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The overall median frequency of mutations was 0.5/Mb, which is in contrast to overall mutation rate of other cancers such as melanoma (14.4/Mb) (15), colorectal cancer (9.9-11.6/Mb) (16) or lung cancer (7.2/Mb) (17). High-mutational burden is a well-established predictive biomarker for checkpoint inhibition in several cancers (18); however, the scarcity of mutations in testicular cancer suggests a low probability to achieve a treatment effect with such agents. The methylation patterns in nonseminoma were consistent with silencing of important tumor-suppressor genes such as BRCA1, RAD51C, MGMT and RASSF1A (all involved in DNA repair pathways). Landscape of tumor mutation load, mismatch repair deficiency, and PD-L1 expression in a large patient cohort of gastrointestinal cancers.