RESUMEN
BACKGROUND AND AIMS: Therapeutic, clinical trial entry and stratification decisions for hepatocellular carcinoma (HCC) are made based on prognostic assessments, using clinical staging systems based on small numbers of empirically selected variables that insufficiently account for differences in biological characteristics of individual patients' disease. APPROACH AND RESULTS: We propose an approach for constructing risk scores from circulating biomarkers that produce a global biological characterization of individual patient's disease. Plasma samples were collected prospectively from 767 patients with HCC and 200 controls, and 317 proteins were quantified in a Clinical Laboratory Improvement Amendments-certified biomarker testing laboratory. We constructed a circulating biomarker aberration score for each patient, a score between 0 and 1 that measures the degree of aberration of his or her biomarker panel relative to normal, which we call HepatoScore. We used log-rank tests to assess its ability to substratify patients within existing staging systems/prognostic factors. To enhance clinical application, we constructed a single-sample score, HepatoScore-14, which requires only a subset of 14 representative proteins encompassing the global biological effects. Patients with HCC were split into three distinct groups (low, medium, and high HepatoScore) with vastly different prognoses (medial overall survival 38.2/18.3/7.1 months; P < 0.0001). Furthermore, HepatoScore accurately substratified patients within levels of existing prognostic factors and staging systems (P < 0.0001 for nearly all), providing substantial and sometimes dramatic refinement of expected patient outcomes with strong therapeutic implications. These results were recapitulated by HepatoScore-14, rigorously validated in repeated training/test splits, concordant across Myriad RBM (Austin, TX) and enzyme-linked immunosorbent assay kits, and established as an independent prognostic factor. CONCLUSIONS: HepatoScore-14 augments existing HCC staging systems, dramatically refining patient prognostic assessments and therapeutic decision making and enrollment in clinical trials. The underlying strategy provides a global biological characterization of disease, and can be applied broadly to other disease settings and biological media.
Asunto(s)
Biomarcadores de Tumor/sangre , Carcinoma Hepatocelular/sangre , Neoplasias Hepáticas/sangre , Índice de Severidad de la Enfermedad , Carcinoma Hepatocelular/patología , Estudios de Casos y Controles , Femenino , Humanos , Neoplasias Hepáticas/patología , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Factores de RiesgoRESUMEN
Convex clustering is a promising new approach to the classical problem of clustering, combining strong performance in empirical studies with rigorous theoretical foundations. Despite these advantages, convex clustering has not been widely adopted, due to its computationally intensive nature and its lack of compelling visualizations. To address these impediments, we introduce Algorithmic Regularization, an innovative technique for obtaining high-quality estimates of regularization paths using an iterative one-step approximation scheme. We justify our approach with a novel theoretical result, guaranteeing global convergence of the approximate path to the exact solution under easily-checked non-data-dependent assumptions. The application of algorithmic regularization to convex clustering yields the Convex Clustering via Algorithmic Regularization Paths (CARP) algorithm for computing the clustering solution path. On example data sets from genomics and text analysis, CARP delivers over a 100-fold speed-up over existing methods, while attaining a finer approximation grid than standard methods. Furthermore, CARP enables improved visualization of clustering solutions: the fine solution grid returned by CARP can be used to construct a convex clustering-based dendrogram, as well as forming the basis of a dynamic path-wise visualization based on modern web technologies. Our methods are implemented in the open-source R package clustRviz, available at https://github.com/DataSlingers/clustRviz.