Personalized risk stratification in colorectal cancer via PIANOS system
- Du Cai
- Haoning Qi
- Qiuxia Yang
- Huayu Li
- Chenghang Li
- Chuling Hu
- Baowen Gai
- Xu Zhang
- Yize Mao
- Feng Gao
- Xiaojian Wu
2025-07-16
Current prognostic biomarkers for colorectal cancer (CRC) lack stability and generalizability across different cohorts and platforms, challenging precise patient stratification. Here, we introduce a Platform Independent and Normalization Free Single-sample Classifier (PIANOS), designed to refine treatment decisions by accurately categorizing patients with CRC into distinct risk groups. Developed using gene expression data from 562 patients and employing a rank-based k-Top Scoring Pairs (k-TSP) algorithm alongside resampling, PIANOS was rigorously validated in 15 cohorts comprising 3666 patients with CRC. It effectively differentiates high-risk from low-risk patients, outperforms 105 existing models, and demonstrates robust performance across technologies like microarrays and RNA sequencing. PIANOS-based stratification is validated as an independent predictor of disease-free survival. Moreover, PIANOS discriminates treatment responses across risk categories, with high-risk patients showing increased sensitivity to bevacizumab and low-risk patients exhibiting enhanced responsiveness to chemotherapy and immunotherapy. This study reports significant advancements in supporting clinical decision-making for CRC and provides a reliable framework for optimizing patient treatment strategies.