Abstract
Background
Mutations in the telomerase reverse transcriptase promoter (TERTp) region have been associated with worse prognosis in some cancers. Meningiomas are the most common type of primary central nervous tumors, and evaluation of the prognostic significance of TERTp mutations across the literature is lacking. The aim of this study was to pool all current evidence to assess for clinical relevance of TERTp mutations in meningioma and survival effect.
Methods
Searches of seven electronic databases from inception to September 2018 were conducted following the appropriate guidelines. Two hundred and twenty seven articles were identified for screening. Hazard ratio (HR) and mean difference (MD) statistics were obtained and pooled utilizing both fixed- and random-effect (RE) models. Meta-regression was utilized to determine potential sources of heterogeneity and statistical influence.
Results
A total of five retrospective observational cohort studies describing 532 meningioma patients satisfied selection criteria. The incidence of TERTp mutations was 8%, and was associated with significantly worse prognosis (HR 3.79; P = 0.005) and significantly shorter overall survival (MD 59.8 months; P = 0.037) by RE modelling. Meningioma grade was not significantly associated with a TERTp mutation effect, however, preliminary meta-regression trends indicated this may be significant once greater statistical power is achieved.
Conclusion
The current evidence indicates the presence of a TERTp mutation in meningioma can be associated with worse prognosis, and shorter overall survival. Routine detection in greater numbers will allow for further validation, as well as delineate the effect across histological grades. By identifying this subgroup of meningioma patients early in management, it may support more frequent follow-up and aggressive management to optimize survival outcomes.
Similar content being viewed by others
References
Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS (2015) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008–2012. Neuro-oncology 17(Suppl 4):iv1–iv62. https://doi.org/10.1093/neuonc/nov189
Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta neuropathologica 131(6):803–820. https://doi.org/10.1007/s00401-016-1545-1
Pasquier D, Bijmolt S, Veninga T, Rezvoy N, Villa S, Krengli M, Weber DC, Baumert BG, Canyilmaz E, Yalman D, Szutowicz E, Tzuk-Shina T, Mirimanoff RO (2008) Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network. Int J Radiat Oncol Biol Phys 71(5):1388–1393. https://doi.org/10.1016/j.ijrobp.2007.12.020
van Alkemade H, de Leau M, Dieleman EM, Kardaun JW, van Os R, Vandertop WP, van Furth WR, Stalpers LJ (2012) Impaired survival and long-term neurological problems in benign meningioma. Neuro-oncology 14(5):658–666. https://doi.org/10.1093/neuonc/nos013
Ehresman JS, Mampre D, Rogers D, Olivi A, Quinones-Hinojosa A, Chaichana KL (2018) Volumetric tumor growth rates of meningiomas involving the intracranial venous sinuses. Acta Neurochir 160(8):1531–1538. https://doi.org/10.1007/s00701-018-3571-3
Ehresman JS, Garzon-Muvdi T, Rogers D, Lim M, Gallia GL, Weingart J, Brem H, Bettegowda C, Chaichana KL, and Meningiomas III (2018) The relevance of simpson grade resections in modern neurosurgical treatment of World Health Organization Grade I, II. World Neurosurg 109:e588–e593. https://doi.org/10.1016/j.wneu.2017.10.028
Chaichana KL, Pendleton C, Zaidi H, Olivi A, Weingart JD, Gallia GL, Lim M, Brem H, Quinones-Hinojosa A (2013) Seizure control for patients undergoing meningioma surgery. World Neurosurg 79(3–4):515–524. https://doi.org/10.1016/j.wneu.2012.02.051
Quinones-Hinojosa A, Kaprealian T, Chaichana KL, Sanai N, Parsa AT, Berger MS, McDermott MW (2009) Pre-operative factors affecting resectability of giant intracranial meningiomas. Can J Neurol Sci 36(5):623–630
Horn S, Figl A, Rachakonda PS, Fischer C, Sucker A, Gast A, Kadel S, Moll I, Nagore E, Hemminki K, Schadendorf D, Kumar R (2013) TERT promoter mutations in familial and sporadic melanoma. Science 339(6122):959–961. https://doi.org/10.1126/science.1230062
Huang FW, Hodis E, Xu MJ, Kryukov GV, Chin L, Garraway LA (2013) Highly recurrent TERT promoter mutations in human melanoma. Science 339(6122):957–959. https://doi.org/10.1126/science.1229259
Leao R, Apolonio JD, Lee D, Figueiredo A, Tabori U, Castelo-Branco P (2018) Mechanisms of human telomerase reverse transcriptase (hTERT) regulation: clinical impacts in cancer. J Biomed Sci 25(1):22. https://doi.org/10.1186/s12929-018-0422-8
Hosen I, Rachakonda PS, Heidenreich B, de Verdier PJ, Ryk C, Steineck G, Hemminki K, Kumar R (2015) Mutations in TERT promoter and FGFR3 and telomere length in bladder cancer. Int J cancer 137(7):1621–1629. https://doi.org/10.1002/ijc.29526
Eckel-Passow JE, Lachance DH, Molinaro AM, Walsh KM, Decker PA, Sicotte H, Pekmezci M, Rice T, Kosel ML, Smirnov IV, Sarkar G, Caron AA, Kollmeyer TM, Praska CE, Chada AR, Halder C, Hansen HM, McCoy LS, Bracci PM, Marshall R, Zheng S, Reis GF, Pico AR, O’Neill BP, Buckner JC, Giannini C, Huse JT, Perry A, Tihan T, Berger MS, Chang SM, Prados MD, Wiemels J, Wiencke JK, Wrensch MR, Jenkins RB (2015) Glioma groups based on 1p/19q, IDH, and TERT promoter mutations in tumors. N Engl J Med 372(26):2499–2508. https://doi.org/10.1056/NEJMoa1407279
Killela PJ, Reitman ZJ, Jiao Y, Bettegowda C, Agrawal N, Diaz LA Jr, Friedman AH, Friedman H, Gallia GL, Giovanella BC, Grollman AP, He TC, He Y, Hruban RH, Jallo GI, Mandahl N, Meeker AK, Mertens F, Netto GJ, Rasheed BA, Riggins GJ, Rosenquist TA, Schiffman M, Shih Ie M, Theodorescu D, Torbenson MS, Velculescu VE, Wang TL, Wentzensen N, Wood LD, Zhang M, McLendon RE, Bigner DD, Kinzler KW, Vogelstein B, Papadopoulos N, Yan H (2013) TERT promoter mutations occur frequently in gliomas and a subset of tumors derived from cells with low rates of self-renewal. Proc Natl Acad Sci USA 110(15):6021–6026. https://doi.org/10.1073/pnas.1303607110
Moher D, Liberati A, Tetzlaff J, Althman D (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med 6(7):e1000097
Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Controll Clin Trials 7(3):177–188
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101
Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O’Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer T, Varonen H, Vist GE, Williams JW Jr, Zaza S (2004) Grading quality of evidence and strength of recommendations. BMJ 328(7454):1490. https://doi.org/10.1136/bmj.328.7454.1490
Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, Tugwell P (2016) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute, Ottawa (ON)
Spiegl-Kreinecker S, Lotsch D, Neumayer K, Kastler L, Gojo J, Pirker C, Pichler J, Weis S, Kumar R, Webersinke G, Gruber A, Berger W (2018) TERT promoter mutations are associated with poor prognosis and cell immortalization in meningioma. Neuro-oncology. https://doi.org/10.1093/neuonc/noy104
Peyre M, Gauchotte G, Giry M, Froehlich S, Pallud J, Graillon T, Bielle F, Cazals-Hatem D, Varlet P, Figarella-Branger D, Loiseau H, Kalamarides M (2018) De novo and secondary anaplastic meningiomas: a study of clinical and histomolecular prognostic factors. Neuro-oncology 20(8):1113–1121. https://doi.org/10.1093/neuonc/nox231
Biczok A, Kraus T, Suchorska B, Terpolilli NA, Thorsteinsdottir J, Giese A, Tonn JC, Schichor C (2018) TERT promoter mutation is associated with worse prognosis in WHO grade II and III meningiomas. J Neuro-oncol 139(3):671–678. https://doi.org/10.1007/s11060-018-2912-7
Juratli TA, Thiede C, Koerner MVA, Tummala SS, Daubner D, Shankar GM, Williams EA, Martinez-Lage M, Soucek S, Robel K, Penson T, Krause M, Appold S, Meinhardt M, Pinzer T, Miller JJ, Krex D, Ely HA, Silverman IM, Christiansen J, Schackert G, Wakimoto H, Kirsch M, Brastianos PK, Cahill DP (2017) Intratumoral heterogeneity and TERT promoter mutations in progressive/higher-grade meningiomas. Oncotarget 8(65):109228–109237. https://doi.org/10.18632/oncotarget.22650
Sahm F, Schrimpf D, Olar A, Koelsche C, Reuss D, Bissel J, Kratz A, Capper D, Schefzyk S, Hielscher T, Wang Q, Sulman EP, Adeberg S, Koch A, Okuducu AF, Brehmer S, Schittenhelm J, Becker A, Brokinkel B, Schmidt M, Ull T, Gousias K, Kessler AF, Lamszus K, Debus J, Mawrin C, Kim YJ, Simon M, Ketter R, Paulus W, Aldape KD, Herold-Mende C, von Deimling A (2016) TERT promoter mutations and risk of recurrence in meningioma. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djv377
Juratli TA, McCabe D, Nayyar N, Williams EA, Silverman IM, Tummala SS, Fink AL, Baig A, Martinez-Lage M, Selig MK, Bihun IV, Shankar GM, Penson T, Lastrapes M, Daubner D, Meinhardt M, Hennig S, Kaplan AB, Fujio S, Kuter BM, Bertalan MS, Miller JJ, Batten JM, Ely HA, Christiansen J, Baretton GB, Stemmer-Rachamimov AO, Santagata S, Rivera MN, Barker FG, Schackert G, Wakimoto H, Iafrate AJ, Carter SL, Cahill DP, Brastianos PK (2018) DMD genomic deletions characterize a subset of progressive/higher-grade meningiomas with poor outcome. Acta Neuropathol. https://doi.org/10.1007/s00401-018-1899-7
Furtjes G, Kochling M, Peetz-Dienhart S, Wagner A, Hes K, Hasselblatt M, Senner V, Stummer W, Paulus W, Brokinkel B (2016) hTERT promoter methylation in meningiomas and central nervous hemangiopericytomas. J Neuro-oncol 130(1):79–87
Abedalthagafi MS, Bi WL, Merrill PH, Gibson WJ, Rose MF, Du Z, Francis JM, Du R, Dunn IF, Ligon AH, Beroukhim R, Santagata S (2015) ARID1A and TERT promoter mutations in dedifferentiated meningioma. Cancer Genet 208(6):345–350. https://doi.org/10.1016/j.cancergen.2015.03.005
Goutagny S, Nault JC, Mallet M, Henin D, Rossi JZ, Kalamarides M (2014) High incidence of activating TERT promoter mutations in meningiomas undergoing malignant progression. Brain Pathol (Zurich Switzerland) 24(2):184–189. https://doi.org/10.1111/bpa.12110
Okuducu AF, Zils U, Michaelis SA, Mawrin C, von Deimling A (2006) Increased expression of avian erythroblastosis virus E26 oncogene homolog 1 in World Health Organization grade 1 meningiomas is associated with an elevated risk of recurrence and is correlated with the expression of its target genes matrix metalloproteinase-2 and MMP-9. Cancer 107(6):1365–1372. https://doi.org/10.1002/cncr.22130
Kim NW, Piatyszek MA, Prowse KR, Harley CB, West MD, Ho PL, Coviello GM, Wright WE, Weinrich SL, Shay JW (1994) Specific association of human telomerase activity with immortal cells and cancer. Science 266(5193):2011–2015
Chiba K, Lorbeer FK, Shain AH, McSwiggen DT, Schruf E, Oh A, Ryu J, Darzacq X, Bastian BC, Hockemeyer D (2017) Mutations in the promoter of the telomerase gene TERT contribute to tumorigenesis by a two-step mechanism. Science 357(6358):1416–1420. https://doi.org/10.1126/science.aao0535
Kressner M, Arlt F, Riepl W, Meixensberger J (2018) Prognostic factors of microsurgical treatment of intracranial meningiomas—a multivariate analysis. PLoS ONE 13(10):e0202520. https://doi.org/10.1371/journal.pone.0202520
Proctor DT, Ramachandran S, Lama S, Sutherland GR (2018) Towards molecular classification of meningioma: evolving treatment and diagnostic paradigms. World Neurosurg 119:366–373. https://doi.org/10.1016/j.wneu.2018.08.019
Serakinci N, Mega Tiber P, Orun O (2018) Chromatin modifications of hTERT gene in hTERT-immortalized human mesenchymal stem cells upon exposure to radiation. Eur J Med Genet 61(5):288–293. https://doi.org/10.1016/j.ejmg.2017.12.014
Chen W, Shin KH, Kim S, Shon WJ, Kim RH, Park NH, Kang MK (2018) hTERT peptide fragment GV1001 demonstrates radioprotective and antifibrotic effects through suppression of TGFbeta signaling. Int J Mol Med 41(6):3211–3220. https://doi.org/10.3892/ijmm.2018.3566
Li Y, Pan G, Chen Y, Yang Q, Hao T, Zhao L, Zhao L, Cong Y, Diao A, Yu P (2018) Inhibitor of the human telomerase reverse trancriptase (hTERT) gene promoter induces cell apoptosis via a mitochondrial-dependent pathway. Eur J Med Chem 145:370–378. https://doi.org/10.1016/j.ejmech.2017.12.077
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors report no funding sources or conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Lu, V.M., Goyal, A., Lee, A. et al. The prognostic significance of TERT promoter mutations in meningioma: a systematic review and meta-analysis. J Neurooncol 142, 1–10 (2019). https://doi.org/10.1007/s11060-018-03067-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-018-03067-x