Génomique intégrée des tumeurs corticosurrénaliennes : implications cliniques et physiopathologiques

Unilateral adrenocortical tumors are common (prevalence : 2 to 9% of the population). Most of these tumors are adenomas. Adrenocortical cancer (ACC) has a poor prognosis, with a 5-yr survival rate not exceeding 40% in most series. Pathological diagnosis of these tumors relies on several histological features and can be difficult. The prognosis of adrenocortical carcinomas is heterogeneous and unpredictable. Knowledge of the pathophysiology of these tumors is also limited. The genome has a central role in the development of cancers in general. The occurrence of genomic alterations (mutations, abnormal copy number, loss of heterozygosity, translocations, abnormal methylation) will lead to the overexpression of oncogenes and repression of tumor suppressor genes. Genomic approaches became essential to study the pathophysiology of cancer. Transcriptome studies of adrenocortical tumors have shown that the gene expression profile discriminate ACC and adenomas, and identified two distinct groups of ACC with different prognoses. In addition to gene expression, genomics now covers a large spectrum of alterations, including chromosomal alterations, DNA sequence modifications, and epigenetic alterations. I studied chromosomal alterations and DNA methylation abnormalities in ACC during my thesis.In the first part the genome of 38 adrenocortical adenomas and 21 ACC were identified by comparative genomic hybridization arrays. The transcriptome of 54 of these tumors was already available. A larger proportion of the genome is altered in carcinomas compared with adenomas (44 % of the genome is lost or gained, versus 10% for adenomas , p = 2.10-10 ) . In adenomas, the 9q34 region, which includes the steroidogenic factor 1locus, is commonly gained and associated with an overexpression of steroidogenic factor 1 (SF-1). In carcinomas, recurrent gains include chromosomes 5, 7, 12, 16, 19, and 20 and recurrent losses chromosomes 13 and 22. Filtering the genes from these regions according to their expression profile identified genes potentially relevant to adrenocortical tumorigenesis. A diagnostic tool was built by combining DNA copy number estimates at six loci (5q, 7p, 11p, 13q, 16q, and 22q). This tool discriminates carcinomas from adenomas in an independent validation cohort (sensitivity 100%, specificity 83%). In carcinomas, the number of chromosomal alterations was not associated with survival (Cox p=0.84). A prognostic tool based on tumor DNA was designed with a clustering strategy and validated in an independent cohort. In the second part, methylation patterns of CpG islands in promoter regions of 51 adrenocortical carcinomas and 84 adenomas were studied by the Infinium HumanMethylation27 Beadchip (Illumina) . Gene expression data were available for 87 tumors. Methylation was higher in carcinomas than in adenomas (t test : p=3.1x10-9). Unsupervised clustering of DNA methylation profiles identified two groups of carcinomas, one with an elevated methylation level, evoking a CpG island methylator phenotype (CIMP). The subgroup of hypermethylated carcinomas was further divided in two subgroups, with different levels of methylation (CIMP-high and CIMP-low). This classification could be confirmed by methylation-specific multiplex ligation-dependent probe amplification. Hypermethylation was associated with a poor survival (Cox model p= 0.02). The transcriptome/methylation correlation showed 1741 genes (of 12250) negatively correlated; among the top genes were H19 and other tumor suppressors (PLAGL-1, G0S2, and NDRG2). The subgroups identified by the transcriptome adrenocortical have different levels of methylation. In conclusion, genomic alterations discriminate carcinomas from adenomas and contain prognostic information. The subgroups identified by the adrenocortical transcriptome profiles of different genomic alterations. Chromosomal alterations and abnormal methylation alter the expression of genes important for tumorigenesis.