tumors. Multivariate analysis revealed independent prognostic values of grading and genetic signature. Grade II IDHwt-ET gliomas exhibited shorter survival than IDH1/2 mutated grade III gliomas, suggesting combination genetic signature potentially superseded grading in prognostication. In summary, biomarker-based stratification is useful in the diagnosis and prognostication of lower-grade gliomas, and should be used together with grading.
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