Can a Tissue-derived Progression Signature Accurately Predict Colorectal Cancer Stage Transitions in Blood?

Abstract

Colorectal cancer (CRC) is challenging to track because its molecular changes are very complex as the disease progresses, creating significant challenges for robust biomarker discovery. In this study, we developed a machine learning framework by integrating monotonic progression and the StepMiner approach. We conducted external validation to identify reproducible, consistent transcriptomic biomarkers associated with CRC progression. Gene expression datasets were analyzed across four disease states from publicly available GEO: normal colon, adenoma, primary colorectal cancer, and metastasis. First, we identified genes with monotonic expression, then used the StepMiner approach to identify genes that act as switches between stages. A balanced 74-gene signature was used for machine-learning classification with a Random Forest. External validation showed strong performance in tissue-based datasets. However, tissue-derived signatures and plasma and blood-based datasets showed poor performance, highlighting biological differences between transcriptomic profiles. Cross-filtering between tissue-derived genes and blood expression datasets was performed, which resulted in the selection of 62 blood-compatible gene signatures. Leakage-free retraining on GSE164191 achieved a mean AUC of 0.868 with balanced precision. Functional enrichment analysis showed that these genes are highly active in cancer growth. Specifically, genes CBX3, S100A11, PDK4, NCOR1, and SOX4 demonstrated stable and reliable performance across the validation fold. Overall, our study presents a progression-aware transcriptomic framework for CRC biomarker discovery and demonstrates the importance of external validation. Additionally, we evaluate whether tissue-derived signatures can predict blood profiles. This proposed approach may help the future development of tissue-based diagnostics and minimally liquid-biopsy strategies for CRC. To ensure reproducibility, our proposed workflow was automated as a Nextflow pipeline. The tissue-derived model was deployed as an application utilizing Angular, ASP.NET Core, and Plumber (R).