Genetic and Epigenetic Alterations of TERT Are Associated with Inferior Outcome in Adolescent and Young Adult Patients with Melanoma

• Type of Material: Article
• Authors: Brittani Seynnaeve, University of Pittsburgh; Seungjae Lee, St Jude Children's Research Hospital; Sumit Borah, St Jude Children's Research Hospital; Yongseok Park, University of Pittsburgh; Alberto Pappo, St Jude Children's Research Hospital; John M. Kirkwood, University of Pittsburgh; Armita Bahrami, Emory University
• Language: English
• Date: 2017-04-05
• Publisher: NATURE PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © 2017, The Author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1038/srep45704
• Title of Journal or Parent Work: SCIENTIFIC REPORTS
• Volume: 7
• Issue: 1
• Start Page: 45704
• End Page: 45704
• Grant/Funding Information: This research was supported by the National Institutes of Health (National Cancer Institute P30CA021765 and 5T32CA175294-02, and by ALSAC.
• Keywords: CHILDHOOD; PROMOTER MUTATIONS; PEDIATRIC MELANOMA; Multidisciplinary Sciences; CANCER INCIDENCE; BRAF; AFFORDABLE CARE ACT; CUTANEOUS MELANOMA; UNITED-STATES; TUMORS; Science & Technology - Other Topics; CLINICOPATHOLOGICAL FEATURES; Science & Technology
• Research Categories: Health Sciences, Oncology; Biology, Genetics; Health Sciences, Human Development

Abstract

Progression of melanoma to distant sites in adolescents and young adults (AYAs) is not reliably predicted by clinicopathologic criteria. TERT promoter mutations when combined with BRAF/NRAS mutations correlate with adverse outcome in adult melanoma. To determine the prognostic value of TERT alterations in AYA melanoma, we investigated the association of TERT promoter mutations, as well as promoter methylation, an epigenetic alteration also linked to TERT upregulation, with TERT mRNA expression and outcome using a well-characterized cohort of 27 patients with melanoma (ages 8-25, mean 20). TERT mRNA expression levels were significantly higher in tumors harboring TERT promoter mutation and/or hypermethylation than those without either aberration (P = 0.046). TERT promoter mutations alone did not predict adverse outcomes (P = 0.50), but the presence of TERT promoter methylation, alone or concurrent with promoter mutations, correlated with reduced recurrence-free survival (P = 0.001). These data suggest that genetic and epigenetic alterations of TERT are associated with TERT upregulation and may predict clinical outcomes in AYA melanoma. A more exhaustive understanding of the different molecular mechanisms leading to increased TERT expression may guide development of prognostic assays to stratify AYA melanoma patients according to clinical risk.