Gene Test Predicts Survival with Mesothelioma

NEW YORK (Reuters Health) - A 4-gene expression ratio test accurately predicts survival in patients with malignant pleural mesothelioma, according to a report in the May 6th Journal of the National Cancer Institute.

"Molecular profiling may seem complex, but it can be easily simplified for specific cases for clinical use so that any physician can find it useful," Dr. Raphael Bueno from Harvard Medical School, Boston, told Reuters Health.

Dr. Bueno and colleagues used results of a prospective clinical trial to evaluate the ability of the 4-gene expression ratio test to predict overall survival and cancer-specific survival in 120 patients undergoing surgery for malignant pleural mesothelioma.

Patients assigned by the test to the good outcome group had significantly better median overall survival (16.8 months) and median cancer-specific survival (21.9 months) than did patients assigned by the test to the poor outcome group (9.5 months and 15.9 months, respectively), the authors report.

Based on a multivariable analysis, the gene ratio test appeared to provide additional predictive information beyond that provided by current pathological staging methods.

The repeatability of the test results was 88.5% for tumor specimen analyses and 93.4% for pleural biopsy specimens, the researchers note.

Within-patient reproducibility of prognosis predictions was 96.1% using tumor specimens and 94.1% using pleural biopsies.

"Patients assigned to the predicted poor outcome group, particularly when other established prognostic factors such as histology and lymph node status are also suggestive of poor outcome, could be counseled to forgo surgery, which would not benefit them, and to seek best supportive care," the investigators propose."

Patients whose gene ratio test results predict a good prognosis after surgery may more confidently select the treatment option that includes surgery."

Dr. Bueno said that similar tests could prove useful in "lung cancer, bladder cancer, prostate cancer, breast cancer, etc." He added that the test is already being used at their clinical lab.

J Natl Cancer Inst 2009;101:678-686.