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Histological grade 2 and non-contrast-enhancing phenotype provide prognostic information complementary to DNA methylation classification in TERTp-mutant molecular glioblastomas.

Overview

Authors: Hiroyuki Sueyoshi1, Kenji Fujimoto1, Katsumi Fujita2, Kazuhito Tanaka3, Hirotaka Inoue1, Rin Yamada4, Takahiro Yamamoto1, Yutaka Nakachi5, Jun-ichiro Kuroda1, Naoki Shinojima1, Kazuya Iwamoto5, Yoshiki Mikami3, Akitake Mukasa1
  1. Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
  2. School of Medicine, Kumamoto University, Kumamoto, Japan
  3. Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
  4. Department of Cell Pathology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
  5. Department of Molecular Brain Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Institutions: Kumamoto University (Japan); Kumamoto University Hospital (Japan)
Journal: Acta neuropathologica communications, volume 14, issue 1, article 88
Dates: received 9 November 2025; accepted 20 February 2026; published online 4 March 2026
Type: Research article · Language: English
License: CC BY
Identifiers: DOI 10.1186/s40478-026-02269-z · PMID 41781993 · PMCID PMC13069819 · OpenAlex W7133497045
Open access: gold, a free copy (OpenAlex)
Status: data only
Categories: genetics / omics (modality), histology / microscopy (modality), human (organism), other condition (population)
Methods: Statistics, Smoothing, state filtering, decompositions, Connectivity
Keywords: Glioblastoma, Molecular GBM, TERT promoter mutation, DNA methylation profiling, WIF-1
MeSH: Brain Neoplasms*, DNA Methylation*, Glioblastoma*, Telomerase*, Adult, Aged, Female, Humans, Male, Middle Aged, Mutation, Neoplasm Grading, Phenotype, Prognosis, Promoter Regions, Genetic, Retrospective Studies (* major topic)
Topic: Glioma Diagnosis and Treatment (Genetics, Medicine), according to OpenAlex
Funding: Japan Society for the Promotion of Science (23K27713, 25K19938)
Citations: not cited yet (Europe PMC); 45 references in the paper

Abstract

Glioblastoma (GBM), IDH-wildtype, is the most common and aggressive primary brain tumor in adults. According to the 2021 WHO classification, IDH-wildtype diffuse gliomas with a TERT promoter (TERTp) mutation, EGFR amplification, or combined whole-chromosome 7 gain and 10 loss (+ 7/− 10) are designated as GBM, IDH-wildtype, regardless of histological grade, and termed molecular GBM (mol-GBM). Although this redefinition has been widely adopted, the prognostic implications of mol-GBM remain uncertain. To clarify its clinical relevance, we retrospectively analyzed adult patients treated at our institution between 2010 and 2024. We identified 22 cases of TERTp-mutant mol-GBM (grade 2, n = 7; grade 3, n = 15) and compared them with 218 cases of TERTp-mutant histologically confirmed GBM (hist-GBM). Overall survival (OS) was assessed using Kaplan–Meier analysis, log-rank test, and propensity score matching (PSM) adjusted for age, preoperative Karnofsky Performance Status, extent of resection, adjuvant therapy, and MGMT methylation status. Mol-GBM showed significantly longer OS than hist-GBM after PSM (p = 0.019), with grade 2 mol-GBM showing particularly favorable survival (p = 0.008). Cox regression analysis revealed mol-GBM as an independent predictor of good prognosis (hazard ratio: 0.37, 95% confidence interval: 0.22–0.62, p < 0.001). Across all TERTp-mutant GBMs, a non-contrast-enhancing (non-CE) MRI phenotype correlated with significantly longer OS than CE tumors, persisting after PSM (p = 0.004). Within mol-GBM, an isolated TERTp mutation did not stratify OS, whereas CDKN2A/B homozygous deletion predicted worse outcomes (p = 0.026). DNA methylation profiling classified most mol-GBM as GBM, IDH-wildtype methylation class, and all cases clustered with GBM on t-SNE, confirming molecular proximity to GBM. Integrated methylation and RNA-seq analysis revealed WIF-1 promoter hypermethylation with reduced expression in grade 3 cases. These findings suggest that histological grade 2 and the non-CE phenotype may provide exploratory prognostic information in TERTp-mutant mol-GBM, complementary to DNA methylation classification.

Supplementary Information: The online version contains supplementary material available at 10.1186/s40478-026-02269-z.

Reproduced under the paper's license (CC BY), from the paper cited above.

Code

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Data

Datasets cited

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Reproduced under the paper's license (CC BY), from the paper cited above.

Versions

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Version 1, 30 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 13 authors, 5 keywords, 16 MeSH terms, 1 funder, 44 references, 7 RRIDs.

Cite

This paper

Sueyoshi, H., Fujimoto, K., Fujita, K., Tanaka, K., Inoue, H., Yamada, R., Yamamoto, T., Nakachi, Y., Kuroda, J.-i., Shinojima, N., Iwamoto, K., Mikami, Y., & Mukasa, A. (2026). Histological grade 2 and non-contrast-enhancing phenotype provide prognostic information complementary to DNA methylation classification in TERTp-mutant molecular glioblastomas. Acta neuropathologica communications, 14(1), 88. https://doi.org/10.1186/s40478-026-02269-z

BibTeX

@article{sueyoshi2026histological,
author = {Sueyoshi, Hiroyuki and Fujimoto, Kenji and Fujita, Katsumi and Tanaka, Kazuhito and Inoue, Hirotaka and Yamada, Rin and Yamamoto, Takahiro and Nakachi, Yutaka and Kuroda, Jun-ichiro and Shinojima, Naoki and Iwamoto, Kazuya and Mikami, Yoshiki and Mukasa, Akitake},
title = {{Histological grade 2 and non-contrast-enhancing phenotype provide prognostic information complementary to DNA methylation classification in TERTp-mutant molecular glioblastomas}},
journal = {Acta neuropathologica communications},
year = {2026},
month = mar,
volume = {14},
number = {1},
pages = {88},
publisher = {BMC},
issn = {2051-5960},
doi = {10.1186/s40478-026-02269-z},
url = {https://doi.org/10.1186/s40478-026-02269-z},
pmid = {41781993},
pmcid = {PMC13069819}
}

RIS

TY - JOUR
AU - Sueyoshi, Hiroyuki
AU - Fujimoto, Kenji
AU - Fujita, Katsumi
AU - Tanaka, Kazuhito
AU - Inoue, Hirotaka
AU - Yamada, Rin
AU - Yamamoto, Takahiro
AU - Nakachi, Yutaka
AU - Kuroda, Jun-ichiro
AU - Shinojima, Naoki
AU - Iwamoto, Kazuya
AU - Mikami, Yoshiki
AU - Mukasa, Akitake
TI - Histological grade 2 and non-contrast-enhancing phenotype provide prognostic information complementary to DNA methylation classification in TERTp-mutant molecular glioblastomas
T2 - Acta neuropathologica communications
J2 - Acta Neuropathol Commun
PY - 2026
DA - 2026/03/04
VL - 14
IS - 1
SP - 88
SN - 2051-5960
PB - BMC
DO - 10.1186/s40478-026-02269-z
UR - https://doi.org/10.1186/s40478-026-02269-z
LA - en
ER -

CSL-JSON

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