Integration of genetic signature and TNM staging system for predicting the relapse of locally advanced colorectal cancer

To identify potential genetic markers in treated stage II-III colorectal cancer patients and predict 3-year tumor relapse using statistical models based on important clinical factors and significant genetic markers. Gene expression profiling by cDNA-mediated Annealing, Selection, extension and Ligation assay was performed in a prospectively collected 95 stage II-III colorectal cancer patients with Fluorouracil-based adjuvant chemotherapy. We studied the gene expression level of 502 genes for patients with different outcomes. The prognostic effect of genetic signature was evaluated in multivariate analysis. We further integrated the genetic signature to clinical Classification of Malignant Tumors (TNM) staging system for predicting of 3-year tumor relapse. An 8-gene signature was identified to well discriminate patients with different treatment outcomes. An integrated risk factor, which including 8-gene signature and TNM staging has been developed. ROC curve revealed that our integrated risk factor was better than genetic signature or current sixth edition TNM staging system alone. Our 8-gene signature was promising in predicting 3-year disease-free survival rate for locally advanced colorectal cancer. The integrated risk factor, which combining genetic signature with clinical TNM staging system may further improve the outcome prediction.