- Panwalkar, Pooja;
- Clark, Jonathan;
- Ramaswamy, Vijay;
- Hawes, Debra;
- Yang, Fusheng;
- Dunham, Christopher;
- Yip, Stephen;
- Hukin, Juliette;
- Sun, Yilun;
- Schipper, Matthew J;
- Chavez, Lukas;
- Margol, Ashley;
- Pekmezci, Melike;
- Chung, Chan;
- Banda, Adam;
- Bayliss, Jill M;
- Curry, Sarah J;
- Santi, Mariarita;
- Rodriguez, Fausto J;
- Snuderl, Matija;
- Karajannis, Matthias A;
- Saratsis, Amanda M;
- Horbinski, Craig M;
- Carret, Anne-Sophie;
- Wilson, Beverly;
- Johnston, Donna;
- Lafay-Cousin, Lucie;
- Zelcer, Shayna;
- Eisenstat, David;
- Silva, Marianna;
- Scheinemann, Katrin;
- Jabado, Nada;
- McNeely, P Daniel;
- Kool, Marcel;
- Pfister, Stefan M;
- Taylor, Michael D;
- Hawkins, Cynthia;
- Korshunov, Andrey;
- Judkins, Alexander R;
- Venneti, Sriram
Posterior fossa ependymomas (EPN_PF) in children comprise two morphologically identical, but biologically distinct tumor entities. Group-A (EPN_PFA) tumors have a poor prognosis and require intensive therapy. In contrast, group-B tumors (EPN_PFB) exhibit excellent prognosis and the current consensus opinion recommends future clinical trials to test the possibility of treatment de-escalation in these patients. Therefore, distinguishing these two tumor subtypes is critical. EPN_PFA and EPN_PFB can be distinguished based on DNA methylation signatures, but these assays are not routinely available. We have previously shown that a subset of poorly prognostic childhood EPN_PF exhibits global reduction in H3K27me3. Therefore, we set out to determine whether a simple immunohistochemical assay for H3K27me3 could be used to segregate EPN_PFA from EPN_PFB tumors. We assembled a cohort of 230 childhood ependymomas and H3K27me3 immunohistochemistry was assessed as positive or negative in a blinded manner. H3K27me3 staining results were compared with DNA methylation-based subgroup information available in 112 samples [EPN_PFA (n = 72) and EPN_PFB tumors (n = 40)]. H3K27me3 staining was globally reduced in EPN_PFA tumors and immunohistochemistry showed 99% sensitivity and 100% specificity in segregating EPN_PFA from EPN_PFB tumors. Moreover, H3K27me3 immunostaining was sufficient to delineate patients with worse prognosis in two independent, non-overlapping cohorts (n = 133 and n = 97). In conclusion, immunohistochemical evaluation of H3K27me3 global reduction is an economic, easily available and readily adaptable method for defining high-risk EPN_PFA from low-risk posterior fossa EPN_PFB tumors to inform prognosis and to enable the design of future clinical trials.