A four-gene expression ratio test prospectively distinguished mesothelioma patients who had a statistically significant longer overall survival from those who had shorter survival in a single-institution study.
There are few effective treatment options available for patients with malignant pleural mesothelioma other than surgery. However, not all patients appear to derive benefit from surgery. Raphael Bueno, M.D., of the Brigham and Women's Hospital in Boston and colleagues showed in retrospective studies that measuring expression ratios of four genes could distinguish between those who have a good prognosis after surgery and those who have a poor prognosis.
In the current study, Bueno and colleagues tested the four-gene expression ratio test in 120 patients with mesothelioma who were treated at Brigham and Women's Hospital and participated in a prospective clinical trial. To evaluate the robustness and reproducibility of the test, the researchers evaluated the test on multiple tumor samples from each patient and used two different microarray platforms and two different biopsy techniques.
The test was able to predict overall survival after adjusting for other clinical factors. The test results were consistent for individual patients regardless of the techniques used for the test. When the researchers combined the gene ratio test results with known prognostic factors, they were able to separate patients into high-risk and low-risk groups. The median survival for patients in the high-risk group was 6.9 months compared with 31.9 months in the low-risk group.
"Patients whose gene ratio test results predict a good prognosis after surgery may more confidently select the treatment option that includes surgery," the authors write.
This research was published in the Journal of the National Cancer Institute on April 28, 2009.
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