TERT promoter mutations in primary and secondary WHO grade III meningioma

Abstract

Purpose: TERT promoter mutation (TERTpMut) has a strong association to recurrence and has been suggested to act as a driver mutation for malignant transformation of WHO grade I and II meningiomas. TERTpMut has been investigated in selected high‐grade meningioma samples. The existence of TERTpMut across recurrent tumors in a population‐based cohort needs to be investigated in order to identify when TERTpMut emerges across recurrent samples and to validate prognostic impact among WHO grade III tumors. Methods: We gathered material from a consecutive single‐center cohort of 40 patients with malignant meningioma (WHO grade III) treated between 2000 and 2018, including specimens from primary and secondary malignant meningiomas with the corresponding earlier benign specimens and later malignant recurrences. In total 107 tumor samples were studied by Sanger sequencing for TERT promoter mutational status. Results: Seven of 40 patients (17.5%) harbored TERTpMut thus validating the incidence of TERTpMut in previous non‐population‐based cohorts. In 6/7 patients, the TERTpMut was present at initial surgery (WHO grade I–III) while in one patient the TERTpMut was found de novo when the meningioma became malignant. The incidences were 2/1.000.000/year for TERTpMut WHO grade III meningioma and 8/1.000.000/year for TERTpwt WHO grade III meningioma in our catchment area. We found a 1.7 times higher recurrence rate (CI 95% 0.65–4.44) and a 2.5 higher mortality rate per 10 person‐years (CI 95% 1.01–6.19) for TERTpMut compared to TERTpwt. Conclusion: TERTpMut can occur independently of malignant progression in meningioma and was most often present from the first tumor sample across recurring tumors. TERTpMut in WHO grade III may represent a marker of an aggressive subset of tumors.

Human TERT Promoter Mutations in Atypical and Anaplastic Meningiomas

“…However, the observed mutation rate in de novo anaplastic tumours (3/9, 33.3%) is similar to that observed in anaplastic tumours secondary to a malignant progression (4/12, 33.3%). This finding confirms previous observations about the pTERT mutation rate in primary and secondary grade III meningiomas [ 34 ]. Conversely, no case in progression from grade I to II harboured a pTERT mutation.…”

Potential Molecular Mechanisms of Recurrent and Progressive Meningiomas: A Review of the Latest Literature

“…In addition to the genes mentioned previously herein, a 2018 study showed that mutations in the promoter of telomerase reverse transcriptase ( TERTp ) enhance the degree of malignancy of meningiomas and lead to poor prognosis ( 51 ). Other studies have corroborated that TERTp mutations predict poor survival in progressive/high-grade meningiomas ( 33 , 52 , 53 ). Telomere maintenance is a marker of tumor formation, and most tumors express telomerase to prevent telomere shortening ( 52 ).…”

LncRNA-IMAT1 Promotes Invasion of Meningiomas by Suppressing KLF4/hsa-miR22-3p/Snai1 Pathway

“…Meningiomas are common CNS tumors in adults, and their diagnosis is based on histopathology. Although some somatic mutations have been reported, such as those in the NF2, TRAF7, AKT1, KLF4 ( Galani et al, 2017 ), SMARCE1 ( Sievers et al, 2021 ), and TERT promoters ( Maier et al, 2021 ), these molecules have limitations as diagnostic criteria. Therefore, finding new molecules to diagnose and screen early-stage meningiomas is urgently needed.…”