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Objective:  Glioma is the most common and fatal primary brain tumor that has a high risk of recurrence in adults. Identification of predictive biomarkers is necessary to optimize therapeutic strategies. This study investigated the predictive efficacy of a previously identified radiosensitivity signature as well as Exportin 1 (XPO1) expression levels.   Methods:  A total of 1,552 patients diagnosed with glioma were analyzed using the Chinese Glioma Genome Atlas and The Cancer Genome Atlas databases. The radiosensitive and radioresistant groups were identified based on a radiosensitivity signature. Patients were also stratified into XPO1-high and XPO1-low groups based on  XPO1  mRNA expression levels. Overall survival rates were compared across patient groups. Differential gene expression was detected and analyzed through pathway enrichment and Gene Set Enrichment Analysis (GSEA). To predict 1-, 3-, and 5-years survival rates for glioma patients, a nomogram was established combining the radiosensitivity gene signature, XPO1 status, and clinical characteristics. An artificial intelligence clustering system and a survival prediction system of glioma were developed to predict individual risk.   Results:  This proposed classification based on a radiosensitivity gene signature and XPO1 expression levels provides an independent prognostic factor for glioma. The RR-XPO1-high group shows a poor prognosis and may benefit most from radiotherapy-combined anti-XPO1 treatment. The nomogram based on the radiosensitivity gene signature, XPO1 expression, and clinical characteristics performs more optimally compared to the WHO classification and IDH status in predicting survival rates for glioma patients. The online clustering and prediction systems make it accessible to predict risk and optimize treatment for a special patient. The cell cycle, p53, and focal adhesion pathways are associated with more invasive glioma cases.   Conclusion:  Combining the radiosensitivity signature and XPO1 expression is a favorable approach to predict outcomes as well as determine optimal therapeutic strategies for glioma patients.

A Radiosensitivity Gene Signature and XPO1 Predict Clinical Outcomes for Glioma Patients