Presence of an oligodendroglioma-like component in newly diagnosed glioblastoma identifies a pathogenetically heterogeneous subgroup and lacks prognostic value: central pathology review of the EORTC_26981/NCIC_CE.3 trial

Acta Neuropathol. 2012 Jun;123(6):841-52. doi: 10.1007/s00401-011-0938-4. Epub 2012 Jan 15.

Abstract

Glioblastoma (GBM) is a morphologically heterogeneous tumor type with a median survival of only 15 months in clinical trial populations. However, survival varies greatly among patients. As part of a central pathology review, we addressed the question if patients with GBM displaying distinct morphologic features respond differently to combined chemo-radiotherapy with temozolomide. Morphologic features were systematically recorded for 360 cases with particular focus on the presence of an oligodendroglioma-like component and respective correlations with outcome and relevant molecular markers. GBM with an oligodendroglioma-like component (GBM-O) represented 15% of all confirmed GBM (52/339) and was not associated with a more favorable outcome. GBM-O encompassed a pathogenetically heterogeneous group, significantly enriched for IDH1 mutations (19 vs. 3%, p = 0.003) and EGFR amplifications (71 vs. 48%, p = 0.04) compared with other GBM, while co-deletion of 1p/19q was found in only one case and the MGMT methylation frequency was alike (47 vs. 46%). Expression profiles classified most of the GBM-O into two subtypes, 36% (5/14 evaluable) as proneural and 43% as classical GBM. The detection of pseudo-palisading necrosis (PPN) was associated with benefit from chemotherapy (p = 0.0002), while no such effect was present in the absence of PPN (p = 0.86). In the adjusted interaction model including clinical prognostic factors and MGMT status, PPN was borderline nonsignificant (p = 0.063). Taken together, recognition of an oligodendroglioma-like component in an otherwise classic GBM identifies a pathogenetically mixed group without prognostic significance. However, the presence of PPN may indicate biological features of clinical relevance for further improvement of therapy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Brain Neoplasms / genetics
  • Brain Neoplasms / pathology*
  • Brain Neoplasms / therapy
  • Chemoradiotherapy
  • Clinical Trials, Phase III as Topic
  • DNA Methylation
  • Dacarbazine / analogs & derivatives
  • Dacarbazine / therapeutic use
  • ErbB Receptors / genetics
  • ErbB Receptors / metabolism
  • Female
  • Glioblastoma / genetics
  • Glioblastoma / pathology*
  • Glioblastoma / therapy
  • Humans
  • Male
  • Middle Aged
  • Mutation
  • Oligodendroglioma / genetics
  • Oligodendroglioma / pathology*
  • Oligodendroglioma / therapy
  • Prognosis
  • Survival Analysis
  • Temozolomide
  • Treatment Outcome
  • Young Adult

Substances

  • Dacarbazine
  • EGFR protein, human
  • ErbB Receptors
  • Temozolomide