e16073 Background: Esophageal squamous cell cancer (ESCC) is a malignant tumor with a poor 5-year relative survival. A prognosis prediction signature associated with DNA Damage Response (DDR) genes in ESCC was explored in this study. Methods: The clinical and gene expression profiles of ESCC patients were downloaded from the GEO and TCGA database. Univariate Cox regression and 1000 iterations of 10-fold cross-validation of LASSO Cox regression with binomial deviance minimization criteria were used to identify DDR genes as potential object and a prognostic signature for ESCC survival prediction, followed by validation of the signature via TCGA cohort and identification of independent prognostic predictors. A nomogram for prognosis prediction was built and Gene Set Enrichment Analysis (GSEA) was performed to further understand the underlying molecular mechanisms. Results: A signature of 8 DDR genes were constructed as being significantly associated with overall survival (OS) among patients with esophageal squamous cell carcinoma. The pronostic signature stratified ESCC patients into low- vs high-risk groups in terms of OS in the training set, testing set and the validation cohorts, and remained as an independent prognostic factor in multivariate analyses (hazard ratio (HR) in training set, 0.17 [95% CI, 0.09-0.35; P < 0 .001], HR in testing set, 0.38 [95% CI, 0.16-0.93; P = 0.029], HR in discovery cohort, 0.171 [95% CI, 0.03-0.48; P < 0 .001]) after adjusting for clinicopathological factors. The 8-DDR gene signature achieved a higher accuracy (C-index, 0.69; AUCs for 1-, 3- and 5-year OS, 0.74, 0.77 and 0.76, respectively) than 7 previously reported multigene signatures (C-index range, 0.53 to 0.60; AUCs range, 0.55to 0.66, 0.54 to 0.64 and 0.62 to 0.66, respectively) for estimation of survival in comparable cohorts. A nomogram incorporating tumor location, grade, adjuvant therapy and signature-based risk group showed better predictive performance for 1- and 3- year survival than for 5 year survival. Moreover, GSEA revealed that the DNA repair was more prominently enriched in the high-risk group while the low-risk group had not enrichment of any process (P > 0.05 for all). Conclusions: Taken together, our study identified 8 DDR genes related to the prognosis of ESCC patients, and constructed a robust prognostic signature to effectively stratify ESCC patients with different survival rates, which may help recognize high-risk patients potentially benefiting from more aggressive treatment.
Identification of a Ten-Gene Signature of DNA Damage Response Pathways with Prognostic Value in Esophageal Squamous Cell Carcinoma
