Abstract
Pilocytic astrocytoma (PA) is the most common glioma in the pediatric population. PAs can exhibit variable behavior that does not always correlate with location. Although oncogenic rearrangements of the BRAF gene have recently been described in PAs, it is not clear whether such alterations have an impact on outcome. An institutional cohort of 147 PAs (118 with outcome data) from both cerebellar and non-cerebellar locations (spine, diencephalon, midbrain, brainstem, and cortex) was utilized in this study. Parameters included quantification of characteristic morphologic variables as well as genes and molecular loci previously shown to be of relevance in high-grade gliomas, including 1p, 9p, 10q, 17p, 19q, and BRAF. Neither 1p, 9p, and 10q nor 19q showed significant association with outcome in PAs, although p16 deletion was more common in PAs of the midbrain, brainstem, and spinal cord. Loss of heterozygosity on 17p13 correlated with increased risk of recurrence in cerebellar tumors. BRAF gene rearrangements were more common in cerebellar tumors than non-cerebellar tumors and associated with classic biphasic histology in the cerebellum. However, clinical outcome was independent of BRAF status. The molecular biology of PAs differs according to location, yet BRAF rearrangements do not appear to produce PAs with different behavior. Nevertheless, such tumors may have altered sensitivity to pathway-specific adjuvant therapy. Additionally, deletion on 17p13 may be an adverse prognostic biomarker in cerebellar tumors.
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Adjei AA, Cohen RB, Franklin W et al (2008) Phase I pharmacokinetic and pharmacodynamic study of the oral, small-molecule mitogen-activated protein kinase kinase 1/2 inhibitor AZD6244 (ARRY-142886) in patients with advanced cancers. J Clin Oncol 26(13):2139–2146
Agamanolis DP, Malone JM (1995) Chromosomal abnormalities in 47 pediatric brain tumors. Cancer Genet Cytogenet 81(2):125–134
Bar EE, Lin A, Tihan T, Burger PC, Eberhart CG (2008) Frequent gains at chromosome 7q34 involving BRAF in pilocytic astrocytoma. J Neuropathol Exp Neurol 67(9):878–887
Bhattacharjee MB, Armstrong DD, Vogel H, Cooley LD (1997) Cytogenetic analysis of 120 primary pediatric brain tumors and literature review. Cancer Genet Cytogenet 97(1):39–53
Blumenschein GR Jr, Gatzemeier U, Fossella F et al (2009) Phase II, multicenter, uncontrolled trial of single-agent sorafenib in patients with relapsed or refractory, advanced non-small-cell lung cancer. J Clin Oncol 27(26):4274–4280
Campbell JW, Pollack IF (1996) Cerebellar astrocytomas in children. J Neurooncol 28(2–3):223–231
Cheng Y, Pang JC, Ng HK et al (2000) Pilocytic astrocytomas do not show most of the genetic changes commonly seen in diffuse astrocytomas. Histopathology 37(5):437–444
Ciampi R, Knauf JA, Kerler R et al (2005) Oncogenic AKAP9-BRAF fusion is a novel mechanism of MAPK pathway activation in thyroid cancer. J Clin Invest 115(1):94–101
Dirven CM, Mooij JJ, Molenaar WM (1997) Cerebellar pilocytic astrocytoma: a treatment protocol based upon analysis of 73 cases and a review of the literature. Childs Nerv Syst 13(1):17–23
Due-Tonnessen BJ, Helseth E, Scheie D, Skullerud K, Aamodt G, Lundar T (2002) Long-term outcome after resection of benign cerebellar astrocytomas in children and young adults (0–19 years): report of 110 consecutive cases. Pediatr Neurosurg 37(2):71–80
Elisei R, Ugolini C, Viola D et al (2008) BRAF(V600E) mutation and outcome of patients with papillary thyroid carcinoma: a 15-year median follow-up study. J Clin Endocrinol Metab 93(10):3943–3949
Fecher LA, Cummings SD, Keefe MJ, Alani RM (2007) Toward a molecular classification of melanoma. J Clin Oncol 25(12):1606–1620
Fernandez C, Figarella-Branger D, Girard N et al (2003) Pilocytic astrocytomas in children: prognostic factors—a retrospective study of 80 cases. Neurosurgery 53(3):544–553 (discussion 554–545)
Forshew T, Tatevossian RG, Lawson AR et al (2009) Activation of the ERK/MAPK pathway: a signature genetic defect in posterior fossa pilocytic astrocytomas. J Pathol 218(2):172–181
Forsyth PA, Shaw EG, Scheithauer BW, O’Fallon JR, Layton DD Jr, Katzmann JA (1993) Supratentorial pilocytic astrocytomas. A clinicopathologic, prognostic, and flow cytometric study of 51 patients. Cancer 72(4):1335–1342
Hayes VM, Dirven CM, Dam A et al (1999) High frequency of TP53 mutations in juvenile pilocytic astrocytomas indicates role of TP53 in the development of these tumors. Brain Pathol 9(3):463–467
Hoeflich KP, Herter S, Tien J et al (2009) Antitumor efficacy of the novel RAF inhibitor GDC-0879 is predicted by BRAFV600E mutational status and sustained extracellular signal-regulated kinase/mitogen-activated protein kinase pathway suppression. Cancer Res 69(7):3042–3051
Horbinski C, Hamilton RL, Lovell C, Burnham J, Pollack IF (2009) Impact of morphology, MIB-1, p53 and MGMT on outcome in pilocytic astrocytomas. Brain Pathol. doi:10.1111/j.1750-3639.2009.00336.x
Jass JR (2006) Colorectal cancer: a multipathway disease. Crit Rev Oncog 12(3–4):273–287
Jones DT, Kocialkowski S, Liu L et al (2008) Tandem duplication producing a novel oncogenic BRAF fusion gene defines the majority of pilocytic astrocytomas. Cancer Res 68(21):8673–8677
Jones DT, Kocialkowski S, Liu L, Pearson DM, Ichimura K, Collins VP (2009) Oncogenic RAF1 rearrangement and a novel BRAF mutation as alternatives to KIAA1549:BRAF fusion in activating the MAPK pathway in pilocytic astrocytoma. Oncogene 28(20):2119–2123
Korshunov A, Meyer J, Capper D et al (2009) Combined molecular analysis of BRAF and IDH1 distinguishes pilocytic astrocytoma from diffuse astrocytoma. Acta Neuropathol 118(3):401–405
Lavon I, Fuchs D, Zrihan D et al (2007) Novel mechanism whereby nuclear factor kappaB mediates DNA damage repair through regulation of O(6)-methylguanine-DNA-methyltransferase. Cancer Res 67(18):8952–8959
Liu D, Liu Z, Jiang D, Dackiw AP, Xing M (2007) Inhibitory effects of the mitogen-activated protein kinase kinase inhibitor CI-1040 on the proliferation and tumor growth of thyroid cancer cells with BRAF or RAS mutations. J Clin Endocrinol Metab 92(12):4686–4695
Lo RS, Witte ON (2008) Transforming growth factor-beta activation promotes genetic context-dependent invasion of immortalized melanocytes. Cancer Res 68(11):4248–4257
Lorusso PM, Adjei AA, Varterasian M et al (2005) Phase I and pharmacodynamic study of the oral MEK inhibitor CI-1040 in patients with advanced malignancies. J Clin Oncol 23(23):5281–5293
Nagasaka T, Sasamoto H, Notohara K et al (2004) Colorectal cancer with mutation in BRAF, KRAS, and wild-type with respect to both oncogenes showing different patterns of DNA methylation. J Clin Oncol 22(22):4584–4594
Nikiforov YE (2008) Thyroid carcinoma: molecular pathways and therapeutic targets. Mod Pathol 21(Suppl 2):S37–S43
Ohgaki H, Kleihues P (2007) Genetic pathways to primary and secondary glioblastoma. Am J Pathol 170(5):1445–1453
Patra SK (2008) Ras regulation of DNA-methylation and cancer. Exp Cell Res 314(6):1193–1201
Pfister S, Janzarik WG, Remke M et al (2008) BRAF gene duplication constitutes a mechanism of MAPK pathway activation in low-grade astrocytomas. J Clin Invest 118(5):1739–1749
Pollack IF, Campbell JW, Hamilton RL, Martinez AJ, Bozik ME (1997) Proliferation index as a predictor of prognosis in malignant gliomas of childhood. Cancer 79(4):849–856
Pollack IF, Finkelstein SD, Burnham J et al (2001) Age and TP53 mutation frequency in childhood malignant gliomas: results in a multi-institutional cohort. Cancer Res 61(20):7404–7407
Pollack IF, Finkelstein SD, Woods J et al (2002) Expression of p53 and prognosis in children with malignant gliomas. N Engl J Med 346(6):420–427
Pollack IF, Hamilton RL, Finkelstein SD et al (1997) The relationship between TP53 mutations and overexpression of p53 and prognosis in malignant gliomas of childhood. Cancer Res 57(2):304–309
Pollack IF, Hamilton RL, Sobol RW et al (2006) O6-methylguanine-DNA methyltransferase expression strongly correlates with outcome in childhood malignant gliomas: results from the CCG-945 Cohort. J Clin Oncol 24(21):3431–3437
Rinehart J, Adjei AA, Lorusso PM et al (2004) Multicenter phase II study of the oral MEK inhibitor, CI-1040, in patients with advanced non-small-cell lung, breast, colon, and pancreatic cancer. J Clin Oncol 22(22):4456–4462
Roberts P, Chumas PD, Picton S, Bridges L, Livingstone JH, Sheridan E (2001) A review of the cytogenetics of 58 pediatric brain tumors. Cancer Genet Cytogenet 131(1):1–12
Sanoudou D, Tingby O, Ferguson-Smith MA, Collins VP, Coleman N (2000) Analysis of pilocytic astrocytoma by comparative genomic hybridization. Br J Cancer 82(6):1218–1222
Sharma MK, Zehnbauer BA, Watson MA, Gutmann DH (2005) RAS pathway activation and an oncogenic RAS mutation in sporadic pilocytic astrocytoma. Neurology 65(8):1335–1336
Shinozaki M, Fujimoto A, Morton DL, Hoon DS (2004) Incidence of BRAF oncogene mutation and clinical relevance for primary cutaneous melanomas. Clin Cancer Res 10(5):1753–1757
Sievert AJ, Jackson EM, Gai X et al (2009) Duplication of 7q34 in pediatric low-grade astrocytomas detected by high-density single-nucleotide polymorphism-based genotype arrays results in a novel BRAF fusion gene. Brain Pathol 19(3):449–458
Souglakos J, Philips J, Wang R et al (2009) Prognostic and predictive value of common mutations for treatment response and survival in patients with metastatic colorectal cancer. Br J Cancer 101(3):465–472
Tada K, Kochi M, Saya H et al (2003) Preliminary observations on genetic alterations in pilocytic astrocytomas associated with neurofibromatosis 1. NeuroOncology 5(4):228–234
Tibbetts KM, Emnett RJ, Gao F et al (2009) Histopathologic predictors of pilocytic astrocytoma event-free survival. Acta Neuropathol 117(6):657–665
von Deimling A, Fimmers R, Schmidt MC et al (2000) Comprehensive allelotype and genetic analysis of 466 human nervous system tumors. J Neuropathol Exp Neurol 59(6):544–558
Willert JR, Daneshvar L, Sheffield VC, Cogen PH (1995) Deletion of chromosome arm 17p DNA sequences in pediatric high-grade and juvenile pilocytic astrocytomas. Genes Chrom Cancer 12(3):165–172
Acknowledgments
The authors thank Colleen Lovell and Judy Burnham for their histological expertise; Kathy Cieply, John Salvatore, and Carol Sherer for their assistance in fluorescence in situ hybridization; and Marianne Notaro and Michelle Bisceglia for TMA preparation. This study was funded by a Brain Tumor Society Award from the Pediatric Low Grade Glioma Foundation and NIH R01 NS37704. CH was supported by a Callie Rohr/American Brain Tumor Association Fellowship. Portions of this data were presented at the American Association of Neuropathologists 2009 Annual Meeting in San Antonio, TX.
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Horbinski, C., Hamilton, R.L., Nikiforov, Y. et al. Association of molecular alterations, including BRAF, with biology and outcome in pilocytic astrocytomas. Acta Neuropathol 119, 641–649 (2010). https://doi.org/10.1007/s00401-009-0634-9
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DOI: https://doi.org/10.1007/s00401-009-0634-9