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Cancer Epidemiol Biomarkers Prev. 2019 Sep 18. pii: cebp.0359.2019. doi: 10.1158/1055-9965.EPI-19-0359. [Epub ahead of print]

A novel scoring system for pivotal autophagy-related genes predicts outcomes after chemotherapy in advanced ovarian cancer patients.

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Department of Toxicology, Zhejiang University School of Public Health.
Pathology, Zhejiang University School of Medicine.
Department of Gynecological Oncology, Zhejiang Cancer Hospital.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine.
Department of Pathology, School of Medicine, Zhejiang University.
Department of Physiology, National University of Singapore.
Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine.
Department of Toxicology of School of Public Health, Zhejiang University School of Public Health



In the clinical practice of ovarian cancer, the application of autophagy, an important regulator of carcinogenesis and chemoresistance, is still limited. This study aimed to establish a scoring system based on expression profiles of pivotal autophagy-related (ATG) genes in stage III/IV ovarian cancer patients who received chemotherapy.


Data of ovarian serous cystadenocarcinoma in The Cancer Genome Atlas (TCGA-OV) were used as training dataset. Two validation datasets comprised patients in a Chinese local database and a dataset from the Gene Expression Omnibus (GEO). ATG genes significantly (P < 0.1) associated with overall survival (OS) were selected and aggregated into an ATG scoring scale, of which the abilities to predict OS and recurrence-free survival (RFS) were examined.


43 autophagy-related genes were selected to develop the ATG score. In TCGA-OV, patients with lower ATG scores had better OS [hazard ratio, 0.41; 95% confidence interval (CI), 0.26-0.65; P < 0.001) and RFS (hazard ratio, 0.47; 95% CI, 0.27-0.82; P = 0.007). After complete or partial remission to primary therapy, the rate of recurrence was 47.2% in the low-score group and 68.3% in the high-score group (odds ratio, 0.42; 95% CI, 0.18-0.92; P = 0.03). Such findings were verified in the two validation datasets.


We established a novel scoring system based on pivotal ATG genes, which accurately predicts the outcomes of advanced ovarian cancer patients after chemotherapy.


The present ATG scoring system may provide a novel perspective and a promising tool for the development of personalized therapy in the future.

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