Abstract

BackgroundIdentification of biomarkers associated with the prognosis of different cancer subtypes is critical to achieve better therapeutic assistance. In colorectal cancer (CRC) the discovery of stable and consistent survival markers remains a challenge due to the high heterogeneity of this class of tumors. In this work, we identified a new set of gene markers for CRC associated to prognosis and risk using a large unified cohort of patients with transcriptomic profiles and survival information.ResultsWe built an integrated dataset with 1273 human colorectal samples, which provides a homogeneous robust framework to analyse genome-wide expression and survival data. Using this dataset we identified two sets of genes that are candidate prognostic markers for CRC in stages III and IV, showing either up-regulation correlated with poor prognosis or up-regulation correlated with good prognosis. The top 10 up-regulated genes found as survival markers of poor prognosis (i.e. low survival) were: DCBLD2, PTPN14, LAMP5, TM4SF1, NPR3, LEMD1, LCA5, CSGALNACT2, SLC2A3 and GADD45B. The stability and robustness of the gene survival markers was assessed by cross-validation, and the best-ranked genes were also validated with two external independent cohorts: one of microarrays with 482 samples; another of RNA-seq with 269 samples. Up-regulation of the top genes was also proved in a comparison with normal colorectal tissue samples. Finally, the set of top 100 genes that showed overexpression correlated with low survival was used to build a CRC risk predictor applying a multivariate Cox proportional hazards regression analysis. This risk predictor yielded an optimal separation of the individual patients of the cohort according to their survival, with a p-value of 8.25e-14 and Hazard Ratio 2.14 (95% CI: 1.75–2.61).ConclusionsThe results presented in this work provide a solid rationale for the prognostic utility of a new set of genes in CRC, demonstrating their potential to predict colorectal tumor progression and evolution towards poor survival stages. Our study does not provide a fixed gene signature for prognosis and risk prediction, but instead proposes a robust set of genes ranked according to their predictive power that can be selected for additional tests with other CRC clinical cohorts.

Highlights

  • Identification of biomarkers associated with the prognosis of different cancer subtypes is critical to achieve better therapeutic assistance

  • The results presented in this work provide a solid rationale for the prognostic utility of a new set of genes in colorectal cancer (CRC), demonstrating their potential to predict colorectal tumor progression and evolution towards poor survival stages

  • Our study does not provide a fixed gene signature for prognosis and risk prediction, but instead proposes a robust set of genes ranked according to their predictive power that can be selected for additional tests with other CRC clinical cohorts

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Summary

Introduction

Identification of biomarkers associated with the prognosis of different cancer subtypes is critical to achieve better therapeutic assistance. The heterogeneity of CRC increases the complexity of this tumoral pathology, making subtyping and stratification a difficult task for therapeutic decisions. In this way, personalized medicine for CRC is becoming increasingly needed, especially for targeted therapies where large variations between individual’s treatment responses exist [1, 2]. In this context, the need to find robust gene markers associated with specific subtypes of CRC led us to this study. The specific purpose of our work was to find consistent biomolecular targets that, together to facilitate samples stratification, could be related to the prognosis of the disease using survival data

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