Prognostic role of H3K27M mutation, histone H3K27 methylation status, and EZH2 expression in diffuse spinal cord gliomas


The objective of this study is to clarify clinical significance of the H3F3A K27M mutation (H3K27M) and analyze the correlation between H3K27M, H3K27me3 status, and EZH2 expression and prognosis in spinal cord gliomas. Patients with spinal cord diffuse glioma regardless of World Health Organization (WHO) grade underwent genetic analysis for H3F3A, HIST1H3B, TERT promoter, IDH1/2, and BRAF. H3K27me3 status and EZH2 expression were analyzed through immunohistochemistry. Thereafter, the association between H3K27M, H3K27me3 status, and EZH2 expression and prognosis was retrospectively analyzed using the log-rank test. A total of 26 cases, 5 with WHO grade 4, 9 with grade 3, and 12 with grade 2 glioma, were analyzed. Although WHO grade 2 cases tended to present favorable overall survival, the difference was not statistically significant. H3K27M, which was detected in four grade 4 cases (80%) and three grade 3 cases (33%), was not associated with prognosis among grade 3 and 4 cases. Among WHO grade 2–4 cases, the combination of retained H3K27me3 and negative EZH2 expression was correlated with favorable overall survival (p = 0.03). The combination of H3K27me3 status and EZH2 expression was considered as a potential prognostic marker in WHO grade 2–4 diffuse spinal cord gliomas.

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Fig. 1.
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Diffuse midline glioma


Formalin-fixed paraffin embedded




Histone H3K27M mutation


Hematoxylin and eosin


Immunohistochemical staining


Lysine-specific demethylase 6A


Methylguanine methyltransferase


Magnetic resonance imaging


Overall survival


Polycomb repressive complex 2




World Health Organization


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The authors would like to thank Enago ( for the English review.

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Correspondence to Shigeru Yamaguchi.

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Ishi, Y., Takamiya, S., Seki, T. et al. Prognostic role of H3K27M mutation, histone H3K27 methylation status, and EZH2 expression in diffuse spinal cord gliomas. Brain Tumor Pathol 37, 81–88 (2020).

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  • Spinal cord
  • Glioma
  • H3F3A
  • H3K27me3
  • EZH2