The Prognostic Value and Clinical Utility of the 40-Gene Expression Profile (40-GEP) Test in Cutaneous Squamous Cell Carcinoma: Systematic Review and Meta-Analysis

Razan Masarwy; Shahaf Shilo; Narin Nard Carmel Neiderman; Liyona Kampel; Gilad Horowitz; Nidal Muhanna; Jobran Mansour

doi:10.3390/cancers15092456

The Prognostic Value and Clinical Utility of the 40-Gene Expression Profile (40-GEP) Test in Cutaneous Squamous Cell Carcinoma: Systematic Review and Meta-Analysis

Cancers (Basel). 2023 Apr 25;15(9):2456. doi: 10.3390/cancers15092456.

Authors

Razan Masarwy^{1

2}, Shahaf Shilo^{1

2}, Narin Nard Carmel Neiderman^{1

2}, Liyona Kampel^{1

2}, Gilad Horowitz^{1

2}, Nidal Muhanna^{1

2}, Jobran Mansour^{1

2}

Affiliations

¹ Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel.
² Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.

Abstract

Background: The current tumor staging systems for cutaneous squamous cell carcinoma (cSCC) are considered inadequate and insufficient for evaluating the risk of metastasis and for identifying patients at high risk of cSCC. This meta-analysis aimed to assess the prognostic significance of a 40-gene expression profile (40-GEP) both independently and integrated with clinicopathologic risk factors and established staging systems (American Joint Committee on Cancer, eighth edition (AJCC8) and Brigham and Women's Hospital (BWH)).

Methods: Electronic databases, including PubMed (MEDLINE), Embase, the Cochrane Library, and Google Scholar, were systematically searched to identify cohort studies and randomized controlled trials on evaluations of the prediction value of 40-GEP in cSCC patients up to January 2023. The metastatic risk analysis of a given 40-GEP class combined with tumor stage and/or other clinicopathologic risk factors was based upon log hazard ratios (HRs) and their standard error (SE). Heterogeneity and subgroup analyses were performed, and data quality was assessed.

Results: A total of 1019 patients from three cohort studies were included in this meta-analysis. The overall three-year metastatic-free survival rates were 92.4%, 78.9%, and 45.4% for class 1 (low risk), class 2A (Intermediate risk), and class 2B (high risk) 40-GEP, respectively, indicating a significant variation in survival rates between the risk classification groups. The pooled positive predictive value was significantly higher in class 2B when compared to AJCC8 or BWH. The subgroup analyses demonstrated significant superiority of integrating 40-GEP with clinicopathologic risk factors or AJCC8/BWH, especially for class 2B patients.

Conclusions: The integration of 40-GEP with staging systems can improve the identification of cSCC patients at high risk of metastasis, potentially leading to improved care and outcomes, especially in the high-risk class 2B group.

Keywords: 40-gene expression profile (40-GEP); cutaneous squamous cell carcinoma; metastasis; skin squamous cell carcinoma.

Publication types

Review

Grants and funding

This research received no external funding.