title: A 41-gene signature derived from breast cancer stem cells as a predictor of survival.
abstract: OBJECTIVE
  The aim of this study was to evaluate the ability of a 41-gene signature derived from breast cancer stem cells (BCSCs) to estimate the risk of metastasis and survival in breast cancer patients.
  
  
  METHODS
  The centroid expression of the 41-gene signature derived from BCSCs was applied as the threshold to classify patients into two separate groups--patients with high expression (high-EL) of the prognostic signature and patients with low expression (low-EL). The predictive ability of the 41-gene signature was evaluated by Cox regression model and was compared against other popular tests, such as Oncotype and MammaPrint.
  
  
  RESULTS
  Our results showed that the 41-gene prognostic signature was significantly associated with age (P = .0351) and ER status (P = .0095). The analysis indicated that patients in the high-EL group had a worse prognosis than those in the low-EL group in terms of both overall survival (OS: HR, 2.05, P = .009) and distant metastasis-free survival (DMFS: HR, 2.24, P = .002). Additionally, the 41-gene signature was an independent risk factor and separates patients based on estrogen receptor status. While comparable to Oncotype, the analysis demonstrated that the 41-gene signature had a better prognostic value in predicting DMFS and OS than AOL, NPI, St. Gallen, Veridex, and MammaPrint.
  
  
  CONCLUSIONS
  This study confirms the utility of the 41-gene signature and adds to the growing evidence that gene expression signatures of BCSCs have clinical potential to predict patient outcome and aid in treatment choice.
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Yin
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Liu
authors.forename: Ying-Chun
authors.initials: YC
authors.lastname: Xu
authors.forename: Jian
authors.initials: J
authors.lastname: Yu
authors.forename: Guo-Hui
authors.initials: GH
authors.lastname: Ding
authors.forename: Feng
authors.initials: F
authors.lastname: Yang
authors.forename: Lei
authors.initials: L
authors.lastname: Tang
authors.forename: Bao-Hong
authors.initials: BH
authors.lastname: Liu
authors.forename: Yue
authors.initials: Y
authors.lastname: Ma
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Xia
authors.forename: Xiao-Lin
authors.initials: XL
authors.lastname: Lin
authors.affiliation: Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China. whx365@126.com.
authors.forename: Hong-Xia
authors.initials: HX
authors.lastname: Wang
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology*; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D009362:Neoplasm Metastasis; D014411:Neoplastic Stem Cells / Q000502:physiology*; D057285:Precision Medicine / Q000379:methods; D011379:Prognosis; D016019:Survival Analysis