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000143580 1001_ $$0P:(DE-He78)36e1ec4777d5b7887344177dca41eae9$$aSharma, Tanvi$$b0$$eFirst author
000143580 245__ $$aSecond-generation molecular subgrouping of medulloblastoma: an international meta-analysis of Group 3 and Group 4 subtypes.
000143580 260__ $$aHeidelberg$$bSpringer$$c2019
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000143580 520__ $$aIn 2012, an international consensus paper reported that medulloblastoma comprises four molecular subgroups (WNT, SHH, Group 3, and Group 4), each associated with distinct genomic features and clinical behavior. Independently, multiple recent reports have defined further intra-subgroup heterogeneity in the form of biologically and clinically relevant subtypes. However, owing to differences in patient cohorts and analytical methods, estimates of subtype number and definition have been inconsistent, especially within Group 3 and Group 4. Herein, we aimed to reconcile the definition of Group 3/Group 4 MB subtypes through the analysis of a series of 1501 medulloblastomas with DNA-methylation profiling data, including 852 with matched transcriptome data. Using multiple complementary bioinformatic approaches, we compared the concordance of subtype calls between published cohorts and analytical methods, including assessments of class-definition confidence and reproducibility. While the lowest complexity solutions continued to support the original consensus subgroups of Group 3 and Group 4, our analysis most strongly supported a definition comprising eight robust Group 3/Group 4 subtypes (types I-VIII). Subtype II was consistently identified across all component studies, while all others were supported by multiple class-definition methods. Regardless of analytical technique, increasing cohort size did not further increase the number of identified Group 3/Group 4 subtypes. Summarizing the molecular and clinico-pathological features of these eight subtypes indicated enrichment of specific driver gene alterations and cytogenetic events amongst subtypes, and identified highly disparate survival outcomes, further supporting their biological and clinical relevance. Collectively, this study provides continued support for consensus Groups 3 and 4 while enabling robust derivation of, and categorical accounting for, the extensive intertumoral heterogeneity within Groups 3 and 4, revealed by recent high-resolution subclassification approaches. Furthermore, these findings provide a basis for application of emerging methods (e.g., proteomics/single-cell approaches) which may additionally inform medulloblastoma subclassification. Outputs from this study will help shape definition of the next generation of medulloblastoma clinical protocols and facilitate the application of enhanced molecularly guided risk stratification to improve outcomes and quality of life for patients and their families.
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000143580 7001_ $$aSchwalbe, Edward C$$b1
000143580 7001_ $$aWilliamson, Daniel$$b2
000143580 7001_ $$0P:(DE-He78)45440b44791309bd4b7dbb4f73333f9b$$aSill, Martin$$b3
000143580 7001_ $$aHovestadt, Volker$$b4
000143580 7001_ $$aMynarek, Martin$$b5
000143580 7001_ $$aRutkowski, Stefan$$b6
000143580 7001_ $$aRobinson, Giles W$$b7
000143580 7001_ $$aGajjar, Amar$$b8
000143580 7001_ $$aCavalli, Florence$$b9
000143580 7001_ $$aRamaswamy, Vijay$$b10
000143580 7001_ $$aTaylor, Michael D$$b11
000143580 7001_ $$aLindsey, Janet C$$b12
000143580 7001_ $$aHill, Rebecca M$$b13
000143580 7001_ $$0P:(DE-He78)bff9e3e3d86865d2b0836bb8f3ce98f3$$aJäger, Natalie$$b14
000143580 7001_ $$0P:(DE-He78)8d9c904a6cea14d4c99c78ba46e41f93$$aKorshunov, Andrey$$b15
000143580 7001_ $$aHicks, Debbie$$b16
000143580 7001_ $$aBailey, Simon$$b17
000143580 7001_ $$0P:(DE-He78)4c28e2aade5f44d8eca9dd8e97638ec8$$aKool, Marcel$$b18
000143580 7001_ $$aChavez, Lukas$$b19
000143580 7001_ $$aNorthcott, Paul A$$b20
000143580 7001_ $$0P:(DE-He78)f746aa965c4e1af518b016de3aaff5d9$$aPfister, Stefan$$b21$$eLast author
000143580 7001_ $$aClifford, Steven C$$b22
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