LAUSR

Expert’s summary: Seiler and colleagues recently published a 51-gene signature (KNN51) comprising coding and noncoding transcripts that allows prediction of lymph node (LN) metastases in patients with muscle-invasive bladder cancer (MIBC). To generate their new classifier, they performed whole-transcriptome analysis on RNA isolated from cystectomy specimens from a 133-patient discovery cohort and validated their findings in a validation cohort of 66 patients. Interestingly, none of the 51 genes included in KNN51 overlapped with the 20 genes from a previously published expression signature (20-gene lymph node signature [LN20]) [1]. Moreover, KNN51 greatly outperformed LN20, with an area under the receiver operating characteristic curve of 0.82 versus 0.46. Every 10% increase in the KNN51 score was associated with a significant increase in the presence of LN metastases (odds ratio 2.65, p < 0.001). Thus, KNN51 helps to improve clinical risk stratification for guiding optimal therapy (eg, neoadjuvant chemotherapy [NAC]) for patients with MIBC.