Pediatric CNS Cancer Metastasis and the Immune System: A Dynamic Interplay
摘要
Brain tumors continue to be the most common solid tumors in children, accounting for approximately 25% of all pediatric cancers (Heath et al. 2012). Primary malignant central nervous system (CNS) tumors include medulloblastomas, ependymomas, astrocytomas, and germ cell tumors (Bhakta et al. 2019). Primary brain tumors have surpassed leukemia as the leading cause of cancer-related death in children (Thomas et al. 2021). The most common of these tumors is medulloblastoma (MB). MBs most commonly develop in the cerebellum, the bottom part of the brain located behind the skull (Roussel and Hatten 2011). Medulloblastoma is classified as an embryonal neuroepithelial tumor because it develops in fetal cells that survive birth (Kristensen et al. 2019). Classically, medulloblastoma can be categorized into four distinct genetic subgroups: Wingless (WNT) driven, Sonic Hedgehog (SHH) driven, Group 3 (G3), and Group 4 (G4) (Cavalli et al. 2017). Clinical factors such as age, metastasis extent, and scope of surgical resection as well as histological subgrouping (classic, desmoplastic, and large cell anaplastic) are currently used for clinical prognosis and stratification (Taylor et al. 2012). Patients with the localized disease usually successfully undergo treatment with 78% of individuals achieving cancer-free status; albeit at the cost of significant long-term sequelae caused by cytotoxic therapies (Sekeres et al. 2018). The cause of death in medulloblastoma patients is rarely the primary tumor or recurrence at the primary site, but rather metastases at the time of recurrence (Martirosian et al. 2021). Medulloblastoma metastases have been shown to be highly genetically divergent from their matched primary tumors with only a few overlapping molecular signatures (Wu et al. 2012) indicating that molecular targets for therapy are different in metastatic and primary compartments. This emphasizes the role of metastatic disease as the major driver of dismal prognosis in children with medulloblastoma and therefore the need to understand the mechanism of medulloblastoma dissemination and metastasis to identify therapeutic targets.