CINSARC signature as a prognostic marker for clinical outcome in sarcomas and beyond

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Abstract
Prognostication is a key issue for sarcoma patients' care since it triggers the therapeutic approach including chemotherapy, which is still not standard for localized patients. Current prognostic evaluation, internationally based on the FNCLCC grading system, has recently been improved by the CINSARC signature. It outperforms the histology‐based grading system by identifying high‐risk patients in every grade, even in those considered as having a good clinical outcome. CINSARC is an expression‐based signature related to mitosis and chromosome integrity. Since these pathways are deregulated in almost every type of metastasizing cancer, it has demonstrated its prognostic value in a wide range of cancers, that is, carcinoma, lymphoma, leukaemia and melanoma. First developed in a research context with frozen material, CINSARC is now coupled with Nanostring technology to evaluate its expression with RNA extracted from FFPE blocks, the material used in clinical practice. Consequently, CINSARC is currently being evaluated in clinical trials with a dual objective of demonstrating the benefit of chemotherapy in high‐risk sarcoma patients and testing its ability to predict response to chemotherapy. Considering its overarching value in oncology, its development is welcome in any cancers where the prognostication of outcome needs to be improved.

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