With the help of his team, Raphael Bueno, the Director of the Thoracic Surgery Residency Program at Brigham and Women’s Hospital in Boston, MA, has developed a new test that could prove useful for mesothelioma patients considering surgery. The new test would help to qualify patients for surgery more accurately, indicating them as either more or less likely to be good outcome patients, that is, patients with a longer survival time after surgery.
Typically, to better understand a patient’s prognosis, the doctor weighs a few different factors including the cancer’s stage, whether it can be removed, the appearance of the malignant cells under a microscope, and whether the cancer has spread to the lymph nodes. Unfortunately, these examinations themselves can involve invasive procedures, and all just to better understand how beneficial surgery might actually be.
Raphael Bueno says “Usually you need major surgery to determine the stage which can help predict outcome.”
Raphael and his team have been working to uncover less invasive ways to predict the results of major surgery. Some gene based methods for understanding the behaviors of certain cancers do exist, but their test results are difficult to duplicate due to their inherent complexity which involves the analysis of huge data sets.
Fortunately, Dr Bueno’s team has developed a simpler test, which, while it also uses gene comparison, compares the ratios of just four gene sets making it considerably less complex than other techniques. The four key genes were selected by comparing gene sets of mesothelioma patients who had good outcomes after surgery against patients who had poor outcomes.
The test appears to be very effective. In a study performed to better understand the accuracy of the test, tissue samples from 120 mesothelioma patients preparing to undergo surgery were analyzed, and the results used to place the patients in either a “good outcome” or “poor outcome” group. The patients themselves were then carefully observed after their surgery to determine the success of the procedure. The results showed that members of the “poor outcome” group survived an average of 9.5 months, while members of the “good outcome” group survived a substantially greater 16.8 months, corroborating the accuracy of the gene test.
According to the authors of a study concerning the test published in the May 6 Journal of the National Cancer Institute, the test could prove useful to mesothelioma patients who are weighing their treatment options. The study states:
“Patients whose gene ratio test results predict a good prognosis after surgery may more confidently select the treatment option that includes surgery. Patients assigned to the predicted poor outcome group…could be counseled to forgo surgery, which would not benefit them, and to seek best supportive care.”
By preventing surgeries that could shorten a patient’s survival expectancy and promoting those that would benefit patients, the test is expected to improve overall survival for mesothelioma patients.
Source: Gordon GJ, Dong L, Yeap BY, Richards WG, Glickman JN, Edenfield H, Mani M, Colquitt R, Maulik G, Van Oss B, Sugarbaker DJ, Bueno R. Four-gene expression ratio test for survival in patients undergoing surgery for mesothelioma. Journal of the National Cancer Institute. 2009;101:678-686.
