Analysis Of TERT Promoter Mutation,ATRX And PML Protein Expression And Prognosis In Secondary Glioblastoma

[Objective]Mechanism of TA and ALT are important mechanisms of tumorigenesis and development,have become a research hotspot.Mutation of the TERT promoter causes the TA mechanism,ATRX protein lost and PML protein expression are important molecular changes that occur in the ALT mechanism.At present,the status of TERT promoter,ATRX and PML are less studied in sGBM.This study examined the status of TERT promoter,the expression of ATRX and PML proteins in sGBM,explored the correlation with the prognosis of sGBM.[Methods]We reviewed the clinical and pathological data of 45 patients who were diagnosed with sGBM in the Affiliated Hospital of Qingdao University from January 2013 to December 2018.The patient's wax block data were collected.The mutation state of the TERT promoter in tumor tissues was detected by Real-time PCR.Histochemical staining was used to observe the expression of ATRX and PML proteins.Establish clinical data database,mainly including clinical characteristics and prognosis of sGBM patients.Data processing was performed using SPSS 20.0 software.All statistical results were significant at p<0.05.[Result]1.45 patients with sGBM included 25(55.56%)males and 20(44.44%)females,age:46.67±11.41 years old,tumor diameter: 51.08±16.67 mm,31(68.89%)were located in the frontal lobe,median survival time is 16.77 months.2.The results showed that the mutation rate of TERT promoter was 35.56%(16/45).The patients with TERT promoter mutation were older(p=0.004),the tumor was smaller(p=0.019).More patients were located in the non-frontal lobe(p=0.016)and the patients' progression free survival time was shortened(p=0.031).3.The positive rates of ATRX and PML were 51.11%(23/45)and 53.33%(24/45),respectively.Patients with positive ATRX expression were older(p=0.002),tumors were smaller(p=0.006),more patients were located in the non-frontal lobe(p=0.03).Patients with positive expression of PML were older(p=0.022).4.TERT promoter mutation is a risk factor for PFS in sGBM patients(HR=8.694,95% CI 1.076-70.226,p=0.042).Tumor length more than 6cm is a risk factor for overall survival time(HR=3.261,95% CI 1.128-9.425,p=0.029).5.Some sGBM patients also have TERT promoter mutation,ATRX negative expression and PML positive expression,with a composition ratio of 11.11%(5/45).[Conclusion]Through the analysis of 45 sGBM patients in Qingdao in the past six years,we found that TERT promoter mutation is a risk factor for poor prognosis of PFS in sGBM patients.Tumor length more than 6cm is an independent risk factor for OS in sGBM patients.In some sGBM patients,there are TA and ALT mechanisms at the same time,which provides a theoretical basis for further exploration of the pathogenic mechanism of sGBM.It needs to be confirmed by subsequent work to collect more cases.