Validation of Prognostic and Diagnostic molecular tests in Mesothelioma

恶性胸膜间皮瘤（MPM）是一种高度致命的癌症，缺乏有效的治疗。 即使是治疗这种恶性肿瘤的基本要素，如快速诊断和准确诊断， 预后仍然具有挑战性，需要积极的手术摘除以确定分期， 预后我们以前描述了一种新的技术，使用基因表达率翻译整个 将基因组表达研究转化为临床相关测试，可以准确预测许多临床参数 例如癌症诊断和预后。具体来说，我们开发了一个测试来区分MPM 以及另一项预测MPM患者手术结果的测试。这些基于比率的 测试需要少量的肿瘤RNA，以统计学显著的方式预测诊断， 接受MPM手术的患者的临床结局。 我们建议通过鉴定额外的基因来扩大这些检测的诊断能力， 一旦怀疑MPM，就应进行正确诊断。这种方法可以作为基因组的模板。 鉴别诊断算法是病理学的辅助工具。然后，我们将完善和验证这些测试， 更多的标本。我们还建议改进和发展方法学， 微创或同时使用图像引导细针抽吸可以适当地测试。 为了将预后和诊断测试带到床边，它们需要与实际患者相关 管理，标准化和验证，最好是在多中心环境中。我们建议 前瞻性验证细针穿刺和微创活检的预后测试， 在我们机构的临床试验和多中心研究中前瞻性地招募了额外的患者。 这项拟议的工作将利用新技术，可以测量整个基因组的表达（RNA）。 肿瘤基因组，以开发新的测试，可以很容易地应用于患者。除了提供新的测试之外， 这将改变MPM患者的管理-最终使手术诊断变得不必要， 挽救某些病人不必要的大手术-这项工作将使我们能够开发一种诊断， 预后和治疗指导平台，最终可用于其他癌症和人类 疾病，以允许针对癌症和其他疾病的个体基因组定向治疗。

Malignant pleural mesothelioma (MPM) is a highly lethal cancer for which effective therapy is lacking. Even the basic elements to treatment for this malignancy such as expedient diagnosis and accurate prognosis remain challenging and aggressive surgical extirpation is required for definitive staging and prognosis. We have previously described a novel technique using gene expression ratios to translate whole genome expression studies into clinically relevant tests that can accurately predict many clinical parameters such as diagnosis and prognosis in cancers. Specifically, we developed a test to distinguish between MPM and lung cancer and another test to,predict outcome in MPM patients undergoing surgery. These ratio-based tests require small amounts of tumor RNA, to predict in a statistically significant manner diagnosis as well as clinical outcome for patients undergoing surgery for MPM. We propose to expand the diagnostic capability of these tests by identifying additional genes to make the correct diagnosis whenever MPM is suspected. This methodology can serve as a template for a genomic . differential diagnosis algorithm to be an adjunct for pathology. We will then refine and validate these tests on additional specimens. We also propose to refine and develop the methodology so that specimens obtained minimally invasively or while using image-guided fine needle aspiration can be appropriately tested. To bring the prognostic and diagnostic tests to bedside they need to be made relevant to actual patient management, be standardized and be validated, preferably in a multi-center setting. We propose to prospectively validate the prognostic tests both with fine needle aspiration and minmally invasive biopsies in additional patients enrolled prospectively in clinical trials at our institution and in a multi center study. The proposed work will capitalize on new technology that can measure the expression (RNA) of the entire tumor genome to develop new tests that can be easily applied to patients. In addition to providing new tests that will alter the management of MPM patients--by eventually making surgery for diagnosis unecessary and save certain patientsfrom unecessary major surgery- this work will allow us to develop a diagnostic, prognostic and treatment directing platform that can be ultimately used for other cancers and human diseases to allow individual genome directed therapy for cancer and other diseases.