Hot spot mutations in the promoter region of
telomerase reverse transcriptase (TERT) have recently been described in several human
tumor entities. These mutations result in an upregulation of the
telomerase complex activity and thus constitute a relevant mechanism for immortalization of
tumor cells. Knowledge of the TERT promoter status in
tumors is likely to be of interest for molecular classification and as a potential target for
therapy. We, therefore, performed a systematic analysis of TERT promoter mutations in 1,515
tumors of the human nervous system and its coverings including 373 pediatric and 1,142 adult patients. We detected a total of 327 mutations. TERT promoter mutations were exceedingly rare in
tumors typically encountered in pediatric patients. In entities typically encountered in adult patients TERT promoter mutations were strongly associated with older age (p < 0.0001). Highest mutation frequencies were detected in
gliosarcomas (81 %),
oligodendrogliomas (78 %), oligoastrocytomas (58 %), primary
glioblastomas (54 %), and
solitary fibrous tumors (50 %). Related to other molecular alterations, TERT promoter mutations were strongly associated with 1p/19q loss (p < 0.0001), but inversely associated with loss of ATRX expression (p < 0.0001) and IDH1/IDH2 mutations (p < 0.0001). TERT promoter mutations are typically found in adult patients and occur in a highly
tumor type-associated distribution.