H3K27M Mutation Doesn't Mean Worse Prognosis in Old Patients

Xiao Mu Hu; Xiao Yu Nie; Kai Lun Xu; Yin Wang; Feng Tang; Zun Guo Du; Ji Xiong

doi:10.3389/fonc.2022.912166

H3K27M Mutation Doesn't Mean Worse Prognosis in Old Patients

Front Oncol. 2022 Jun 8:12:912166. doi: 10.3389/fonc.2022.912166. eCollection 2022.

Authors

Xiao Mu Hu¹, Xiao Yu Nie², Kai Lun Xu³, Yin Wang¹, Feng Tang¹, Zun Guo Du¹, Ji Xiong¹

Affiliations

¹ Huashan Hospital, Fudan University, Shanghai, China.
² Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³ Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Abstract

Objective: Diffuse midline glioma (DMG), H3K27 altered is a new entity that has become widely recognized. However, studies concerning DMG in adult patients remain rare. We did a retrospective study covering the largest amount of patients to date to analyze the clinicopathological characteristics of diffuse glioma in midline structures of the adult.

Methods: We reviewed 108 cases of adult DMG, collected their clinical data, and pathological results including H3K27 mutation. Summarized their features and the connection with overall survival in different age groups.

Results: Among 108 cases, 79 tumors were located at the thalamus. 38 patients had H3K27M mutation, whose average age was 35.7 years. The median overall survival of H3K27M-mutant gliomas and the 80 H3K27M wild-type gliomas were both 12 months. For young patients (age ≤ 35), The median survival time of the H3K27M-mutant was 18 months, while that of the H3K27M wild-type was 37 months. For older patients (age>35), the median survival time of the H3K27M-mutant was 16 months, while that of the H3K27M wild-type was 13 months. Other clinicopathological factors including sex, tumor location, the approach of surgery, histological grade, ATRX, and P53 were statistically irrelevant to prognosis.

Conclusion: The DMG in adults mainly occurred in the thalamus. H3K27M mutations tend to happen more frequently in young adults, and this genetic alteration results in a worse outcome only in young patients (≤35). For old patients, age is the only independent prognostic factor. Patients who underwent different surgical operations including biopsy, subtotal resection, and total resection had similar prognoses.

Keywords: H3K27M; age; clinicopathological study; midline glioma; prognosis.