摘要
目的探讨快速检测MYOD1 L122R突变的新方法并分析突变阳性横纹肌肉瘤的临床病理学特征。方法利用等位基因特异性Taqman荧光探针技术开发一种MYOD1突变检测试剂盒,并收集首都医科大学附属北京儿童医院2022年6月至2023年6月诊断为横纹肌肉瘤的80例样本进行测试,同Sanger测序相比较,分析试剂盒灵敏度、特异度和一致性以及MYOD1突变横纹肌肉瘤的临床特征、组织病理学和分子遗传学特征。结果80例横纹肌肉瘤中男性46例,女性34例。发病年龄0~16(6.0±4.4)岁。其中胚胎型32例,腺泡型18例,梭形细胞/硬化性30例。新试剂盒共检出11例突变,其中10例为梭形细胞/硬化性,1例为胚胎型。MYOD1突变患者整体年龄偏大(4例大于10岁),但也可发生在低龄儿童(最小3岁2个月)。原发位于头颈部8例,四肢2例,盆腔1例。6例有明确分期分级信息的初诊患者中,1例2期,5例3期,全部为中危。11例突变患者中,6例出现复发转移,其中3例死亡,其余病例截至末次随访未观测到肿瘤进展。同野生型相比,突变患者的MYOD1表达显著升高(χ^(2)=10.66,P=0.01),无事件生存率(χ^(2)=9.925,P<0.01)和总生存率(χ^(2)=4.53,P=0.03)显著降低。与Sanger测序相比,试剂盒取得了100%的灵敏度和特异度。试剂盒最低可检测到2%含量的突变,最快可2 h完成。此外,本试剂盒还可检测MYOD1表达,用于横纹肌肉瘤辅助诊断。结论开发了一种准确快速检测横纹肌肉瘤MYOD1突变的新方法,尤其适合临床石蜡样本使用。MYOD1突变好发于儿童头颈部位的梭形细胞/硬化性横纹肌肉瘤,患者预后极差,与分期分级无关。横纹肌肉瘤中开展MYOD1突变检测具有重要辅助诊断和预后指导价值。
ObjectiveTo investigate a new method for rapid detection of the MYOD1 L122R mutation and to analyze the clinical and pathological characteristics of mutation-positive rhabdomyosarcoma.MethodsA MYOD1 mutation detection kit was developed using allele-specific Taqman fluorescence probe technology.A total of 80 rhabdomyosarcoma samples diagnosed at Beijing Children′s Hospital,Capital Medical University from June 2022 to June 2023 were collected for testing.The detection sensitivity,specificity,and consistency rate of the kit were compared with those of the gold standard Sanger sequencing.The demographic,histopathological,and molecular genetic characteristics of patients with MYOD1 mutations were analyzed.ResultsAmong the 80 rhabdomyosarcoma cases,there were 46 males and 34 females,with an age of onset ranging from 0 to 16 years[mean(6.0±4.4)years],including 32 embryonal rhabdomyosarcoma,18 alveolar rhabdomyosarcoma,and 30 spindle cell/sclerosing rhabdomyosarcoma.The new kit screened a total of 11 mutations,of which 10 were spindle cell/sclerosing rhabdomyosarcoma and one was embryonal rhabdomyosarcoma.Patients with MYOD1 mutations were typically older(four cases over 10 years old)but could also occur in young children(the youngest being 3-year and 2-month-old).The primary sites were the head and neck region in eight cases,limbs in two cases,and pelvic cavity in one case.Among the six patients with available staging information at initial diagnosis,one was classified as stage 2 and five were stage 3,all of which were intermediate risk.Among the 11 mutation patients,six had recurrence and metastasis,with three deaths;the remaining patients had not shown tumor progression until last follow-up.Compared with the wild type group,the expression level of MYOD1 in mutation patients increased significantly(χ^(2)=10.66,P=0.01),while the event-free survival rate(χ^(2)=9.925,P<0.01)and overall survival(χ^(2)=4.53,P=0.03)rate decreased.Compared with Sanger sequencing,the kit achieved 100%sensitivity and specificity.The kit had a minimum mutation content detection limit of 2%and the reaction could be finished within 2 hours.Additionally,this kit might also be used to detect the expression of MYOD1,thereby aiding the diagnosis of rhabdomyosarcoma.ConclusionsThe study has established a new method for accurate and rapid detection of MYOD1 mutation in rhabdomyosarcoma,particularly suitable for the formalin-fixed and paraffin-embedded samples in clinical settings.MYOD1 mutations more likely occur in spindle cell/sclerosing rhabdomyosarcoma of the head and neck region in children.Patients with MYOD1 mutations have an extremely poor prognosis,which is independent of clinical staging and grading.MYOD1 mutation detection in rhabdomyosarcoma has significant value for auxiliary diagnosis and prognostic assessment.
作者
张朦
姚兴凤
张楠
徐佳童
贾超
管晓星
倪鑫
何乐健
Zhang Meng;Yao Xingfeng;Zhang Nan;Xu Jiatong;Jia Chao;Guan Xiaoxing;Ni Xin;He Lejian(Department of Pathology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Otolaryngology Head and Neck Surgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)
出处
《中华病理学杂志》
北大核心
2025年第6期604-611,共8页
Chinese Journal of Pathology
基金
北京研究型病房卓越计划(BRWEP2024W102090104)
北京市属医院科研培育计划(PX2025044)
首都医科大学附属北京儿童医院科技成果转化孵育基金(ZHFY3-1-015⁃06)
首都医科大学附属北京儿童医院苗圃人才项目(3-1-014-01-37)。
