Research Paper Volume 12, Issue 1 pp 35—52

Prognostic value of a hypoxia-related microRNA signature in patients with colorectal cancer

Yongmei Yang1,2, , Ailin Qu1,2, , Qi Wu4, , Xin Zhang1,2, , Lili Wang1,2, , Chen Li3, , Zhaogang Dong1,2, , Lutao Du3, , Chuanxin Wang3, ,

  • 1 Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
  • 2 Key Laboratory of Tumor Marker Translational Medicine, Shandong Provincial Medicine and Health, Jinan 250012, Shandong Province, China
  • 3 Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
  • 4 Department of Blood Transfusion, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China

Received: May 13, 2019       Accepted: October 21, 2019       Published: January 11, 2020
How to Cite

Copyright: © 2020 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Hypoxia has been particularly associated with poor prognosis in cancer patients. Recent studies have suggested that hypoxia-related miRNAs play a critical role in various cancers, including colorectal cancer (CRC). In the present study, we found 52 differentially expressed miRNAs in HT-29 cells under hypoxic conditions versus normoxic conditions by analyzing the profiles of miRNAs. Using Cox model, we developed a hypoxia-related miRNA signature consisting of four miRNAs, which could successfully discriminate high-risk patients in the Cancer Genome Atlas (TCGA) training cohort (n=381). The prognostic value of this signature was further confirmed in the TCGA testing cohort (n=190) and an independent validation cohort composed of formalin-fixed paraffin-embedded clinical CRC samples (n=220), respectively. Multivariable Cox regression and stratified survival analysis revealed this signature was an independent prognostic factor for CRC patients. Time-dependent receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of this signature was significantly larger than that of any other clinical risk factors or single miRNA alone. A nomogram was constructed for clinical use, which incorporated both the miRNA signature and clinical risk factors and performed well in the calibration plots. Collectively, this novel hypoxia-related miRNA signature was an independent prognostic factor, and it possessed a stronger predictive power in identifying high-risk CRC patients than currently used clinicopathological features.


AUC: area under receiver operating characteristic; CI: confidence interval; CRC: colorectal cancer; FFPE: formalin-fixed paraffin-embedded; OS: overall survival; ROC: receiver operating characteristic; RPM: reads per million total reads; TCGA: The Cancer Genome Atlas; TNM: tumor-node-metastasis.