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Many cancers can be cured by surgery and/or systemic therapies when detected before they have metastasized. This clinical reality, coupled with the growing appreciation that cancer's rapid genetic evolution limits its response to drugs, have fueled interest in methodologies for earlier detection of the disease. Cohen et al. developed a noninvasive blood test, called CancerSEEK that can detect eight common human cancer types (see the Perspective by Kalinich and Haber). The test assesses eight circulating protein biomarkers and tumor-specific mutations in circulating DNA. In a study of 1000 patients previously diagnosed with cancer and 850 healthy control individuals, CancerSEEK detected cancer with a sensitivity of 69 to 98% (depending on cancer type) and 99% specificity. Science , this issue p. 926 ; see also p. 866 A blood test that combines protein and DNA markers may allow earlier detection of eight common cancer types. Earlier detection is key to reducing cancer deaths. Here, we describe a blood test that can detect eight common cancer types through assessment of the levels of circulating proteins and mutations in cell-free DNA. We applied this test, called CancerSEEK, to 1005 patients with nonmetastatic, clinically detected cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung, or breast. CancerSEEK tests were positive in a median of 70% of the eight cancer types. The sensitivities ranged from 69 to 98% for the detection of five cancer types (ovary, liver, stomach, pancreas, and esophagus) for which there are no screening tests available for average-risk individuals. The specificity of CancerSEEK was greater than 99%: only 7 of 812 healthy controls scored positive. In addition, CancerSEEK localized the cancer to a small number of anatomic sites in a median of 83% of the patients.

Current non-invasive approaches for detection of urothelial cancers are suboptimal. We developed a test to detect urothelial neoplasms using DNA recovered from cells shed into urine. UroSEEK incorporates massive parallel sequencing assays for mutations in 11 genes and copy number changes on 39 chromosome arms. In 570 patients at risk for bladder cancer (BC), UroSEEK was positive in 83% of those who developed BC. Combined with cytology, UroSEEK detected 95% of patients who developed BC. Of 56 patients with upper tract urothelial cancer, 75% tested positive by UroSEEK, including 79% of those with non-invasive tumors. UroSEEK detected genetic abnormalities in 68% of urines obtained from BC patients under surveillance who demonstrated clinical evidence of recurrence. The advantages of UroSEEK over cytology were evident in low-grade BCs; UroSEEK detected 67% of cases whereas cytology detected none. These results establish the foundation for a new non-invasive approach for detection of urothelial cancer.

Determining the etiologic basis of the mutations that are responsible for cancer is one of the fundamental challenges in modern cancer research. Different mutational processes induce different types of DNA mutations, providing ‘mutational signatures’ that have led to key insights into cancer etiology. The most widely used signatures for assessing genomic data are based on unsupervised patterns that are then retrospectively correlated with certain features of cancer. We show here that supervised machine-learning techniques can identify signatures, called SuperSigs, that are more predictive than those currently available. Surprisingly, we found that aging yields different SuperSigs in different tissues, and the same is true for environmental exposures. We were able to discover SuperSigs associated with obesity, the most important lifestyle factor contributing to cancer in Western populations.

A Molecular Features Set (MFS), is a result of a vast diversity of bioinformatics pipelines. The lack of a \"gold standard\" for most experimental data modalities makes it difficult to provide valid estimation for a particular MFS's quality. Yet, this goal can partially be achieved by analyzing inner-sample Distance Matrices (DM) and their power to distinguish between phenotypes. The quality of a DM can be assessed by summarizing its power to quantify the differences of inner-phenotype and outer-phenotype distances. This estimation of the DM quality can be construed as a measure of the MFS's quality.  Here we propose Hobotnica, an approach to estimate MFSs quality by their ability to stratify data, and assign them significance scores, that allow for collating various signatures and comparing their quality for contrasting groups.

Background: Despite the growing acceptance of uterine artery embolization (UAE) to treat women with fibroid disease, its wider use remains limited because it is not considered to be a definitive therapy, as opposed to surgical treatments such as myomectomy or hysterectomy. Given the evolution of health care towards outpatient medicine, it is critical to determine the impact of UAE on the quality of life (QoL) of women with fibroid disease treated in an outpatient setting. Objectives: The purpose of this study was to assess the QoL of patients with fibroids treated with UAE in an office-based lab setting. Study Design: This prospective single-arm study was approved by the western IRB (wIRB) and included 1285 consecutive patients—the largest study on UAE to date—enrolled from September 2021 to December 2023 who were seen for a baseline evaluation in a clinic and then, subsequently, between 2 and 8 months post-UAE for follow-up clinical and imaging evaluation. Patient QoL was assessed using the validated QoL questionnaire: the Uterine Fibroid Symptom and Health-Related Quality of Life questionnaire. Results: The results from all 1285 patients were analyzed. The median and mean follow-up periods were 182 and 180 days, respectively (interquartile range of 19 days). UAE led to reduced bleeding in 96% of patients, pelvic pain and bulk-related symptoms in 94%, fatigue in 94%, and urination frequency in 92%. On the other hand, improvements were seen in the level of activity in 82%, energy and mood in 85%, and sexual function in 71% of the patients, whereas the general QoL index significantly increased in 86% of the patients (p < 0.001). More than one third of our patients (39%) had Medicaid insurance, reflecting the relatively low socioeconomic status of our patient population. Conclusions: In this largest clinical trial on UAE to date, we found that performing UAE in an outpatient setting significantly improved patients’ clinical symptoms such as bleeding and bulk symptoms and, most importantly, their overall QoL.

Background A major challenge in computational biology is to extract knowledge about the genetic nature of disease from high-throughput data. However, an important obstacle to both biological understanding and clinical applications is the \"black box\" nature of the decision rules provided by most machine learning approaches, which usually involve many genes combined in a highly complex fashion. Achieving biologically relevant results argues for a different strategy. A promising alternative is to base prediction entirely upon the relative expression ordering of a small number of genes. Results We present a three-gene version of \"relative expression analysis\" ( RXA ), a rigorous and systematic comparison with earlier approaches in a variety of cancer studies, a clinically relevant application to predicting germline BRCA1 mutations in breast cancer and a cross-study validation for predicting ER status. In the BRCA1 study, RXA yields high accuracy with a simple decision rule: in tumors carrying mutations, the expression of a \"reference gene\" falls between the expression of two differentially expressed genes, PPP1CB and RNF14 . An analysis of the protein-protein interactions among the triplet of genes and BRCA 1 suggests that the classifier has a biological foundation. Conclusion RXA has the potential to identify genomic \"marker interactions\" with plausible biological interpretation and direct clinical applicability. It provides a general framework for understanding the roles of the genes involved in decision rules, as illustrated for the difficult and clinically relevant problem of identifying BRCA 1 mutation carriers.

Analysis of gene sets can implicate activity in signaling pathways that is responsible for cancer initiation and progression, but is not discernible from the analysis of individual genes. Multiple methods and software packages have been developed to infer pathway activity from expression measurements for set of genes targeted by that pathway. Broadly, three major methodologies have been proposed: over-representation, enrichment, and differential variability. Both over-representation and enrichment analyses are effective techniques to infer differentially regulated pathways from gene sets with relatively consistent differentially expressed (DE) genes. Specifically, these algorithms aggregate statistics from each gene in the pathway. However, they overlook multivariate patterns related to gene interactions and variations in expression. Therefore, the analysis of differential variability of multigene expression patterns can be essential to pathway inference in cancers. The corresponding methodologies and software packages for such multivariate variability analysis of pathways are reviewed here. We also introduce a new, computationally efficient algorithm, expression variation analysis (EVA), which has been implemented along with a previously proposed algorithm, Differential Rank Conservation (DIRAC), in an open source R package, gene set regulation (GSReg). EVA inferred similar pathways as DIRAC at reduced computational costs. Moreover, EVA also inferred different dysregulated pathways than those identified by enrichment analysis.

Background A small number of prognostic and predictive tests based on gene expression are currently offered as reference laboratory tests. In contrast to such success stories, a number of flaws and errors have recently been identified in other genomic-based predictors and the success rate for developing clinically useful genomic signatures is low. These errors have led to widespread concerns about the protocols for conducting and reporting of computational research. As a result, a need has emerged for a template for reproducible development of genomic signatures that incorporates full transparency, data sharing and statistical robustness. Results Here we present the first fully reproducible analysis of the data used to train and test MammaPrint, an FDA-cleared prognostic test for breast cancer based on a 70-gene expression signature. We provide all the software and documentation necessary for researchers to build and evaluate genomic classifiers based on these data. As an example of the utility of this reproducible research resource, we develop a simple prognostic classifier that uses only 16 genes from the MammaPrint signature and is equally accurate in predicting 5-year disease free survival. Conclusions Our study provides a prototypic example for reproducible development of computational algorithms for learning prognostic biomarkers in the era of personalized medicine.

A Molecular Features Set (MFS), is a result of a vast diversity of bioinformatics pipelines. The lack of a \"gold standard\" for most experimental data modalities makes it difficult to provide valid estimation for a particular MFS's quality. Yet, this goal can partially be achieved by analyzing inner-sample Distance Matrices (DM) and their power to distinguish between phenotypes. The quality of a DM can be assessed by summarizing its power to quantify the differences of inner-phenotype and outer-phenotype distances. This estimation of the DM quality can be construed as a measure of the MFS's quality.  Here we propose Hobotnica, an approach to estimate MFSs quality by their ability to stratify data, and assign them significance scores, that allow for collating various signatures and comparing their quality for contrasting groups.