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TP53 alterations determine clinical subgroups and survival of patients with choroid plexus tumors.

Abstract
PURPOSE Choroid plexus carcinomas are pediatric tumors with poor survival rates and a strong, but poorly understood, association with Li-Fraumeni syndrome (LFS). Currently, with lack of biologic predictors, most children are treated with aggressive chemoradiation protocols. PATIENTS AND METHODS We established a multi-institutional tissue and clinical database, which enabled the analysis of specific alterations of the TP53 tumor suppressor and its modifiers in choroid plexus tumors (CPTs). We conducted high-resolution copy-number analysis to correlate these genetic parameters with family history and outcome. Results We studied 64 patients with CPTs. All individuals with germline TP53 mutations fulfilled LFS criteria, whereas all patients not meeting these criteria harbored wild-type TP53 (P < .001). TP53 mutations were found in 50% of choroid plexus carcinomas (CPCs). Additionally, two sequence variants known to confer TP53 dysfunction, TP53 codon72 and MDM2 SNP309, coexisted in the majority of TP53 wild-type CPCs (92%) and not in TP53 mutated CPC (P = .04), which suggests a complementary mechanism of TP53 dysfunction in the absence of a TP53 mutation. High-resolution single nucleotide polymorphism (SNP) array analysis revealed extremely high total structural variation (TSV) in TP53-mutated CPC tumor genomes compared with TP53 wild-type tumors and choroid plexus papillomas (CPPs; P = .006 and .004, respectively). Moreover, high TSV was associated with significant risk of progression (P < .001). Five-year survival rates for patients with TP53-immunopositive and -immunonegative CPCs were 0% and 82 (+/- 9%), respectively (P < .001). Furthermore, 14 of 16 patients with TP53 wild-type CPCs are alive without having received radiation therapy. CONCLUSION Patients with CPC who have low tumor TSV and absence of TP53 dysfunction have a favorable prognosis and can be successfully treated without radiation therapy.
AuthorsUri Tabori, Adam Shlien, Berivan Baskin, Sarah Levitt, Peter Ray, Noa Alon, Cynthia Hawkins, Eric Bouffet, Malgorzata Pienkowska, Lucie Lafay-Cousin, Alexa Gozali, Nataliya Zhukova, Lisa Shane, Ignacio Gonzalez, Jonathan Finlay, David Malkin
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 28 Issue 12 Pg. 1995-2001 (Apr 20 2010) ISSN: 1527-7755 [Electronic] United States
PMID20308654 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
Chemical References
  • TP53 protein, human
  • Tumor Suppressor Protein p53
Topics
  • Carcinoma (chemistry, genetics, mortality, therapy)
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Choroid Plexus Neoplasms (chemistry, genetics, mortality, therapy)
  • Databases as Topic
  • Disease-Free Survival
  • Gene Expression Regulation, Neoplastic
  • Genetic Predisposition to Disease
  • Germ-Line Mutation
  • Humans
  • Immunohistochemistry
  • Kaplan-Meier Estimate
  • Oligonucleotide Array Sequence Analysis
  • Ontario (epidemiology)
  • Papilloma, Choroid Plexus (chemistry, genetics, mortality, therapy)
  • Phenotype
  • Polymorphism, Single Nucleotide
  • Time Factors
  • Treatment Outcome
  • Tumor Suppressor Protein p53 (analysis, genetics)
  • United States (epidemiology)

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