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Clin Cancer Res. 2009 Dec 15;15(24):7642-7651.

Metastasis-Associated Gene Expression Changes Predict Poor Outcomes in Patients with Dukes Stage B and C Colorectal Cancer.

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Authors' Affiliations: Ludwig Colon Cancer Initiative Laboratory, Ludwig Institute for Cancer Research; Anatomic Pathology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Clinical Pharmacology, University of Oxford, Oxford, United Kingdom; Department of Medical Genetics, Biomedicum, University of Helsinki, Helsinki, Finland; Group of Molecular Oncology, Nanomedicine Research Program, Molecular Biology and Biochemistry Research Center (Centro de Investigación Bioquímica y Biología Molecular), Vall d'Hebron Hospital Research Institute, Barcelona, Spain; Molecular Diagnostic Laboratory, Department of Clinical Biochemistry, Aarhus University Hospital, Skejby, Denmark; and GI Surgical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.



Colorectal cancer prognosis is currently predicted from pathologic staging, providing limited discrimination for Dukes stage B and C disease. Additional markers for outcome are required to help guide therapy selection for individual patients.


A multisite single-platform microarray study was done on 553 colorectal cancers. Gene expression changes were identified between stage A and D tumors (three training sets) and assessed as a prognosis signature in stage B and C tumors (independent test and external validation sets).


One hundred twenty-eight genes showed reproducible expression changes between three sets of stage A and D cancers. Using consistent genes, stage B and C cancers clustered into two groups resembling early-stage and metastatic tumors. A Prediction Analysis of Microarray algorithm was developed to classify individual intermediate-stage cancers into stage A-like/good prognosis or stage D-like/poor prognosis types. For stage B patients, the treatment adjusted hazard ratio for 6-year recurrence in individuals with stage D-like cancers was 10.3 (95% confidence interval, 1.3-80.0; P = 0.011). For stage C patients, the adjusted hazard ratio was 2.9 (95% confidence interval, 1.1-7.6; P = 0.016). Similar results were obtained for an external set of stage B and C patients. The prognosis signature was enriched for downregulated immune response genes and upregulated cell signaling and extracellular matrix genes. Accordingly, sparse tumor infiltration with mononuclear chronic inflammatory cells was associated with poor outcome in independent patients.


Metastasis-associated gene expression changes can be used to refine traditional outcome prediction, providing a rational approach for tailoring treatments to subsets of patients. (Clin Cancer Res 2009;15(24):7642-51).

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