Abstract
Glioblastoma is a highly aggressive tumour of the central nervous system, characterised by poor prognosis irrespective of the applied treatment. The aim of our study was to analyse whether the molecular markers of glioblastoma (i.e. TP53 and IDH1 mutations, CDKN2A deletion, EGFR amplification, chromosome 7 polysomy and EGFRvIII expression) could be associated with distinct prognosis and/or response to the therapy. Moreover, we describe a method which allows for a reliable, as well as time- and cost-effective, screening for EGFR amplification and chromosome 7 polysomy with quantitative Real-Time PCR at DNA level. In the clinical data, only the patient’s age had prognostic significance (continuous: HR = 1.04; p<0.01). At the molecular level, EGFRvIII expression was associated with a better prognosis (HR = 0.37; p = 0.04). Intriguingly, EGFR amplification was associated with a worse outcome in younger patients (HR = 3.75; p<0.01) and in patients treated with radiotherapy (HR = 2.71; p = 0.03). We did not observe any difference between the patients with the amplification treated with radiotherapy and the patients without such a treatment. Next, EGFR amplification was related to a better prognosis in combination with the homozygous CDKN2A deletion (HR = 0.12; p = 0.01), but to a poorer prognosis in combination with chromosome 7 polysomy (HR = 14.88; p = 0.01). Importantly, the results emphasise the necessity to distinguish both mechanisms of the increased EGFR gene copy number (amplification and polysomy). To conclude, although the data presented here require validation in different groups of patients, they strongly advocate the consideration of the patient’s tumour molecular characteristics in the selection of the therapy.
Highlights
Glioblastoma is the most common tumour of the central nervous system in adults with annual occurrence of about 3 per 100,000 population [1]
The molecular characteristics may be potentially informative with regards to the prognosis; no molecular marker has been unanimously validated in glioblastoma for that purpose
The aim of this article is to analyse the impact of several molecular alterations characteristic for glioblastoma (i.e. TP53 and IDH1 mutations, CDKN2A deletion, EGFR amplification, chromosome 7 polysomy and EGFRvIII expression) in patients treated with a neurosurgical operation and with or without the following therapy
Summary
Glioblastoma is the most common tumour of the central nervous system in adults with annual occurrence of about 3 per 100,000 population [1]. Taking into account the high heterogeneity of glioblastoma, it is reasonable to assume that certain molecular subtypes may be characterised by a different response to distinct therapies. To date, this has been shown only for the classical subtype (according to Verhaak’s classification) as well as for the MGMT promoter methylation in the temozolomide-based radio-chemotherapy [5,6]. The aim of this article is to analyse the impact of several molecular alterations characteristic for glioblastoma (i.e. TP53 and IDH1 mutations, CDKN2A deletion, EGFR amplification, chromosome 7 polysomy and EGFRvIII expression) in patients treated with a neurosurgical operation and with or without the following therapy (radiotherapy or radio-chemotherapy)
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