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The diverse landscape of histone-mutant pediatric high-grade gliomas: A narrative review 组蛋白突变的儿童高级别胶质瘤的多样性景观:叙述回顾
Pub Date : 2022-01-01 DOI: 10.4103/glioma.glioma_1_22
Evan Lubanszky, Cynthia Hawkins
Pediatric high-grade gliomas (pHGGs) are the leading cause of tumor-related death in children, with diffuse midline gliomas representing the worst prognoses. Despite decades of clinical trials, no effective treatment has been found, and we are in desperate need of novel therapeutics. The discovery of highly recurrent histone H3 mutations in pHGGs represents a major breakthrough in our understanding of tumor initiation and development. In this review, we summarize our current knowledge of the molecular pathology of these tumors, including their genomic/epigenetic alterations, mechanism of action, and partner mutations contributing to tumor progression.
儿童高级别胶质瘤(pHGGs)是儿童肿瘤相关死亡的主要原因,弥漫性中线胶质瘤预后最差。尽管经过数十年的临床试验,仍未发现有效的治疗方法,我们迫切需要新的治疗方法。pHGGs中高复发性组蛋白H3突变的发现代表了我们对肿瘤发生和发展的理解的重大突破。在这篇综述中,我们总结了我们目前对这些肿瘤的分子病理学的了解,包括它们的基因组/表观遗传改变,作用机制,以及促进肿瘤进展的伴侣突变。
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引用次数: 0
Tumor growth, angiogenesis, and invasion as clinical hallmarks of glioblastoma: A case report 肿瘤生长、血管生成和侵袭是胶质母细胞瘤的临床特征:1例报告
Pub Date : 2022-01-01 DOI: 10.4103/glioma.glioma_2_22
E. Wong
The clinical hallmarks of tumor growth, angiogenesis, and invasion were identified in a patient with isocitrate dehydrogenase-1 wild-type glioblastoma at initial diagnosis and management issues were examined. The head magnetic resonance imaging (MRI) showed multiple solid and cystic contrast enhancements in the rostral portion of the tumor located within the left motor gyrus and the adjacent brain. Extensive tumor invasion was noted along the left corticospinal tract extending into the cerebral peduncle and pons. After an open craniotomy for tissue biopsy, the patient underwent external beam radiotherapy and concomitant temozolomide, and his motor deficit was stabilized with concurrent bevacizumab infusion while dexamethasone was weaned off. After two cycles of adjuvant temozolomide, the patient experienced worsening motor deficit in the right hand. A repeat gadolinium-enhanced head MRI revealed increased fluid-attenuated inversion recovery hyperintensity in the left cerebral peduncle indicating tumor progression. This case illustrates the extensive invasion from a glioblastoma that cannot be adequately quantified or effectively treated. A wider margin of radiation may be needed to cover microscopic and infiltrative tumor cells. The early use of bevacizumab can also reverse neurological deficits and obviate the long-term use of dexamethasone and insulin in this patient. This study was approved by the Institutional Review Board at Dana Farber Cancer Institute #12-519 onMay 5, 2020.
在一名异柠檬酸脱氢酶-1野生型胶质母细胞瘤患者的初步诊断和治疗问题中,确定了肿瘤生长、血管生成和侵袭的临床特征。头部磁共振成像(MRI)显示,位于左运动回和邻近大脑内的肿瘤吻部有多处实体和囊性对比增强。肿瘤沿左侧皮质脊髓束广泛侵袭,延伸至脑脚和脑桥。在开颅组织活检后,患者接受了外照射放疗和替莫唑胺治疗,同时输注贝伐单抗稳定了他的运动功能障碍,同时停用地塞米松。在两个周期的辅助替莫唑酰胺治疗后,患者右手运动功能障碍恶化。重复钆增强的头部MRI显示,左侧大脑蒂的液体衰减反转恢复高信号增加,表明肿瘤进展。该病例说明了胶质母细胞瘤的广泛侵袭,无法充分量化或有效治疗。可能需要更宽的辐射范围来覆盖显微镜下和浸润性肿瘤细胞。贝伐单抗的早期使用也可以逆转该患者的神经功能缺陷,并避免长期使用地塞米松和胰岛素。这项研究于2020年5月5日由Dana Farber癌症研究所12-519的机构审查委员会批准。
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引用次数: 0
A novel nomogram based on DNA damage response-related gene expression in patients with O-6-methylguanine-DNA methyltransferase unmethylated glioblastoma receiving temozolomide chemotherapy: A population-based analysis 在接受替莫唑胺化疗的o -6-甲基鸟嘌呤-DNA甲基转移酶未甲基化胶质母细胞瘤患者中,基于DNA损伤反应相关基因表达的新nomogram:一项基于人群的分析
Pub Date : 2022-01-01 DOI: 10.4103/glioma.glioma_3_22
Rong Wang, Ying-peng Peng, Wei Wei, Yu-ling Zhou, Xiaonan Li, Yunfei Xia, Zhigang Liu
Background and Aim: Glioblastoma (GBM) is the most lethal primary brain tumor. Patients with unmethylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter have higher MGMT expression, are less sensitive to temozolomide (TMZ), and are linked to poor prognosis. The aim of this study was to identify patients from this population with a better prognosis, explore the molecular mechanism, and provide a theoretical basis for the formulation of treatment strategies. Materials and Methods: Prognostic genes involved in the DNA damage response (DDR) pathway were screened, and the risk score of each GBM patient undergoing TMZ chemotherapy from The Cancer Genome Atlas (TCGA) and Chinese Glioma Genome Atlas (CGGA) database was calculated. A comprehensive prognostic nomogram model was constructed by combining the risk score and other clinical features. Results: Two DDR-related genes (replication factor C subunit 2 [RFC2] and methyl-CpG binding domain 4, DNA glycosylase [MBD4]) were identified as having a prognostic value in GBM patients with unmethylated MGMT promoter. Patients were classified into high- and low-risk groups using the risk score based on the expression of these two genes. The median overall survival of patients in the low-risk group was significantly longer than that recorded in the high-risk group in the TCGA cohort (15.95 vs. 11.90 months, respectively, P = 0.027) and CGGA cohort (25.90 vs. 11.87 months, respectively, P = 0.0082). The expression of those two genes was confirmed in tissue samples, and the risk scoring model showed that their prognostic value was independent of other clinical characteristics (P = 0.032), such as age. A final nomogram model was constructed, and its good performance was validated (concordance-index = 0.6656). Conclusions: A comprehensive prognostic model for patients with MGMT unmethylated GBM receiving TMZ chemotherapy was constructed using RFC2 and MBD4 gene expression, age, sex, and isocitrate dehydrogenase. The model showed good performance.
背景与目的:胶质母细胞瘤(GBM)是最致命的原发性脑肿瘤。未甲基化的o -6-甲基鸟嘌呤- dna甲基转移酶(MGMT)启动子患者MGMT表达较高,对替莫唑胺(TMZ)不敏感,预后较差。本研究旨在从这一人群中发现预后较好的患者,探讨其分子机制,为制定治疗策略提供理论依据。材料与方法:筛选与DNA损伤反应(DDR)通路相关的预后基因,从肿瘤基因组图谱(TCGA)和中国胶质瘤基因组图谱(CGGA)数据库中计算每位GBM患者TMZ化疗的风险评分。结合风险评分及其他临床特征,构建综合预后nomogram模型。结果:两个ddr相关基因(复制因子C亚基2 [RFC2]和甲基- cpg结合结构域4,DNA糖基化酶[MBD4])在MGMT启动子未甲基化的GBM患者中具有预后价值。根据这两种基因的表达进行风险评分,将患者分为高危组和低危组。在TCGA队列中,低危组患者的中位总生存期(15.95个月比11.90个月,P = 0.027)和CGGA队列中(25.90个月比11.87个月,P = 0.0082)显著高于高危组。在组织样本中证实了这两个基因的表达,风险评分模型显示它们的预后价值与年龄等其他临床特征无关(P = 0.032)。构建了最终的nomogram模型,并验证了模型的良好性能(concorance -index = 0.6656)。结论:结合RFC2、MBD4基因表达、年龄、性别、异柠檬酸脱氢酶等因素,构建了MGMT未甲基化GBM患者接受TMZ化疗的综合预后模型。该模型具有良好的性能。
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引用次数: 0
Glioma stem cells and their microenvironment: A narrative review on docking and transformation 胶质瘤干细胞及其微环境:对接与转化综述
Pub Date : 2022-01-01 DOI: 10.4103/glioma.glioma_5_22
Wenyu Zhu, Hua Chen, Ke Yan, Jie Wu, Yao-dong Zhao, Qiang Huang
Significant new progress was made 10 years ago in the hypothesis that neuroglial cells, neural stem cells, and glioma stem cells (GSCs) depend on the tumor microenvironment (TME) transformation: (1) Because GSCs also have heterogeneity, they are a state, not an entity. (2) The importance of the border niche among many tumor niches is emphasized because it is a shelter for tumor resistance to radiotherapy and chemotherapy. (3) The plasticity of GSCs and TME cells allows TME cells to become GSC-initiating cells. (4) Future development will entail a close interaction between high-throughput molecular biology and artificial intelligence. In this review, we summarize recent advances in GSCs and their microenvironment from the following three aspects: the constantly updated of concept of stem cells, the concept of TME and niche, and the plasticity of GSCs and TME cells.
10年前,神经胶质细胞、神经干细胞和神经胶质瘤干细胞(GSC)依赖于肿瘤微环境(TME)转化的假设取得了重大的新进展:(1)由于GSC也具有异质性,它们是一种状态,而不是一个实体。(2) 在许多肿瘤小生境中,边界小生境的重要性得到了强调,因为它是肿瘤对放疗和化疗耐药性的避难所。(3) GSCs和TME细胞的可塑性使TME细胞成为GSC启动细胞。(4) 未来的发展将需要高通量分子生物学和人工智能之间的密切互动。本文从干细胞概念的不断更新、TME和小生境的概念以及GSCs和TME细胞的可塑性三个方面综述了GSCs及其微环境的最新进展。
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引用次数: 0
New changes in pathological diagnosis of brain tumors in the modern molecular era 现代分子时代脑肿瘤病理诊断的新变化
Pub Date : 2022-01-01 DOI: 10.4103/glioma.glioma_7_22
Zhi Li
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引用次数: 1
Initial report of a clinical trial evaluating the safety and efficiency of neoadjuvant camrelizumab and apatinib in patients with recurrent high-grade gliomas: A prospective, phase II, single-arm study 评估新辅助camrelizumab和apatinib在复发性高级别胶质瘤患者中的安全性和有效性的临床试验的初步报告:一项前瞻性II期单臂研究
Pub Date : 2022-01-01 DOI: 10.4103/glioma.glioma_6_22
Fu-Hua Lin, C. Guo, Qunying Yang, Yinsheng Chen, Chao Ke, K. Sai, Ji Zhang, Xiaobing Jiang, Wanming Hu, S. Xi, Jian Zhou, Depei Li, Zhihuan Zhou, Qinqin Zhao, X. Cao, Zhongyan Chen
Background and Aim: High-grade glioma is the most common malignant primary brain tumor in the central nervous system. Multiple strategies such as surgery, radiotherapy, and chemotherapy have been used, but the prognosis of patients with high-grade glioma remains poor. No standard treatment exists for recurrent gliomas; however, combination therapies of programmed cell death protein 1 blockades with antiangiogenic agents have demonstrated promising effects in different solid tumors. Therefore, since the end of 2020, a clinical trial designed to evaluate the safety and efficiency of neoadjuvant therapy using camrelizumab and apatinib in patients with recurrent high-grade gliomas has been carried out in our institution. Methods/Design: In this prospective, Phase II, single-arm study, patients with recurrent high-grade gliomas will receive single-dose intravenous injection of camrelizumab (200 mg) and daily oral administration of apatinib (250 mg/day for 7 days) 14 days before reoperation for tumor resection. Sequential therapy will begin 2 weeks after surgery with the biweekly injection of camrelizumab and 4 weeks after surgery with the daily administration of apatinib. Treatment of camrelizumab and apatinib will be continued until disease progression or unacceptable toxicity or death. The primary outcome measure will be the median overall survival rate. Secondary outcome measures will include progression-free survival rate at 6 months and at 12 months and other measures. The trial is planned to enroll 30 patients. This study was approved by the Ethics Committee of Sun Yat-sen University Cancer Center (Guangzhou, China; approval No. SL-B2020-149-01) on July 27, 2020. Results and Conclusions: Although an evaluation is still impossible to be conducted yet, 11 patients had been enrolled by the end of January 2022. Some patients have shown a promising outcome. These preliminary data suggest that this study would be worthwhile. We hope that this study will provide scientific evidence to better care of patients with recurrent high-grade glioma. Trial registration: This study was registered with ClinicalTrials.gov under identifier NCT04588987 on October 19, 2020.
背景与目的:高级别胶质瘤是中枢神经系统最常见的恶性原发性脑肿瘤。已经使用了多种策略,如手术、放疗和化疗,但高级别胶质瘤患者的预后仍然很差。复发性胶质瘤没有标准的治疗方法;然而,程序性细胞死亡蛋白1阻断剂与抗血管生成剂的联合治疗已在不同的实体瘤中显示出有希望的效果。因此,自2020年底以来,我们机构开展了一项临床试验,旨在评估卡雷珠单抗和阿帕替尼新辅助治疗复发性高级别胶质瘤患者的安全性和有效性。方法/设计:在这项前瞻性II期单臂研究中,复发性高级别胶质瘤患者将在肿瘤切除术再次手术前14天接受单剂量静脉注射卡雷珠单抗(200 mg)和每日口服阿帕替尼(250 mg/天,持续7天)。顺序治疗将在术后2周开始,每两周注射一次卡雷珠单抗,术后4周开始,每天给药阿帕替尼。卡雷利珠单抗和阿帕替尼的治疗将持续到疾病进展或不可接受的毒性或死亡。主要的结果衡量标准是中位总生存率。次要结果指标包括6个月和12个月的无进展生存率以及其他指标。该试验计划招募30名患者。本研究于2020年7月27日经中山大学癌症中心伦理委员会批准(中国广州;批准号:slB2020-149-01)。结果和结论:尽管仍无法进行评估,但截至2022年1月底,已有11名患者入选。一些患者已经显示出有希望的结果。这些初步数据表明,这项研究是值得的。我们希望这项研究能为更好地护理复发性高级别胶质瘤患者提供科学依据。试验注册:本研究于2020年10月19日在ClinicalTrials.gov注册,标识符为NCT04588987。
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引用次数: 0
Germline predisposition to glial neoplasms in children and young adults: A narrative review 儿童和年轻人神经胶质肿瘤的种系易感性:叙述性综述
Pub Date : 2021-10-01 DOI: 10.4103/glioma.glioma_12_21
Anirban Das, C. Hawkins, U. Tabori
Gliomas are the most common malignancies of the central nervous system (CNS). A significant proportion of both low- and high-grade gliomas in children, adolescents, and young adults have specific genetic events which can be traced to the germline. Despite integration of genomic findings in recent CNS tumor classifications, germline origins of these genetic events are seldom highlighted. These cancer predisposition syndromes can predispose the individual and family members to multiple cancers in different organs beyond the CNS and to other non-oncologic manifestations caused by the genetic dysfunction. Recent molecular discoveries and careful surveillance have resulted in improved survival and reduced morbidity for many of these conditions. Importantly, identifying a genetic predisposition can alter treatment of the existing malignancy, by mandating the use of a different protocol, targeted therapy, or other novel therapies. Hence, prompt diagnosis is sometimes crucial for these young patients. High index of suspicion and early referral to genetic testing and counseling are important and may be beneficial to these families. In this review, we discuss the clinical manifestations, genetics, tumor management, and surveillance in these patients. These provide insights into the complex mechanisms in glioma-genesis that can impact the treatment and survival for these patients and families in the future.
神经胶质瘤是中枢神经系统最常见的恶性肿瘤。在儿童、青少年和年轻人中,有相当比例的低级别和高级别胶质瘤具有可追溯到种系的特定遗传事件。尽管在最近的中枢神经系统肿瘤分类中整合了基因组学的发现,但这些遗传事件的种系起源很少得到强调。这些癌症易感综合征可使个体和家庭成员易患除中枢神经系统外的不同器官的多种癌症,并易患由遗传功能障碍引起的其他非肿瘤表现。最近的分子发现和仔细的监测导致许多这些疾病的生存率提高和发病率降低。重要的是,通过强制使用不同的方案、靶向治疗或其他新疗法,确定遗传易感性可以改变现有恶性肿瘤的治疗方法。因此,及时诊断有时对这些年轻患者至关重要。高怀疑指数和早期转介到基因检测和咨询是重要的,可能有利于这些家庭。在这篇综述中,我们讨论了这些患者的临床表现,遗传学,肿瘤管理和监测。这些为胶质瘤发生的复杂机制提供了见解,可以影响这些患者和家庭未来的治疗和生存。
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引用次数: 1
The new WHO molecular criteria for adult glioblastoma – Are we a step too far? 世卫组织成人胶质母细胞瘤的新分子标准——我们是否走得太远了?
Pub Date : 2021-10-01 DOI: 10.4103/glioma.glioma_19_21
H. Ng, Q. Wong, Emma Liu, K. Li
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引用次数: 2
Molecular and clinical correlates of medulloblastoma subgroups: A narrative review 髓母细胞瘤亚群的分子和临床相关性:一篇叙述性综述
Pub Date : 2021-10-01 DOI: 10.4103/glioma.glioma_18_21
Hallie Coltin, V. Ramaswamy
Medulloblastoma is a major cause of cancer-related morbidity and mortality in children, as a significant proportion of patients succumb to their disease and most survivors are left with life-long sequelae of therapy. Prior medulloblastoma classification systems relied heavily on histology and failed to account for tumor biology. The upcoming 2021 WHO classification of central nervous system tumors now firmly establishes that medulloblastoma actually comprises at least four distinct molecular entities, with considerable substructure within each group. For the first time, the study design of contemporary clinical trials has now recognized the molecular heterogeneity of medulloblastoma. The incorporation of routine molecular subgrouping into upcoming clinical trials has the potential to significantly improve survival and quality of life for children and adults diagnosed with medulloblastoma. This review was conducted to summarize these recent advances in the genomics of medulloblastoma and to summarize the timely results of molecularly-informed published clinical trials. Specifically, English language literature will be reviewed in addition to the results of SJMB03, ACNS0331, and ACNS0332.
髓母细胞瘤是儿童癌症相关发病率和死亡率的主要原因,因为相当大比例的患者死于疾病,大多数幸存者都会留下终身的治疗后遗症。以前的髓母细胞瘤分类系统严重依赖组织学,未能考虑肿瘤生物学。即将于2021年世界卫生组织对中枢神经系统肿瘤进行的分类现在坚定地表明,髓母细胞瘤实际上包括至少四个不同的分子实体,每组中都有相当多的亚结构。当代临床试验的研究设计首次认识到髓母细胞瘤的分子异质性。将常规分子亚组纳入即将进行的临床试验有可能显著提高被诊断为髓母细胞瘤的儿童和成人的生存率和生活质量。本综述旨在总结髓母细胞瘤基因组学的最新进展,并总结已发表的分子知情临床试验的及时结果。具体而言,除了SJMB03、ACNS0331和ACNS0332的结果外,还将审查英语文献。
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引用次数: 1
Pediatric posterior fossa ependymoma and metabolism: A narrative review 儿童后窝室管膜瘤与代谢:一篇叙述性综述
Pub Date : 2021-10-01 DOI: 10.4103/glioma.glioma_17_21
Katharine E. Halligan, Antony Kulandaimanuvel, Andy Cruz, James Felker, Craig Daniels, Michael Taylor, S. Agnihotri
Ependymomas are a lethal central nervous system (CNS) tumor found in both adults and children. Recent efforts have focused on risk stratification by classifying the molecular variants of CNS ependymoma. Despite this increased knowledge of molecular drivers, much less is known about the metabolism of these subgroups. Disruption of cellular metabolism can drive the transition of normal neuronal cells to tumor cells. A shift from anaerobic to aerobic metabolism as the primary energy source is a hallmark of cancer, promoting cancer cell proliferation, and avoidance of cellular apoptotic cues. This review aims to discuss the current knowledge regarding metabolism in ependymoma cells compared to normal brain cells and the implications of metabolic changes with regard to tumorigenesis, the tumor microenvironment, and possible targets for treatment.
室管膜瘤是一种致命的中枢神经系统(CNS)肿瘤,在成人和儿童中都有发现。最近的研究重点是通过分类中枢神经系统室管膜瘤的分子变异来进行风险分层。尽管对分子驱动的了解有所增加,但对这些亚群的代谢知之甚少。细胞代谢的破坏可以驱动正常神经元细胞向肿瘤细胞的转变。从无氧代谢到有氧代谢作为主要能量来源的转变是癌症的一个标志,促进癌细胞增殖,并避免细胞凋亡的提示。这篇综述旨在讨论目前关于室管膜瘤细胞与正常脑细胞代谢的知识,以及代谢变化对肿瘤发生、肿瘤微环境和可能的治疗靶点的影响。
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引用次数: 0
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Glioma
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