Abstract:
A time to event data analysis method and system. The present invention relates to the analysis of data to identify relationships between the input data and one or more conditions. One method of analysing such data is by the use of neural networks which are non-linear statistical data modelling tools, the structure of which may be changed based on information that is passed through the network during a training phase. A known problem that affects neural networks is the issue of overtraining which arises in overcomplex or overspecified systems when the capacity of the network significantly exceeds the needed parameters. The present invention provides a method of analysing data, such as bioinformatics or pathology data, using a neural network with a constrained architecture and providing a continuous output that can be used in various contexts and systems including prediction of time to an event, such as a specified clinical event.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims priority to U.S. provisional application 61/382,099, filed Sep. 13, 2010, the content of which is incorporated herein by reference in its entirety. 
     
    
     FIELD OF INVENTION 
       [0002]    The present invention relates to a method of analysing data and in particular relates to the use of artificial neural networks (ANNs) to analyse data and identify relationships between input data and one or more conditions. 
       BACKGROUND TO THE INVENTION 
       [0003]    An artificial neural network (ANN), or “neural network”, is a mathematical or computational model comprising an interconnected group of artificial neurons which is capable of processing information so as to model relationships between inputs and outputs or to find patterns in data. 
         [0004]    A neural network may therefore be considered as a non-linear statistical data modelling tool and generally is an adaptive system that is capable of changing its structure based on external or internal information that flows through the network in a training phase. The strength, or weights, of the connections in the network may be altered during training in order to produce a desired signal flow. 
         [0005]    Various types of neural network can be constructed. For example, a feedforward neural network is one of the simplest types of ANN in which information moves only in one direction and recurrent networks are models with bi-directional data flow. Many other neural network types are available. 
         [0006]    One particular variation of a feedforward network is the multilayer perceptron which uses three or more layers of neurons (nodes) with nonlinear activation functions, and is more powerful than a single layer perceptron model in that it can distinguish data that is not linearly separable. 
         [0007]    The ability of neural networks to be trained in a learning phase enables the weighting function between the various nodes/neurons of the network to be altered such that the network can be used to process or classify input data. Various different learning models may be used to train a neural network such as “supervised learning” in which a set of example data that relates to one or more outcomes or conditions is used to train the network such that it can, for example, predict an outcome for any given input data. Supervised learning may therefore be considered as the inference of a mapping relationship between input data and one or more outcomes. 
         [0008]    Training an artificial neural network may involve the comparison of the network output to a desired output and using the error between the two outputs to adjust the weighting between nodes of the network. In one learning model a cost function C may be defined and the training may comprise altering the node weightings until the function C can no longer be minimised further. In this way a relationship between the input data and an outcome or series of outcomes may be derived. An example of a cost function might be C=E[(f(x)−y) 2 ] where (x, y) is a data pair taken from some distribution D. 
         [0009]    In one application, a neural network might be trained with gene expression data from tissues taken from patients who are healthy and from patients who have cancer. The training of the network in such an example may identify genes or gene sets that are biomarkers for cancer. The trained network may be used to predict the likelihood of a given person developing cancer based on the results of an analysis of a tissue sample. 
         [0010]    Another field of technology in which an artificial neural network might be used is meteorology in which, for example, temperature or pressure data at a series of locations over time could be used to determine the likelihood of there being rainfall at a given location at a given time. 
         [0011]    A known problem with artificial neural networks is the issue of overtraining which arises in overcomplex or overspecified systems when the capacity of the network significantly exceeds the needed free parameters. This problem can lead to a neural network suggesting that particular parameters are important whereas in reality they are not. This is caused by the identification of a set of parameters having a higher importance and by the false detection of parameters. These parameters are likely to have a lower performance when classifying unseen data/cases. 
         [0012]    It is an object of the present invention to provide a method of analysing data using a neural network that overcomes or substantially mitigates the above mentioned problem. 
       SUMMARY OF THE INVENTION 
       [0013]    According to a first aspect the present invention provides a method of determining a relationship between input data and one or more conditions comprising the steps of: receiving input data categorised into one or more predetermined classes of condition; training an artificial neural network with the input data, the artificial neural network comprising an input layer having one or more input nodes arranged to receive input data; a hidden layer comprising two or more hidden nodes, the nodes of the hidden layer being connected to the one or more nodes of the input layer by connections of adjustable weight; and, an output layer having an output node arranged to output data related to the one or more conditions, the output node being connected to the nodes of the hidden layer by connections of adjustable weight; determining relationships between the input data and the one or more conditions wherein the artificial neural network has a constrained architecture in which (i) the number of hidden nodes within the hidden layer is constrained; and, (ii) the initial weights of the connections between nodes are restricted. 
         [0014]    The present invention provides a method of analysis that that highlights those parameters in the input data that are particularly useful for predicting either whether a given outcome is likely, or the probability of time to a give event. In other words, compared to prior art systems the method of the present invention effectively increases the difference or “contrast” between the various input parameters so that the most relevant parameters from a predictive capability point of view are identified. 
         [0015]    The present invention provides a method of determining a relationship between input data and one or more conditions using an artificial neural network (ANN). The present invention is also capable of determining a relationship between input data and time to a specified event that is dependent in part upon the input data using an (ANN). The ANN used in the invention has a constrained architecture in which the number of nodes within the hidden layer of the ANN are constrained and in which the initial weights of the connections between nodes are restricted. 
         [0016]    The method of the present invention therefore proposes an ANN architecture which runs contrary to the general teaching of the prior art. In prior art systems the size of the hidden layer is maximised within the constraints of the processing system being used whereas in the present invention the architecture is deliberately constrained in order to increase the effectiveness of the predictive capability of the network and the contrast between markers of relevance and non relevance within a highly dimensional system. In comparison to known systems, the present invention provides the advantage that the predictive performance for the markers that are identified is improved and those markers identified by the method according to the present invention are relevant to the underlying process within the system. 
         [0017]    Preferably in order to maximise the predictive effectiveness of the present invention the number of hidden nodes is in the range two to five. More preferably the number of hidden nodes is set at two. 
         [0018]    Preferably the initial weights of the connections between nodes have a standard deviation in the range 0.01 to 0.5. It is noted that lowering the standard deviation makes the artificial neural network less predictive. Raising the standard deviation reduces the constraints on the network. More preferably, the initial weights of connections between nodes have a standard deviation of 0.1. 
         [0019]    Conveniently the input data comprises data pairs (e.g. gene and gene expression data) which are categorised into one or more conditions (e.g. cancerous or healthy). In the example of gene data then the gene may be regarded as a parameter and the expression data as the associated parameter value. Furthermore, input data may be grouped into a plurality of samples, each sample having an identical selection of data pairs (e.g. the gene and gene expression data may detail the condition—healthy/cancerous—of a plurality of individuals). 
         [0020]    Training of the neural network may conveniently comprise selecting a particular parameter in each sample (i.e. the same parameter in each sample) and then training the network with the parameter value associated with the selected parameter. The performance of the network may be recorded for the selected parameter and then the process may be repeated for each parameter in the samples in turn. 
         [0021]    The determining step of the first aspect of the invention may comprise ranking the recorded performance of each selected parameter against the known condition or time to an event and the best performing parameter may then be selected. 
         [0022]    Once the best performing parameter from the plurality of samples has been determined then a further selecting step may comprise pairing that best performing parameter with one of the remaining parameters. The network may then be further trained with the parameter values associated with the pair of selected parameters and the network performance recorded. As before, the best performing parameter may then be paired with each of the remaining parameters in turn. 
         [0023]    The selecting, training and recording steps may then be repeated, adding one parameter in turn to the known best performing parameters until no further substantial performance increase is gained. 
         [0024]    Conveniently it is noted that the input data may be grouped into a plurality of samples, each sample having an identical selection of data pairs, each data pair being categorised into the one or more conditions and comprising a parameter and associated parameter value, and the training and determining steps of the first aspect of the invention may comprise: selecting a parameter within the input data, training the artificial neural network with corresponding parameter values and recording artificial neural network performance; repeating for each parameter within the input data; determining the best performing parameter in the input data; and, repeating the selecting, repeating and determining, each repetition adding one of the remaining parameters to the best performing combination of parameters, until artificial neural network performance is not improved. 
         [0025]    In one application of the method according to an embodiment of the present invention the parameters may represent genes and the parameter values may represent gene expression data. In a further application the parameter may represent proteins and the parameter values may represent activity function. 
         [0026]    In other applications of the method according to an embodiment of the present invention the parameter may represent a meteorological parameter, e.g. temperature or rainfall at a given location and the parameter value may represent the associated temperature or rainfall value. 
         [0027]    It is however noted that the method according to the present invention may be applied to any complex system where there are a large number of interacting factors occurring in different states over time. The method of the invention shows particular utility in analysis of apparently stochastic systems. 
         [0028]    According to a second aspect of the present invention there is provided a method of determining a relationship between input data and one or more conditions comprising: receiving input data categorised into one or more predetermined classes of condition; determining relationships between the input data and the one or more conditions using a neural network, the artificial neural network comprising an input layer having one or more input nodes arranged to receive input data; a hidden layer comprising two or more hidden nodes, the nodes of the hidden layer being connected to the one or more nodes of the input layer by connections of adjustable weight; and, an output layer having an output node arranged to output data related to the one or more conditions, the output node being connected to the nodes of the hidden layer by connections of adjustable weight wherein the artificial neural network has a constrained architecture in which (i) the number of hidden nodes within the hidden layer is constrained; and, (ii) the initial weights of the connections between nodes are restricted. 
         [0029]    According to a third aspect of the present invention there is provided an artificial neural network for determining a relationship between input data and one or more conditions comprising: an input layer having one or more input nodes arranged to receive input data categorised into one or more predetermined classes of condition; a hidden layer comprising two or more hidden nodes, the nodes of the hidden layer being connected to the one or more nodes of the input layer by connections of adjustable weight; and, an output layer having an output node arranged to output data related to the one or more conditions, the output node being connected to the nodes of the hidden layer by connections of adjustable weight; wherein the artificial neural network has a constrained architecture in which (i) the number of hidden nodes within the hidden layer is constrained; and, (ii) the initial weights of the connections between nodes are restricted. The output may be optionally either continuous or binary. In embodiments where the output is continuous, the method of the invention is able to predict the probability of time to the occurrence of a predetermined event based upon input data taken at one or more given time points before occurrence of the event. 
         [0030]    The invention extends to a computer system for determining a relationship between input data and one or more conditions, or time to an event, comprising an artificial neural network according to the third aspect of the present invention. 
         [0031]    It will be appreciated that preferred and/or optional features of the first aspect of the invention may be provided in the second and third aspects of the invention also, either alone or in appropriate combinations. 
         [0032]    Accordingly, in one embodiment, the invention provides a computer-implemented method of determining a relationship between input data relating to a specified event and the probability of the time interval to the occurrence of the event in the future. The method includes the steps of receiving input data categorised into one or more predetermined classes; using a microprocessor, training an artificial neural network with the input data, the artificial neural network including an input layer having one or more input nodes arranged to receive input data; a hidden layer including two or more hidden nodes, the nodes of the hidden layer being connected to the one or more nodes of the input layer by connections of adjustable weight; and, an output layer having an output node arranged to continuously output data related to the specified event, the output node being connected to the nodes of the hidden layer by connections of adjustable weight; using a microprocessor, determining a relationship between the input data and the specified event so as to determine a probability value of the time to the occurrence of the event (time to event); wherein the artificial neural network has a constrained architecture in which (i) the number of hidden nodes within the hidden layer is constrained; and (ii) the initial weights of the connections between nodes are restricted. 
         [0033]    In another embodiment the invention provides a computer readable medium containing program instructions for implementing an artificial neural network for determining a relationship between input data relating to a specified event and the probability of the time interval to the occurrence of the event in the future, wherein execution of the program instructions by one or more processors of a computer system causes the one or more processors to carry out the steps of: arranging one or more input nodes in an input layer to receive input data categorised into one or more predetermined classes; providing a hidden layer including two or more hidden nodes; connecting the nodes of the hidden layer to the one or more nodes of the input layer by connections of adjustable weight; providing an output layer having an output node arranged to continuously output data related to the event; and connecting the output node to the nodes of the hidden layer by connections of adjustable weight; wherein the artificial neural network has a constrained architecture in which (i) the number of hidden nodes within the hidden layer is constrained; and (ii) the initial weights of the connections between nodes are restricted. 
         [0034]    In yet another embodiment, the invention provides a diagnostic system that predicts time to a specified clinical event for a given individual following analysis of biomarker expression levels in a biological sample obtained from said individual. The system includes a biomarker profiler for determining the levels of expression of one or more biomarkers within a sample, thereby generating biomarker expression data; a processor for analysing the biomarker expression data and determining from the data a predicted time to a specified clinical event; and a display that presents the predicted time to a specified clinical event to a user of the diagnostic system. 
         [0035]    Other aspects of the invention will become apparent by consideration of the detailed description and accompanying drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0036]    In order that the invention may be more readily understood, reference will now be made, by way of example, to the accompanying drawings in which: 
           [0037]      FIG. 1A  is a block diagram of a computer system for implementing embodiments of the present invention. 
           [0038]      FIG. 1B  shows a representation of a typical (known) artificial neural network. 
           [0039]      FIG. 2  illustrates the mechanism of neural network learning. 
           [0040]      FIG. 3  is a representation of gene expression data to be used in conjunction with an artificial neural network in accordance with an embodiment of the present invention. 
           [0041]      FIG. 4  shows an artificial neural network in accordance with an embodiment of the present invention. 
           [0042]      FIG. 5  is a flow chart detailing the operation of a system which incorporates an artificial neural network in accordance with an embodiment of the present invention. 
           [0043]      FIG. 6  shows how the artificial network in accordance with the present invention develops as the input data set is used. 
           [0044]      FIG. 7  ( a )-( g ) shows screenshot diagrams from the Stepwise ANN modeling software of the invention. Each diagram ( a )-( g ) represents a different option screen available within the software for model building and analysis. 
           [0045]      FIG. 8  is a graph showing the stepwise summary of ions added at each step of analysis of digested peptide data; Stage IV melanoma v Control. The line marked with ♦ points represents mean squared error value at each step with 95% confidence intervals being shown as error bars. The line marked with ▪ points represents median model accuracy at each step of analysis with inter-quartile ranges being shown as error bars. 
           [0046]      FIG. 9  is a graph showing an overall summary of stepwise model performance of diseased groups v control samples. 
           [0047]      FIG. 10  is a graph showing a further overall summary of stepwise model performance of diseased groups v control samples. 
           [0048]      FIG. 11  ( a )-( c ) are scatterplots showing principal components analysis using the biomarker ions identified by ANN stepwise approaches. Sample groups are differentiated by point style. 
           [0049]      FIG. 12  is a bar graph showing mean group intensities of peptide biomarker ions identified by ANNs. All of the key biomarkers across the different stages are shown. 
           [0050]      FIG. 13  is a scatterplot of ion 861 against ion 903 for Stage II and Stage III melanoma. Squares ▪ indicate stage III samples, whilst circles  show stage II samples. 
           [0051]      FIG. 14  is a graph showing model performance with each input addition over the course of the analysis. Line with ▪ points represents median model accuracy with lower and upper inter-quartile ranges shown as error bars. The line with ♦ points shows the mean squared error for the predictions at each step with error bars indicating 95% confidence intervals. 
           [0052]      FIG. 15  ( a )-( b ) are graphs showing model performance with each input addition over the course of the analysis for ( a ) estrogen receptor (ER) status and ( b ) lymph node (LN) status. Line with ▪ points represent median model accuracy with lower and upper inter-quartile ranges shown as error bars. Line with ▴ points shows the mean squared error for the predictions at each step with error bars indicating 95% confidence intervals. 
           [0053]      FIG. 16  ( a )-( b ) are graphs showing a summary of stepwise analysis for the top ten genes identified at step 1 for ( a ) ER and ( b ) LN status. 
           [0054]      FIG. 17  is a graph showing the normal distribution of randomly generated models. 
           [0055]      FIG. 18  ( a )-( c ) are box graphs showing comparison of performance of a random model to those generated with the stepwise approach of the invention. 
           [0056]      FIG. 19  is a graph showing observed versus predicted time to distant metastases using the 31 gene signature on the combined cases from the three datasets used for signature generation. Spearman&#39;s correlation was 0.86 (p&lt;0.0001). 
           [0057]      FIG. 20  is a graph showing event observed versus predicted time to distant metastases using the 31 gene signature on the cases from the validation dataset. Spearman&#39;s correlation was 0.93 (p&lt;0.0001). 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0058]    Before any embodiments of the invention are explained in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of components set forth in the following description or illustrated in the following drawings. The invention is capable of other embodiments and of being practiced or of being carried out in various ways. Also, it is to be understood that the phraseology and terminology used herein are for the purpose of description and should not be regarded as limiting. The use of “including,” “comprising,” or “having” and variations thereof herein is meant to encompass the items listed thereafter and equivalents thereof as well as additional items. 
         [0059]    One drawback of traditional linear based ANN models is that they often cannot generalise well to problems and therefore may only be applicable to the dataset they are originally applied to. Simulation experiments have shown that stepwise logistic regression has limited power in selecting important variables in small data sets, and therefore risks overfitting (Steyerberg, E. W., Eijkemans, M. J. and Habbema, J. D. (1999) Stepwise selection in small data sets: a simulation study of bias in logistic regression analysis,  J Clin Epidemiol,  52, 935-942.). Additionally the automatic selection procedure is non-subjective and ignores logical constraints. The applied neural network stepwise approach of the present invention does not share the limitations of the prior art because the models have been shown to be applicable to a separate datasets used for validation, so are capable of generalisation to new data and as such, overfitting has not been observed when using this approach. 
         [0060]    In various embodiments, a neural network is implemented on a computer system  100  ( FIG. 1A ). The computer system  100  includes an input device  160 , an output device  180 , a storage medium  120 , and a microprocessor  140  ( FIG. 1A ). Possible input devices  160  include a keyboard, a computer mouse, a touch screen, and the like. Output devices  180  include a cathode-ray tube (CRT) computer monitor, a liquid-crystal display (LCD) computer monitor, and the like. In addition, information can be output to a user, a user interface device, a computer-readable storage medium, or another local or networked computer. Storage media  120  include various types of memory such as a hard disk, RAM, flash memory, and other magnetic, optical, physical, or electronic memory devices. The microprocessor  140  is any typical computer microprocessor for performing calculations and directing other functions for performing input, output, calculation, and display of data. The neural network comprises a set of instructions and data that are stored on the storage medium  120 . The data associated with the neural network can include image data and numerical data. Two or more computer systems  100  may be linked using wired or wireless means and may communicate with one another or with other computer systems directly and/or using a publicly-available networking system such as the Internet. Networking of computers permits various aspects of the invention to be carried out, stored in, and shared amongst one or more computer system  100  locally and at remote sites. 
         [0061]      FIG. 1B  is a dependency tree style representation of an artificial neural network  1 . It can be seen that the network  1  depicted in  FIG. 1B  divides into three basic layers: an input layer  3  which receives input data; a hidden layer  5 , and; an output layer  7  which returns a result. In the example of  FIG. 1B  there are three input level nodes, n hidden layer nodes (of which only five are shown for clarity) and two output layer nodes. 
         [0062]    It is noted that the number of hidden layers may be varied. 
         [0063]    The various interconnections between the nodes are indicated in  FIG. 1B  by the connecting arrows  9 . For the first node in the input layer the various weights attributed to the connections to the hidden layer nodes are indicated by the weights w 1 , w 2 , w 3 , w 4  and w n . For clarity the weights on the remaining connections are not shown in this Figure. 
         [0064]    The neural network is arranged such that input data is fed into the input layer  3  and is then multiplied by the interconnection weights as it is passed from the input layer  3  to the hidden layer  5 . Within the hidden layer  5 , the data is summed then processed by a nonlinear function (for example a hyperbolic tangent function or a sigmoidal transfer function). As the processed data leaves the hidden layer to the output later  7  it is, again multiplied by interconnection weights, then summed and processed within the output layer to produce the neural network output. 
         [0065]    One of the most popular training algorithms for multi-layer perceptron and many other neural networks is an algorithm called backpropagation. With backpropagation, the input data is repeatedly presented to the neural network. With each presentation the output of the neural network is compared to the desired output and an error is computed. This error is then fed back (backpropagated) to the neural network and used to adjust the weights such that the error decreases with each iteration and the neural model gets closer and closer to producing the desired output. This process is known as “training”. 
         [0066]      FIG. 2  is a representation of the training of a neural network  1 . During training the network is repeatedly presented with input data  11  (in this case exclusive-or data, Xor data). Each time the data  11  is presented the error  13  between the network output  15  and the desired output  17  is computed and fed back to the neural network  1 . The neural network  1  uses this error to adjust its weights such that the error will be decreased. This sequence of events is usually repeated until an acceptable error has been reached or until the network no longer appears to be learning. 
         [0067]    When training a neural network the learning rate is a parameter found in many learning algorithms that alters the speed at which the network arrives at the minimum solution. If the rate is too high then the network can oscillate about the solution or diverge from the solution. If the rate is too low then the network may take too long to reach the solution. 
         [0068]    A further parameter that may be varied during the training of an artificial neural network is the momentum parameter that is used to prevent the network from converging on a local minimum or saddle point. An overly high momentum parameter can risk overshooting the minimum. A momentum parameter that is too low can result in a network that cannot reliably avoid local minima. 
         [0069]    Having discussed the use and training of artificial neural networks, the application of a neural network in the context of embodiments of the present invention is discussed below. It is noted that while the example discussed below relates to bioinformatics, the invention described herein is applicable to other fields of technology, e.g. meteorological predictions, pollution prediction, environmental prediction etc. 
         [0070]      FIG. 3  is a highly generalised set of gene and gene expression data across 10 individuals (samples). For each sample, the same set of genes and their associated gene expression data are detailed along with a condition or state, in this case “healthy” or “cancer”. The processing of this data set in the context of the present invention is described in relation to the flow chart of  FIG. 5  and the network representations of  FIGS. 4 and 6 . 
         [0071]      FIG. 4  depicts the initial form of an artificial neural network  20  used in conjunction with the method of the present invention. As can be seen from the figure, the hidden layer  22  comprises only two nodes ( 24 ,  26 ) as opposed to the 20+ nodes found in prior art systems. Initially there is a single input node  28  but as described below in relation to  FIGS. 5 and 6  the number of input nodes will gradually be increased until the performance of the neural network cannot be improved further. 
         [0072]    As noted above a known problem with neural networks is the fact that they can be over-trained such that relationships can be derived between the input and output data for virtually all of the input data parameters. 
         [0073]    In the artificial neural network in accordance with embodiments of the present invention the network is set up to as to improve the network&#39;s ability to identify the most relevant input parameters. To this end, the number of nodes within the hidden layer is restricted, preferably below five nodes and particularly to two nodes. In addition to this the standard deviation between the initial weights of the interconnections between nodes is also constrained. Preferably, the standard deviation, σ, of the initial weights of the interconnections are placed in the range 0.01 to 0.5 with an optimum value of 0.1. 
         [0074]      FIG. 5  is a flow chart illustrating the method of analysing the data set of  FIG. 3  in accordance with an embodiment of the present invention. 
         [0075]    In Step  40 , the input and output variables to be used in the method of analysis are identified. In the example of the data set of  FIG. 3 , the input data will be gene expression data relating to a gene and the output data will be condition (i.e. healthy versus cancerous) data. It is noted that the output node will return a numerical output in the range “0” to “1” and the system may be set up such that “0” corresponds to healthy and “1” to cancer. 
         [0076]    In Step  42 , an input (i.e. a particular gene, for example gene C) is chosen as the input (input  1 ) to the ANN shown in  FIG. 4 . 
         [0077]    In Step  44 , the ANN is trained using random sample cross validation. In other words a subset of the overall dataset is used to train the neural network, a “training subset”. In the context of the dataset of  FIG. 3 , this might mean that gene expression data for the chosen gene (gene C) from samples  1 - 3  and  8 - 10  is used to train the network. During this training phase the output condition (healthy versus cancer) from the network can be compared to the true condition. 
         [0078]    In Step  46 , the performance of the artificial neural network for input  1  is recorded and stored. 
         [0079]    In Step  48 , a further gene is chosen as the sole input to train the neural network and the system cycles round to Step  44  again so that the network is trained from its initial state again using this new data. For example, gene H might be the next input to be chosen and the gene expression data for gene H from samples  1 - 3  and  8 - 10  may then be used to train the network again. 
         [0080]    Steps  44  and  46  are then repeated (indicated via arrow  50 ) for each input as sole input to the network (i.e. gene and its associated expression data in the example of  FIG. 3 ) and the network performance is recorded for each input. 
         [0081]    Once each input in the training subset has been used as input the system moves to Step  52  in which the various inputs are ranked according to the error from the true outcome and the best performing input is chosen. 
         [0082]    In Step  54  the system moves onto train the network with a pair of inputs, one of which is the best performing input identified in Step  52  and the other is one of the remaining inputs from the training subset. The performance of the network with this pair of inputs is recorded. 
         [0083]    The system then repeats this process with each of the remaining inputs from the training subset in turn (indicated via arrow  56 ), i.e. each of the remaining inputs is paired in turn with the best performing sole input identified in Step  48 . 
         [0084]    Once each of the remaining inputs has been used, the system identifies, in Step  58 , the best performing pair of inputs. 
         [0085]    The system then returns to Step  42  (indicated via arrow  60 ) and repeats the whole process, continually adding inputs until no further improvement in the performance of the artificial neural network is detected (Step  62 ). At this point, the artificial neural network has identified the inputs which are most closely related to the outcome. In the case of the gene/gene expression data example of  FIG. 3 , the system will have identified the genetic biomarkers for the dataset that point towards the development of cancer in the sampled individuals. 
         [0086]      FIGS. 6   a - c  shows the development of the artificial neural network  20  through the first few cycles of the flow chart of  FIG. 5 . In  FIG. 6   a , the neural network is as shown in  FIG. 4 . A single input  28  is provided for the gene expression data related to input  1 . 
         [0087]    In  FIG. 6   b , the best performing single input has been chosen based on the performance on an unseen (by the model) validation set (Step  52 ) and the system has moved to testing the performance of input pairs. The number of nodes in the input layer has therefore increased to two nodes ( 28 ,  30 ). The number of nodes in the hidden layer is still constrained at two and the initial weights of the interconnections are similarly constrained (as per the set up of  FIG. 4 ) in order to optimise the network performance. 
         [0088]    In  FIG. 6   c , the best performing pair of inputs (comprising the best sole input from  FIG. 6   a  plus one other input identified in  FIG. 6   b ) has been chosen and the system has moved onto testing the performance of three inputs ( 28 ,  30 ,  32 ). The hidden node and initial weight configurations remain unchanged. 
         [0089]    The addition of further input nodes continues until no further improvement in network performance is identified. 
         [0090]    The ANN of the invention shows significant technical utility in analysing complex datasets generated from diverse sources. In one example of the invention in use, clinical data from cancer patients is analysed in order to determine diagnostic and prognostic genetic indicators of cancer. In another example of the invention in use, meteorological measurements are analysed in order to provide predictions of future weather patterns. The invention shows further utility in the fields of ocean current measurements, financial data analysis, epidemiology, climate change prediction, analysis of socio-economic data, and vehicle traffic movements, to name just a few areas. 
       Cancer Prediction: 
       [0091]    Cancer is the second leading cause of death in the United States. An estimated 10.1 million Americans are living with a previous diagnosis of cancer. In 2002, over one million people were newly diagnosed with cancer in the United States (information from Centres for Disease Control and Prevention, 2004 and 2005, and National Cancer Institute, 2005). According to Cancer Research UK, in 2005 over 150,000 people died in the United Kingdom as a result of cancer. Detecting cancer at an early stage in the development of the disease is a key factor in enabling the disease to be effectively treated and prolonging the life of the affected individual. Cancer screening is an attempt to detect (undiagnosed) cancers in the population, so as to enable early therapeutic intervention. Screens for detecting and/or predicting cancer are advantageously suitable for testing large numbers of subjects; are affordable; safe; non-invasive; and accurate (i.e. exhibiting a low rate of false positives). 
         [0092]    At present there are no clinically validated markers for metastatic melanoma. Data has been obtained from mass spectrometry (MS) proteomic profiling of human serum samples from patients with melanoma at various stages of disease. Using the stepwise ANN approaches of the present invention, protein ions have been identified that distinguish stage IV melanoma patients from healthy controls with an accuracy of over 90%. Using the same approach to analyse the proteomic profiles of digested peptides, ions were identified which predicted validation subsets of samples to an accuracy of 100%. The groups of ions identified here distinguish stage IV metastatic melanoma from healthy controls with incredibly high sensitivity and specificity. This is of even greater significance when it is appreciated that conventional S-100 ELISA typically results in a reported 20% ‘false negative’ rate in patients with detectable metastases by routine clinical and radiographic studies 
         [0093]    Potential serum protein melanoma biomarker ions by mass spectrometry using SELDI chips have been reported previously (Mian et al (2005) Serum proteomic fingerprinting discriminates between clinical stages and predicts disease progression in melanoma patients, J Clin Oncol, 23, 5088-5093) where a mass region around 11,700 Da provided a highly statistically significantly difference in intensity between stage I and stage IV melanoma samples. In an example of the invention, described in more detail below, a MALDI MS method was used to generate a more rapid data analysis with higher resolution. These data were subsequently subjected to stepwise ANN analysis and nine ions were identified that discriminated between melanoma stage IV and healthy control sera. This analysis by ANNs of serum proteins resulted in a median accuracy of 92% (inter-quartile range 89.4-94.8%) in discriminating between sera from stage IV melanoma and control patients. The top ion at m/z 12000 was able to discriminate between classes with a median predictive accuracy of 64% (inter-quartile range 58.7-69.2%). This ion is similar in mass to the biomarker ion of m/z 11700 reported using the SELDI technology also for stage IV metastatic cancer reported previously (Mian, et al., 2005). The difference may be attributed to the fact that this ion was found to be significant when used in discriminating between stage I melanoma versus stage IV patients whereas here the ion reported at m/z 12000 was identified when classifying between IV melanoma and unaffected healthy control individuals. Further, in the manuscript by Mian and colleagues (Mian, et al., 2005) predictive performance was based primarily on spectra obtained from Ciphergen SELDI chip platform which are associated with inherent low-resolution read-outs using low-resolution MS equipment whereas here protein biomarker detection was carried out using a higher resolution MALDI-MS analyzer, so the m/z value of 11700 may have some variation associated with it. Although both studies used ANNs the approaches applied were different; here novel stepwise analysis approaches were used which allow for the identification of individual mass ions with high predictive performance, whereas the SELDI analysis (Mian, et al., 2005) used larger mass ranges to identify regions of the profile which were important in discriminating between groups. Therefore it is important to consider different data mining techniques may elicit different markers with differing importance. 
         [0094]    Bioinformatic sequence analysis of the six predictive peptides identified two peptide ions belonging to Alpha 1-acid glycoprotein (AGP) precursor 1/2 (AAG1/2) which when used together in a predictive model could account for 95% (47/50) of the metastatic melanoma patients. Additionally, another of the peptide ions was identified and confirmed to be associated with complement C3 component. Both proteins have been previously associated with metastatic disease in other types of cancers (Djukanovic, D et al (2000) Comparison of S100 protein and MIA protein as serum marker for malignant melanoma, Anticancer Res, 20, 2203-2207). This further confirms the value of the approach taken in the present invention. Other studies have also shown that increased levels of AGP are found in cancer (for example see Duche, J. C. et al (2000) Expression of the genetic variants of human alpha-1-acid glycoprotein in cancer, Clin Biochem, 33, 197-202). AGP, a highly heterogeneous glycoprotein, is an acute-phase protein produced mainly in the liver. However, its physiological significance is not yet fully understood, and as such AGP would not represent an expected melanoma biomarker. 
         [0095]    To further assess whether the method of the invention could also be carried over to the analysis of gene expression data, as opposed to proteomic data, two publicly available datasets were analysed in accordance with the invention. Both of these datasets are associated with breast cancer. The first was a dataset published by van&#39;t Veer and co-workers (van&#39;t Veer et al (2002) Gene expression profiling predicts clinical outcome of breast cancer, Nature, 415, 530-536) and the aims here were to identify subsets of genes which could accurately discriminate between patients who developed distant metastases within five years and those who did not. The initial analysis by van&#39;t Veer and colleagues (van&#39;t Veer, et al., 2002) used a form of unsupervised clustering and supervised classification whereby genes were selected by the correlation coefficient of expression with disease outcome. This approach led to the identification of a 70 gene classifier which predicted correctly disease outcome to an accuracy of 83%. The ANN stepwise approach of the present invention resulted in the identification of twenty genes which accurately predicted patient prognosis to a median accuracy of 100% for blind data over a number of random sample cross validation resampling events. Some of the genes which constitute this expression signature have previously been associated with cancer outcome. For example the first gene identified by our model was Carbonic Anhydrase IX, and was capable of predicting 70% of the samples correctly by itself. Carbonic Anhydrase IX (CA IX) has been suggested to be functionally involved in pathogenesis due to its increased expression and abnormal localization in colorectal tumors (Saarnio, J., et al (1998) Immunohistochemical study of colorectal tumors for expression of a novel transmembrane carbonic anhydrase, MN/CA IX, with potential value as a marker of cell proliferation, Am J Pathol, 153, 279-285). CA IX has also been suggested for use as a diagnostic biomarker due to its expression being related to cervical cell carcinomas (Liao, S. Y., et al. (1994) Identification of the MN antigen as a diagnostic biomarker of cervical intraepithelial squamous and glandular neoplasia and cervical carcinomas, Am J Pathol, 145, 598-609). Surprisingly, seven of the twenty genes identified as important by the ANN method of the invention represent expressed sequence tags (EST&#39;s) and the associated gene is therefore of unknown function. However, given their new-found predictive capability with regards to survival, further clinical analysis is now justified. 
         [0096]    A further dataset was published by West et al. (West, M., et al. (2001) Predicting the clinical status of human breast cancer by using gene expression profiles,  Proc Nat/Acad Sci USA,  98, 11462-11467) and the ANN stepwise approach of the invention was applied to this dataset in order to identify groups of genes would accurately predict the estrogen receptor (ER) status and the lymph node (LN) status of the patient. The initial analysis by West and colleagues used regression models in order to calculate classification probabilities for the various outcomes. In their study, when analyzing ER status, a 100 gene classifier was identified which predicted  34  of the 38 samples used in the training set accurately and with confidence, and which performed well during cross-validation. Using the same approach, the authors identified a 100 gene classifier which could classify a training set of samples according to lymph node status for the samples used in the training set. However, this approach was less successful in predicting LN status during cross-validation, where all of the LN+ cases had estimated probabilities at approximately 0.5, indicating these predictions contained a great deal of uncertainty, possible due to high levels in variation in the expression profiles of these samples. Using the stepwise methodology of the present invention, two gene expression signatures were identified. The first discriminated 100% of the cases correctly with regards to whether they were positive or negative for ER, and the second predicted whether the tumour had spread to the axillary lymph node, again to an accuracy of 100%. The accuracies reported here are from multiple separate validation data splits, with samples treated as blind data over 50 models with random sample cross validation. 
         [0097]    Clearly the stepwise ANN approach of the present invention provides significant advantages over the techniques used previously not only ion identifying biomarkers with improved predictive capability, but also in identifying novel biomarkers for use in diagnostic and prognostic cancer prediction. 
         [0098]    In a further embodiment of the present invention, by using the logistic function, the ANN may be trained to predict against a continuous output variable, which in specific scenarios can be more intuitive than the use of a step-function to separate two classes. Here, a single layered network would be identical to the logistic regression model. However this approach has several disadvantages including the requirement of large numbers of data points per predictor, inter-correlations amongst predictors, and perhaps most importantly the predictor variables are usually required to be linearly related to the output measurement. 
         [0099]    The use of the ANN of the present invention with one or more hidden layers allows for the estimation of non-linear functions. Universal approximation theorem states that every continuous function that maps intervals of real numbers to some output interval of real numbers can be approximated arbitrarily closely by a multi-layered perceptron ANN with a single hidden layer. This offers advantages over other machine learning classifiers (e.g. SVMs, Random Forest) where it may be difficult to approximate continuous output data. 
         [0100]    This multi-layered perceptron ANN forms the basis of a novel algorithm utilising a stepwise modelling approach to identify the key components of a system in predicting against a continuous output variable, referred to hereafter as the “Risk Distiller” algorithm. 
         [0101]    Potential uses for Risk Distiller in the medical arena include predicting actual time to progression, relapse, metastases or death in disease based scenarios, thus generating prognostic models with a view to tailoring therapies in a patient specific manner. This approach can be used in event data, and also may be adopted for predicting combined cohorts of censored and time to event data. Other biological uses include (but are not limited to) climate change prediction, prediction of weather patterns including ocean current measurements, predicting the effect of stresses on the productivity of crops with a view to forecasting crop yield. Other potential uses include financial forecasting and time series predictions, risk management and credit evaluation. 
         [0102]    As described in more detail below, Risk Distiller has been successfully shown to identify a novel gene signature with the ability to predict time to distant metastases over a large series of cases spanning four separate patient cohorts with robust cross-validation. Here, the biomarkers identified were shown to be independent prognosticators of time to metastases. Based on the continuous prediction of time to event, Risk Distiller placed patients into distinct prognostic groups that showed large statistically significant differences in their actual time to metastases. For every year Risk Distiller predicted the patient would be metastases free, there was a two-fold less risk of them succumbing to this event. 
         [0103]    The methods and systems of the present invention are not limited to biomarker data obtained solely from mass spectrometry analysis of biological samples. In alternative embodiments, labeled cDNA or cRNA targets derived from the mRNA of an experimental sample are hybridized to nucleic acid probes immobilized to a solid support. By monitoring the amount of label associated with each DNA location, it is possible to infer the abundance of each mRNA species represented. Such approaches are commonly referred to in the art as nucleic acid microarray, DNA microarray or simply gene-chip technologies. There are two standard types of DNA microarray technology in terms of the nature of the arrayed DNA sequence. In the first format, probe cDNA sequences (typically 500 to 5,000 bases long) are immobilized to a solid surface and exposed to a plurality of targets either separately or in a mixture. In the second format, oligonucleotides (typically 20-80-mer oligos) or peptide nucleic acid (PNA) probes are synthesized either in situ (i.e., directly on-chip) or by conventional synthesis followed by on-chip attachment, and then exposed to labeled samples of nucleic acids. The analysis of gene expression information can be performed using any of a variety of methods, means and variations thereof for carrying out array-based gene expression analysis. Array-based gene expression methods are known and have been described in the art (for example, U.S. Pat. Nos. 5,143,854; 5,445,934; 5,807,522; 5,837,832; 6,040,138; 6,045,996; 6,284,460; and 6,607,885). 
         [0104]    Other biological sample analysis techniques may include protein/peptide microarrays (protein chips), quantitative polymerase chain reaction (PCR), mutiplex PCR, and various well-known nucleic acid sequencing technologies. 
         [0105]    The invention is further illustrated by the following non-limiting examples. 
       Example 1 
       [0106]    A computational approach was taken to analyze genomic data in order to identify genes, proteins or gene/protein signatures, which correspond to prognostic outcome in patients with cancer. Genotypic, and subsequently phenotypic traits determine cell behaviour and, in the case of cancer, govern the cells&#39; susceptibility to treatment. Since tumour cells are genetically unstable, it was postulated that sub-populations of cells arise that assume a more aggressive phenotype, capable of satisfying the requirements necessary for invasion and metastasis. The detection of biomarkers indicative of tumour aggression should be apparent, and consequently their identification would be of considerable value for early disease diagnosis, prognosis and response to therapy. 
         [0107]    The present inventors have developed a novel method for determination of the optimal genomic/proteomic signature for predicting cancer within a clinically realistic time period and not requiring excessive processing power. The approach utilises ANNs and involves sequentially selecting and adding input neurons to a network to identify an optimum cancer biomarker subset based on predictive performance and error, in a form similar to stepwise logistic regression. 
         [0108]    Three datasets were used to test and validate method of the invention. The first interrogates human serum samples with varying stages of melanoma. The samples were analysed by MALDI-TOF MS at Nottingham Trent University (Nottingham, United Kingdom) from samples collected by the German Cancer Research Centre (DKFZ, Heidelberg, Germany). The remaining two datasets were publicly available datasets which both originated from gene expression data derived from breast cancer patients. 
         [0109]    The first dataset was derived from MALDI MS analysis for melanoma serum samples. The aims here were to firstly compare healthy control patients with those suffering from melanoma at the four different clinical stages, I, II, III and IV, in order to identify biomarker ions indicative of stage. Secondly, adjacent stages were to be analysed comparatively in the aim of identifying potential biomarkers representative of disease progression. All developed models were then validated on a second set of sample profiles generated separately from the first. This dataset contained 24,000 variables per sample. 
         [0110]    The second dataset, published by van&#39;t Veer et al. (van&#39;t Veer, et al., 2002), used microarray technology to analyse primary breast tumour tissue in relation to development of metastasis. The authors generated data by gene expression analysis in a cohort of 78 breast cancer patients, 34 of which developed distant metastases within five years, and 44 which remained disease free after at least five years. Each patient had 24,482 corresponding variables specifying the Log 10  expression ratio of a single known gene or expressed sequence tag (EST). 
         [0111]    The third dataset publish by West et al. (West, et al., 2001) used microarray technology to firstly analyse primary breast tumors in relation to estrogen receptor (ER) state and secondly to assess whether the tumor had spread to the axillary lymph node (LN), providing information regarding metastatic state. This dataset consisted of 13 ER+/LN+ tumors, 12 ER−/LN+ tumors, 12 ER+/LN− tumors, and 12 ER−/LN− tumors, each sample having 7,129 corresponding gene expression values. The approach described here was then validated using a second dataset (Huang, et al., 2003) which was made available by the same group as the first, and contained a different population of patients, ran on a different microarray chip. 
       Stepwise Approach Methodology 
     Artificial Neural Network Architecture 
       [0112]    The ANN modelling used a supervised learning approach, multi-layer perceptron architecture with a sigmoidal transfer function, where weights were updated by a back propagation algorithm. Learning rate and momentum were set at 0.1 and 0.5 respectively. Prior to training the data were scaled linearly between 0 and 1 using minimums and maximums. This architecture utilized two hidden nodes in a single hidden layer and initial weights were randomized between 0 and 1. This approach has been previously shown to be a successful method of highlighting the importance of key inputs within highly dimensional systems such as this, while producing generalized models with accurate predictions (Ball, et al., 2002) 
       Artificial Neural Network Model Development 
       [0113]    The same approach was applied across all datasets, with the only differences being the number of samples and input variables. Here, as an example the methodology as applied to the van&#39;t Veer dataset will be described. Data from the microarray experiments was taken in its raw form. This consisted of 78 samples each with 24,482 corresponding variables specifying the expression ratio of each single gene. Prior to training each model the data was randomly divided into three subsets; 60% for training, 20% for testing (to assess model performance during the training process) and 20% for validation (to independently validate the model on previously unseen data). This process is known as random sample cross validation and enables the generation of confidence intervals for the predictions on a separate blind data set, thus producing robust, generalized models. 
         [0114]    Initially, each gene from the microarray dataset was used as an individual input in a network, thus creating n (24,482) individual models. These n models were then trained over 50 randomly selected subsets and network predictions and mean squared error values for these predictions were calculated for each model with regards to the separate validation set. The inputs were ranked in ascending order based on the mean squared error values for blind data and the model which performed with the lowest error was selected for further training. Thus 1,224,100 models were trained and tested at each step of model development. 
         [0115]    Next, each of the remaining inputs were then sequentially added to the previous best input, creating n-1 models each containing two inputs. Training was repeated and performance evaluated. The model which showed the best capabilities to model the data was then selected and the process repeated, creating n-2 models each containing three inputs. This process was repeated until no significant improvement was gained from the addition of further inputs resulting in a final model containing the gene expression signature which most accurately modeled the data. 
         [0116]    This process requires the training and testing of potentially millions of models. To facilitate this, software to automate the procedure has been created using Microsoft Visual Basic. Here, the inputs are added automatically, selecting the best contender biomarkers at each step.  FIGS. 7(   a )-( g ) shows the software design detailing the various options available for ANN design and analysis (It is noted that the screenshots of  FIGS. 7(   a ) to  7 ( g ) are indicative only and the actual layout may vary). The entire process for running the algorithm can be summarized below:
       1. Identify input and output variables   2. Start with input  1  as the first input to the model, input 1      3. Train the ANN using random sample cross validation   4. Record network performance for input 1      5. Repeat steps 3 and 4 using all inputs; input 2  . . . input 3  . . . input 4  . . . input n  as sole inputs in the ANN model   6. Rank inputs in ascending order based on the error on the test data split to determine best performing input at this step, input i      7. Repeat from step 2, using each input sequentially with input i  in an ANN model   8. Determine the best performing input combination for this step       
 
         [0125]    This whole process was repeated from step 3, continually adding inputs until no improvement was gained from the addition of further inputs 
       Results 
     Analysis of Melanoma Dataset 
     Analysis of Control and Stage IV Disease Samples: Protein and Peptide Data 
       [0126]    Because there are no confirmatory blood markers for metastatic melanoma, we sought to develop a validated, robust and reproducible MALDI MS methodology using the same stepwise ANN approach to profile serum protein and tryptically digested peptides. This was applied to data derived from MALDI MS analysis representing (i) protein and (ii) digested peptide data from the control and diseased samples. Various analyses were carried out on these datasets in order to identify biomarker ions indicative of the classes shown in Table 1. 
         [0000]    
       
         
               
             
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 Summary of analyses conducted (i) 
               
             
          
           
               
                 Analysis 
                 Class 1 
                 Class 2 
               
               
                   
               
               
                 Protein ion analysis 1 
                 Healthy Control 
                 Stage IV melanoma 
               
               
                 Tryptic peptide ion analysis 1 
                 Healthy Control 
                 Stage IV melanoma 
               
               
                   
               
             
          
         
       
     
         [0127]    Biomarker patterns containing 9 ions from the protein data and 6 ions from the digested peptides were identified, which when used in combination correctly discriminated between control and Stage IV samples to a median accuracy of 92.3% (inter-quartile range 89.4-94.8%) and 100% (inter-quartile range 96.7-100%) respectively. Table 2a-b shows the performance for the models at each step of the analysis for the protein and peptide data. This shows that with the continual addition of key ions, an overall improvement in both the error associated with the predictive capabilities of the model for blind data, and also the median accuracies for samples correctly classified. Nine ions was determined to be the most effective subset of biomarker ions producing the best model performance for the protein data as no significant improvement was seen in predictive performance with the addition of further ions. No further steps were conducted beyond step 6 for the peptide data because after these step because no significant improvement in performance could be achieved. Therefore these models were considered to contain a subset of ions representing either the proteins or digested peptides, which most accurately modelled the data.  FIG. 8  shows the error and performance progression for the peptide data when using the stepwise approach for biomarker identification. 
         [0000]    
       
         
               
             
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 2a 
               
             
             
               
                   
               
               
                 Summary of stage IV vs control protein ions identified at 
               
               
                 each step of the analysis 
               
             
          
           
               
                   
                   
                 Median 
                   
               
               
                   
                 Protein 
                 Accuracy 
                 Inter-Quartile 
               
               
                 Step 
                 Ion 
                 (%) 
                 Range 
               
               
                   
               
             
          
           
               
                 1 
                 12000 
                 64.1 
                 58.7-69.2 
               
               
                 2 
                 14847 
                 73.2 
                 69.8-75.8 
               
               
                 3 
                 1649 
                 80.4 
                 77.4-83.3 
               
               
                 4 
                 15477 
                 80 
                 77.9-84 
               
               
                 5 
                 13255 
                 82.7 
                 79.1-85.2 
               
               
                 6 
                 3031 
                 83.8 
                 79.8-86.1 
               
               
                 7 
                 4791 
                 87 
                 83.9-90.4 
               
               
                 8 
                 9913 
                 86.6 
                 83.2-89.8 
               
               
                 9 
                 4835 
                 92.3 
                 89.4-94.8 
               
               
                 10 
                 15269 
                 90.4 
                 87.2-92.6 
               
               
                 11 
                 2730 
                 90.3 
                 87.1-92.2 
               
               
                 12 
                 9919 
                 90.4 
                 87.3-92.5 
               
               
                 13 
                 9971 
                 91.9 
                 88.3-94 
               
               
                 14 
                 11735 
                 90.4 
                 87.1-92.5 
               
               
                   
               
             
          
         
       
     
         [0000]    
       
         
               
             
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 2b 
               
             
             
               
                   
               
               
                 Summary of stage IV vs control digested peptide ions 
               
               
                 identified at each step of the analysis 
               
             
          
           
               
                   
                   
                 Median 
                   
               
               
                   
                   
                 Accuracy 
                 Inter-Quartile 
               
               
                 Step 
                 Peptide Ion 
                 (%) 
                 Range 
               
               
                   
               
             
          
           
               
                 1 
                 1753 
                 77.8 
                 74.4-83.2 
               
               
                 2 
                 1161 
                 93.3 
                 90.2-96.4 
               
               
                 3 
                 1505 
                 93.7 
                 92.4-96.7 
               
               
                 4 
                 854 
                 96.7 
                 95.8-100 
               
               
                 5 
                 1444 
                 100 
                 96.5-100 
               
               
                 6 
                 1093 
                 100 
                 96.7-100 
               
               
                   
               
             
          
         
       
     
       Analysis of Digested Peptide Data: Diseased Stages I, II, III and Control Samples 
       [0128]    Next, because the analysis of the peptide data provides the potential for subsequent protein identification, it was decided that these peptide MALDI MS profiles would be analysed in the search for differential biomarker ions which would be representative of firstly disease stage (by analysing the individual stages against control populations) and secondly disease progression (by generating predictive models classifying between adjacent disease stages). The analyses conducted in this part of the study are summarised in Table 3. 
         [0129]    Initially, in order to identify ions which were representative of disease stage, the stepwise approach was applied to identify subsets of biomarker ions which could predict between disease stage and control samples. This would therefore provide valuable information concerning which peptide ions were showing differential intensities that were specific to the disease stage of interest. Table 4 shows the biomarker subsets identified in each model, and their median performance when predicting validation subsets of data over 50 random sample cross validation resampling events.  FIG. 9  shows the stepwise analysis summary across all of the models for each step of analysis. As expected, the models predicted stage I v control with the least accuracy (80%), suggesting that because early stage disease is a non-penetrating skin surface legion, changes occurring in the serum at the protein level are less significant than at advanced stages of disease. Nonetheless, the ability to predict incidence of stage I melanoma to accuracies of 80% using serum would be viewed as clinically significant. It was interesting to note that of the biomarker ions identified by this approach, in several instances the same ions were occurring across different models. Ions 1299 and 3430 (3432) were found to differentiate between both Stage I and Stage II disease vs control samples. Ions 1251 and 1283 (1285) were found to differentiate between Stage II and Stage III disease vs control, whilst ion 1753 (1754) was identified in both the Stage III and Stage IV diseased vs controlled models. 
         [0000]    
       
         
               
             
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 Summary of analyses conducted. 
               
             
          
           
               
                 Analysis 
                 Class 1 
                 Class 2 
               
               
                   
               
               
                 Tryptic peptide ion analysis 2 
                 Healthy Control 
                 Stage I melanoma 
               
               
                 Tryptic peptide ion analysis 3 
                 Healthy Control 
                 Stage II melanoma 
               
               
                 Tryptic peptide ion analysis 4 
                 Healthy Control 
                 Stage III melanoma 
               
               
                 Tryptic peptide ion analysis 5 
                 Stage I melanoma 
                 Stage II melanoma 
               
               
                 Tryptic peptide ion analysis 6 
                 Stage II melanoma 
                 Stage III melanoma 
               
               
                 Tryptic peptide ion analysis 7 
                 Stage III melanoma 
                 Stage IV melanoma 
               
               
                   
               
             
          
         
       
     
         [0130]    Considering that 3500 individual ions are trained and tested at each step of analysis over 50 random sample cross validation resampling events, it seems unlikely that their consistent identification as the most important ions at a given step would be a consequence of chance, providing confidence that these ions are representing proteins which are showing a true change in intensity in patients with disease at differing stages. 
       Analysis of Adjacent Diseased Groups 
       [0131]    Once biomarker ions representative of individual disease stage had been determined, it was decided important to analyse adjacent group stages of disease, which would potentially identify biomarker ions which would represent those responding differently as disease progressed, and would be predictive and indicative of disease stage. Table 5 shows the biomarker subsets identified in each model, and their median performance when predicting validation subsets of data over 50 random sample cross validation resampling events. It was interesting to find that subsets of ions could be identified which were able to predict between stages to extremely high accuracies; 98% for stage I v stage II and 100% for stage II v stage III and stage III v stage IV. Furthermore, only two peptide biomarker ions were required in order to perfectly discriminate between stage II and stage III, with one of these ions,  903 , also being important in the classification of stage III v stage IV, suggesting that this ion is potentially of importance in disease progression to advanced stages, and appears to be downregulated as melanoma stage advances from stage II to IV, which could only be confirmed by further studies. 
         [0000]    
       
         
               
             
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 4 
               
             
             
               
                   
               
               
                 Summary of overall results from digested peptide analysis. 
               
               
                 Stages I, II, III, and IV vs Control 
               
             
          
           
               
                   
                   
                   
                 Additional 
               
               
                   
                   
                 Median Validation 
                 dataset 
               
               
                 Dataset Modelled 
                 Ions identified 
                 Performance (%) 
                 performance 
               
               
                   
               
             
          
           
               
                 Stage I v Control 
                 864, 933, 980, 
                 80 
                   
               
               
                   
                   1299 , 2309, 
               
               
                   
                 2886, 2966, 
               
               
                   
                 3220,  3430 , 3489 
               
               
                 Stage II v Control 
                   1251 ,  1283 , 
                 96.5 
               
               
                   
                   1299 , 1968, 
               
               
                   
                 2244, 2411, 
               
               
                   
                   3432 , 3443 
               
               
                 Stage III v 
                   1251 ,  1285 , 
                 91.7 
               
               
                 Control 
                 1312, 1371, 
               
               
                   
                   1754 , 2624, 
               
               
                   
                 2715, 2999, 
               
               
                   
                 3161, 3326 
               
               
                 Stage IV v 
                 854, 1093, 1161, 
                 100 
               
               
                 Control 
                 1444, 1505,  1753   
               
               
                   
               
               
                 Peptide ions highlighted in bold represent ions corresponding to multiple groups. 
               
             
          
         
       
     
         [0000]    
       
         
               
             
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 5 
               
             
             
               
                   
               
               
                 Summary of overall results from digested peptide analysis. 
               
               
                 Stages I, II, III, and IV vs Control 
               
             
          
           
               
                   
                   
                   
                 Additional 
               
               
                   
                   
                 Median Validation 
                 dataset 
               
               
                 Dataset Modelled 
                 Ions identified 
                 Performance (%) 
                 performance 
               
               
                   
               
             
          
           
               
                 Stage I v Stage II 
                 1251, 1731, 
                 98 
                   
               
               
                   
                 1825, 1978, 
               
               
                   
                 2053 
               
               
                 Stage II v Stage III 
                 861,  903   
                 100 
               
               
                 Stage III v Stage IV 
                 877,  903 , 1625, 
                 100 
                 93.4 
               
               
                   
                 2064, 2754 
               
               
                   
               
               
                 Peptide ions highlighted in bold represent ions corresponding to multiple groups. 
               
             
          
         
       
     
         [0132]    The overall summaries for the stepwise analysis conducted here can be seen in  FIG. 10 . For visualization of the feature space that these samples are occupying, and to understand the decision surface that these models are generating, PCA was conducted using the subset of ions identified by the ANN stepwise approach.  FIG. 11  ( a )-( c ) shows the PCA for the stage I v stage II, stage II v stage III and stage III v stage IV models respectively. It is evident that when using the biomarker ions identified by ANNs the samples can be separated into distinct clusters using PCA, with the clearest separation being with the stage II v stage III model. It is interesting to draw attention to the samples highlighted by arrows and circles in the stage I v stage II model ( FIG. 11(   a )). The first of these samples was identified as a stage I sample, but according to its profile PCA has placed it more indicative of stage II. Interestingly, the ANN model also predicted this sample as a stage II sample, suggesting it has strong features corresponding more to a stage II sample than a stage I sample which it was categorized as by the clinicians. Similarly, the region of samples highlighted on  FIG. 11(   b ) which appear to be lying on the border of the decision surface were also predicted closely to the 0.5 decision threshold by the ANNs, again suggesting that these samples are showing characteristics of both classes according to their proteomic profiles. The relative closeness in feature space of the stage III and stage IV samples according to ( FIG. 11(   c )) suggests that the proteomic profiles of these samples are similar, and cannot be as clearly separated using the PCA as they are when using the ANN modelling, therefore requiring a non-linear decision surface to correctly classify this cohort of samples which are at a more advanced diseased stage. Furthermore, the mean group intensities of these ions has been analysed, with the summary being shown in  FIG. 12 . This shows how the biomarker ions identified as most important in the discrimination of sample groups has changed during the different stages of disease. It is clear from this that not all of these biomarker ions are being up regulated as disease progresses. All five of the ions identified in the stage I v stage II analysis show statistically significant (p=&lt;0.05) increases in intensity. In the stage II v stage III model, both biomarker ions appear to be down regulated when disease is more advanced, with ion 861 significantly so. A scatterplot was produced of the two ions identified in this model, 861 an 903 ( FIG. 13)  and a clear separation of stage II and stage III samples is evident, with the stage III samples clearly showing lesser levels of ion 861. This enables one to derive a hypothetical decision boundary between the two classes. In the stage III v stage IV model, all ions (except for ion 2754) showed a significant increase or decrease in intensity as disease progressed, with ion 1625 showing a highly significant increase in intensity as disease progressed to stage IV. 
       Model Validation 
       [0133]    To study the question of stability of this procedure over multiple experiments and to assess batch to batch reproducibility of the mass spectrometry analysis, both the proteins and peptides were run by the group on two separate occasions and the results of the second experiment were used to validate the stepwise methodology. This dataset was obtained by a different operator and on a different date. The second sample set was then passed through the developed ANN models to blindly classify them as a second order of blind data for class assignment. For the protein data, the model correctly classified 85% of these blind samples correctly, with sensitivity and specificity values of 82 and 88% respectively, with an AUC value of 0.9 when evaluated with a ROC curve. For peptides, the model correctly classified 43/47 samples originating from control patients, and 43/43 samples from cancerous patients. This gave an overall model accuracy of 95.6%, with sensitivity and specificity values of 100 and 91.5% respectively, with AUC value of 0.98. This suggests that the peptide data was more reproducible than the protein data for this second batch of mass spectrometry analysis. The predictive peptide ions were subsequently sequenced and identified by colleagues using a variety of mass spectrometric techniques leading to the identification of two proteins; Alpha 1-acid glycoprotein (AGP) precursor 1/2 (AAG1/2) and complement C3 component. 
         [0000]    Analysis of van&#39;t Veer et al. Dataset 
         [0134]    The aims of the analysis were to utilise the novel stepwise ANN modelling approach of the invention in order to identify a gene expression signature which would accurately predict whether a patient would develop distant metastases within a five year time period, and thus identifying potential markers and giving an insight into disease aetiology. Following the rule of parsimony which suggests that the simplest model fitting the data should be used, an initial analysis was carried out using logistic regression (Subasi and Ercelebi (2005) Comput Methods Programs Biomed. 78(2):87-99). This method led to poor predictive performances with a median accuracy of just 53% (inter-quartile range 47-61%). With logistic regression, there is the potential disadvantage of auto-correlation between the large numbers of independent variables within the dataset, which is possibly the reason for the poor predictive performance suggesting that this dataset is not linearly separable. 
         [0135]    The application of this approach resulted in the identification of a gene expression signature consisting of twenty genes which predicted patient prognosis to a median accuracy of 100% (inter-quartile range 100-100%, mean squared error of 0.085), where samples were treated as blind data over 50 models with random sample cross validation. The overall screening process assessed over ten million individual models. When evaluated with a ROC curve the model had an AUC value of 0.971 with sensitivity and specificity values of 98% and 94% respectively.  FIG. 14  shows the performance for the models at each step of the analysis. It is evident that the continual addition of key genes leads to an overall improvement in the predictive capabilities of the model. The model showed a decrease in performance at steps 10 and 11 which may be due to a possible interaction between the genes present at these steps with one or more of the other genes in the model. After this point the model improved further still until step twenty, so this was considered to contain the genes which most accurately modelled the data. Further steps were not conducted because no significant improvement in performance could be achieved. A summary of the performances of the models at each step, together with the identity of the gene (where known) are given in Table 6. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
             
               
               
               
               
               
               
             
           
               
                 TABLE 6 
               
             
             
               
                   
               
               
                 Summary of twenty genes used in the gene expression signature at each 
               
               
                 step of model development. 
               
             
          
           
               
                   
                   
                   
                   
                   
                 Mean 
               
               
                   
                   
                   
                 Median % 
                 Inter Quartile 
                 Squared 
               
               
                 Step 
                 Gene Name 
                 Gene Description 
                 Accuracy 
                 Range (%) 
                 Error 
               
               
                   
               
             
          
           
               
                 1 
                 CA9 
                 Carbonic anhydrase IX 
                 70 
                 66.7-77   
                 0.438 
               
               
                 2 
                   
                 EST&#39;s 
                 80.5 
                 77.7-87.7 
                 0.383 
               
               
                 3 
                   
                 ESTs, Weakly similar to 
                 83 
                 76.1-85.9 
                 0.377 
               
               
                   
                   
                 RL17_HUMAN 60S 
               
               
                   
                   
                 RIBOSOMAL PROTEIN L17 
               
               
                   
                   
                 [ H. sapiens ] 
               
               
                 4 
                 FLJ13409 
                 ESTs, Weakly similar to 
                 87 
                 79.6-88.7 
                 0.351 
               
               
                   
                   
                 the KIAA0191 gene is 
               
               
                   
                   
                 expressed ubiquitously 
               
               
                   
                   
                 [ H. sapiens ] 
               
               
                 5 
                 LCHN 
                 LCHN protein 
                 80 
                 73.9-84.7 
                 0.397 
               
               
                 6 
                 TMEFF2 
                 Transmembrane protein 
                 94.7 
                 89.4-95.3 
                 0.233 
               
               
                   
                   
                 with EGF-like and two 
               
               
                   
                   
                 follistatin-like domains 2 
               
               
                 7 
                 HEC 
                 Highly expressed in 
                 94.8 
                 89.3-96.7 
                 0.217 
               
               
                   
                   
                 cancer, rich in leucine 
               
               
                   
                   
                 heptad repeats 
               
               
                 8 
                 HSPC333 
                   Homo sapiens  HSPC337 
                 96 
                  95-100 
                 0.171 
               
               
                   
                   
                 mRNA, partial cds 
               
               
                 9 
                   
                 EST&#39;s 
                 98.1 
                 94.6-100  
                 0.154 
               
               
                 10 
                   
                   Homo sapiens  cDNA: 
                 95 
                 90.9-95.9 
                 0.23 
               
               
                   
                   
                 FLJ22044 fis, clone 
               
               
                   
                   
                 HEP09141 
               
               
                 11 
                 HUGT1 
                 UDP-glucose: 
                 78.2 
                 71.3-83.5 
                 0.393 
               
               
                   
                   
                 glycoprotein 
               
               
                   
                   
                 glucosyltransferase 1 
               
               
                 12 
                 LOC56899 
                 putative 47 kDa protein 
                 85.1 
                   80-91.8 
                 0.322 
               
               
                 13 
                 DJ462O23.2 
                 Hypothetical protein 
                 96.1 
                 94.3-100  
                 0.16 
               
               
                   
                   
                 dJ462O23.2 
               
               
                 14 
                 HSU93243 
                 Ubc6p homolog 
                 96.1 
                 95.2-100  
                 0.155 
               
               
                 15 
                 NRG2 
                 Neuregulin 2 
                 95.8 
                  94-100 
                 0.174 
               
               
                 16 
                   
                 EST&#39;s 
                 95.9 
                 90.5-100  
                 0.17 
               
               
                 17 
                   
                 EST&#39;s 
                 100 
                 95.4-100  
                 0.168 
               
               
                 18 
                   
                 EST&#39;s 
                 96.1 
                 92.5-100  
                 0.176 
               
               
                 19 
                 NPHP1 
                 Nephronophthisis 1 
                 95.8 
                  92-100 
                 0.165 
               
               
                   
                   
                 (juvenile) 
               
               
                 20 
                 QDPR 
                 Quinoid dihydropteridine 
                 100 
                 100-100 
                 0.085 
               
               
                   
                   
                 reductase 
               
               
                   
               
             
          
         
       
     
         [0136]    Median accuracy, lower and upper inter-quartile ranges, gene names (where known) and descriptions are shown. 
         [0137]    To further validate the model, an additional set of 19 samples were selected, as in the original manuscript (van&#39;t Veer, et al., 2002). This set consisted of 7 patients who remained metastasis free, and 12 who developed metastases within five years. The 20 gene expression signature that had been identified correctly diagnosed all 19 samples correctly, further emphasising the present models&#39; predictive power. 
       Analysis of West et al Dataset 
       [0138]    The aims here were to identify a gene expression signature which would accurately predict between firstly estrogen receptor (ER) status, and secondly to determine whether it was possible to generate a robust model containing genes which would discriminate between patients based upon lymph node (LN) status. As before, an initial analysis was carried out using logistic regression which again led to poor predictive performances with a median accuracy of 78% (inter-quartile range 67-88%) for the ER data, and just 56% (inter-quartile range 44-67%) for the LN dataset, which is comparable to the predictions one would gain from using a random classifier. 
         [0139]    Here, using the stepwise methodology, two gene expression signatures were identified. The first discriminated 100% of the cases correctly with regards to whether they were positive or negative for ER, and the second predicted whether metastasis of the tumour to the axillary lymph node had occurred, to an accuracy of 100%. Again, the accuracies reported are from separate validation data splits, with samples treated as blind data over 50 models with random sample cross validation. The overall screening process assessed over five million individual models. When evaluated with a ROC curve the model had an area under the curve value of 1.0 with sensitivity and specificity values of 100% and 100% respectively for both ER and LN status.  FIG. 15(   a )-( b ) shows the performance for the models at each step of the analysis. It is evident that the continual addition of key genes leads to an overall improvement in the error associated with the predictive capabilities of the model for blind data. After steps 8 and 7 for the ER and LN data respectively, no further steps were conducted because no significant improvement in performance could be achieved, therefore these models were considered to contain the genes which most accurately modelled the data. A summary of the performances of the models at each step, together with the identity of these are given in Table 7 a-b. 
         [0140]    The models developed using the gene subsets identified by the approach described were applied to 88 samples from Huang and colleagues (Huang, et al (2003) Lancet, 361, 1590-1596). These samples were then subjected to classification based upon ER and LN status as with the first dataset. 88.6% of the samples could be classified correctly based on ER status, with a sensitivity and specificity of 90.4 and 80% respectively. 83% of samples were correctly classified based upon their LN status, with a sensitivity of 86.7% and specificity of 80%. The ROC curves AUC values were 0.874 and 0.812 for the ER and LN gene subset models respectively. It was expected that the predictive accuracies would be reduced when the models were applied to this additional dataset, but the accuracies reported here remain extremely encouraging because of the larger sample size, the differences in sample characteristics and microarray analysis described above. The ability to predict ER status at a higher rate than that of LN status suggests that there is a greater level of variation in the gene expression profiles with respect to LN status compared to that of ER. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
             
               
               
               
               
               
               
             
           
               
                 TABLE 7a-b 
               
             
             
               
                   
               
               
                 Summary genes used in the gene expression signature at each step of 
               
               
                 model development for (a) ER status and (b) LN status. 
               
               
                 (a) 
               
             
          
           
               
                   
                 Gene 
                   
                   
                   
                 Mean 
               
               
                   
                 Accession 
                   
                 Median % 
                 Inter Quartile 
                 Squared 
               
               
                 Step 
                 Number 
                 Gene Description 
                 Accuracy 
                 Range (%) 
                 Error 
               
               
                   
               
             
          
           
               
                 1 
                 X58072-at 
                 Human hGATA3 mRNA 
                 91.7 
                 84.6-93.3 
                 0.291 
               
               
                 2 
                 Z29083-at 
                   H. sapiens  5T4 gene for 
                 93.3 
                 91.1-100  
                 0.214 
               
               
                   
                   
                 5T4 Oncofetal antigen 
               
               
                 3 
                 M81758-at 
                 SkM1 mRNA 
                 100 
                 92.4-100  
                 0.138 
               
               
                 4 
                 M60748-at 
                 Human histone H1 (H1F4) 
                 100 
                 100-100 
                 0.087 
               
               
                   
                   
                 gene 
               
               
                 5 
                 M74093-at 
                 Human cyclin mRNA 
                 100 
                 100-100 
                 0.038 
               
               
                 6 
                 U22029-f-at 
                 Human cytochrome 
                 100 
                 100-100 
                 0.034 
               
               
                   
                   
                 P450 mRNA 
               
               
                 7 
                 U96131-at 
                   Homo sapiens  HPV16 E1 
                 100 
                 100-100 
                 0.028 
               
               
                 8 
                 M96982-at 
                   Homo sapiens  U2 
                 100 
                 100-100 
                 0.017 
               
               
                   
                   
                 snRNP auxiliary factor 
               
               
                   
                   
                 small subunit 
               
               
                   
               
             
          
         
       
     
         [0141]    Median accuracy, lower and upper inter-quartile ranges, gene accession numbers, gene descriptions are shown. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                   
               
               
                 (b) 
               
             
          
           
               
                   
                   
                   
                   
                 Inter 
                   
                   
               
               
                   
                 Gene 
                   
                   
                 Quartile 
                 Mean 
               
               
                   
                 Accession 
                   
                 Median % 
                 Range 
                 Squared 
               
               
                 Step 
                 Number 
                 Gene Description 
                 Accuracy 
                 (%) 
                 Error 
                 Response 
               
               
                   
               
             
          
           
               
                 1 
                 AFFX- 
                 Bacteriophage P1 cre 
                 80 
                   75-86.4 
                 0.384 
                 † 
               
               
                   
                 CreX-3-st 
                 recombinase 
               
               
                 2 
                 M83221-at 
                   Homo sapiens  I-Rel 
                 88.2 
                 83.7-93.2 
                 0.301 
                 * 
               
               
                   
                   
                 mRNA 
               
               
                 3 
                 S79862-s- 
                 PSMD5 
                 92.9 
                 87.5-94.4 
                 0.252 
                 ‡ 
               
               
                   
                 at 
               
               
                 4 
                 U39817-at 
                 Human Bloom 
                 94 
                 92.3-100  
                 0.172 
                 † 
               
               
                   
                   
                 syndrome protein 
               
               
                   
                   
                 (BLM) mRNA 
               
               
                 5 
                 U63139-at 
                 Human Rad50 mRNA 
                 100 
                 100-100 
                 0.085 
                 † 
               
               
                 6 
                 M83652-s- 
                 
                   Homo sapiens 
                 
                 100 
                 100-100 
                 0.062 
                 † 
               
               
                   
                 at 
                 complement 
               
               
                   
                   
                 component properdin 
               
               
                   
                   
                 mRNA 
               
               
                 7 
                 U30894-at 
                 Human N- 
                 100 
                 100-100 
                 0.05 
                 † 
               
               
                   
                   
                 sulphoglucosamine 
               
               
                   
                   
                 sulphohydrolase 
               
               
                   
                   
                 (SGSH) mRNA 
               
               
                   
               
             
          
         
       
     
         [0142]    Median accuracy, lower and upper inter-quartile ranges, gene accession numbers, gene descriptions are shown. 
       Identification of Multiple Biomarker Subsets 
       [0143]    The stepwise methodology described above facilitates the identification of subsets of biomarkers which can accurately model and predict sample class for a given complex dataset. In order to facilitate a more rapid biomarker subset analysis, the stepwise approach described adds only the best performing biomarker each step of analysis. Although this appears to be an extremely robust method of biomarker identification, the question remains as to whether there are additional subsets of biomarkers existing within the dataset, which are also capable of predicting class to high accuracies. If this is true, then this would lead to a further understanding of the system being modelled, and if multiple biomarkers were to appear in more than one model subset, then this would further validate their identification, and enhance the potential of their role in disease status warranting further investigation. 
         [0144]    To achieve these aims, the same West dataset was used as previously (West, et al., 2001). As can be seen from table 8a-b, in addition to the number one ranked biomarker at step one (which was subsequently used as the basis for the gene biomarker signature described earlier), there are several other potential candidate biomarkers which by themselves are able to classify a significant proportion of the sample population into their respective classes. Therefore an individual stepwise analysis was conducted on each of the remaining top ten genes identified in step one of the analysis, for both ER and LN status. 
       Results 
       [0145]      
         [0000]    
       
         
               
             
               
               
               
             
               
             
               
               
               
             
               
             
               
               
               
             
           
               
                 TABLE 8a-b 
               
             
             
               
                   
               
               
                 Summary of step 1 analysis for (a) ER and (b) LN status. 
               
             
          
           
               
                   
                   
                 Blind 
               
               
                 Rank 
                 Gene ID 
                 Performance 
               
               
                   
               
             
          
           
               
                 (a) 
               
             
          
           
               
                 1 
                 GATA3 
                 89.8 
               
               
                 2 
                 ESR1 
                 87.6 
               
               
                 3 
                 SLC39A6 
                 85.5 
               
               
                 4 
                 EST 
                 85.3 
               
               
                 5 
                 HSD17B4 
                 83.3 
               
               
                 6 
                 EST 
                 84.2 
               
               
                 7 
                 AR 
                 83.0 
               
               
                 8 
                 LAD1 
                 84.0 
               
               
                 9 
                 SCNN1A 
                 84.2 
               
               
                 10 
                 MAPT 
                 80.2 
               
             
          
           
               
                 (b) 
               
             
          
           
               
                 1 
                 EST 
                 80.4 
               
               
                 2 
                 GYPA/B 
                 70.9 
               
               
                 3 
                 BLM 
                 71.2 
               
               
                 4 
                 ACVR1B 
                 70.4 
               
               
                 5 
                 EST 
                 64.3 
               
               
                 6 
                 WNT5A 
                 66.7 
               
               
                 7 
                 RELB 
                 61.3 
               
               
                 8 
                 GK 
                 64.1 
               
               
                 9 
                 PDE4B 
                 64.3 
               
               
                 10 
                 TLE1 
                 64.7 
               
               
                   
               
               
                 Table shows the gene identification and respective predictive performances of the top 10 ranked genes identified at step 1 of the analysis. 
               
             
          
         
       
     
         [0146]      FIG. 16(   a )-( b ) shows the network performance at each step of analysis for all of these genes for ( a ) ER and ( b ) LN status. It is evident that all of these subsets have the ability to predict for blind subsets of samples to extremely high accuracies, with no significant differences between individual models. This suggests that there may be multiple genes acting in response to disease status, subsequently altering various pathways and altering the expression levels of many other genes. It is worthwhile to note that some of these genes were identified in many of the models (Table 9), for example an EST appeared in seven out of ten models, further highlighting its potential importance in LN status. This shows that there is not necessarily just one set of biomarkers which are correlates of a particular disease status of interest, but there may be many, and when one particular subset of biomarkers are affected in such a way that is indicative of disease status, then this may consequently have a cascade affect on many other biomarkers, altering their expression in a similar fashion. 
         [0000]    
       
         
               
             
               
               
               
             
               
             
               
               
               
             
               
             
               
               
               
             
           
               
                 TABLE 9 
               
             
             
               
                   
               
               
                 Summary of genes identified in multiple stepwise modelling which 
               
               
                 occur in more than one model in (a) ER and (b) LN status 
               
             
          
           
               
                   
                   
                 Number of 
               
               
                 Gene ID 
                 Actual Gene Name 
                 Occurrences 
               
               
                   
               
             
          
           
               
                 (a) 
               
             
          
           
               
                 CYP2B6 
                 Cytochrome p450 polypeptide 6 
                 3 
               
               
                 CTSC 
                 Cathepsin c 
                 3 
               
               
                 GATA3 
                 Gata binding protein 3 
                 2 
               
               
                 EST 
                 EST 
                 2 
               
               
                 CYP2A7 
                 Cytochrome p450 polypeptide 7 
                 2 
               
               
                 LRRC17 
                 Leucine rich repeat 
                 2 
               
               
                 NFKBIE 
                 Nuclear factor of kappa 
                 2 
               
               
                 COX6C 
                 Cytochrome c oxidase 
                 2 
               
               
                 HLF 
                 Hepatic leukemia factor 
                 2 
               
               
                 IGLC 
                 Immunoglobulin lambda 
                 2 
               
               
                 ZBTB16 
                 Zinc finger 
                 2 
               
               
                 RTN1 
                 Reticulon 1 
                 2 
               
             
          
           
               
                 (b) 
               
             
          
           
               
                 EST 
                 EST 
                 7 
               
               
                 BLM 
                 Bloom syndrome 
                 6 
               
               
                 ACVR1B 
                 Activin a receptor 
                 4 
               
               
                 GYPA/GYPB 
                 Glycophorin a/b 
                 3 
               
               
                 AXIN1 
                 Axin 1 
                 3 
               
               
                 RELB 
                 V-rel reticuloendotheliosis viral 
                 2 
               
               
                   
                 oncogene homolog b 
               
               
                 PSMD5 
                 Proteasome (prosome, macropain) 
                 2 
               
               
                 SGSH 
                 N-sulfoglucosamine sulfohydrolase 
                 2 
               
               
                   
                 (sulfamidase) 
               
               
                 CTSH 
                 Cathepsin h 
                 2 
               
               
                 NUP88 
                 Nucleoporin 88 kda 
                 2 
               
               
                 ENG 
                 Endoglin 
                 2 
               
               
                 SYBL1 
                 Synaptobrevin-like 1 
                 2 
               
               
                   
               
             
          
         
       
     
       Stepwise Analysis Validation 
       [0147]    To provide further evidence and confidence that the biomarker subsets identified in all of the above analyses by the stepwise approach were not random as a consequence of the high dimensionality of the datasets, two validation exercises were conducted. Firstly, ten inputs were randomly selected from the datasets and trained over 50 random sample cross validation events in an ANN model identically as for the stepwise method. This process was repeated 1,000 times, and the summary results are presented in Table 10. 
         [0148]    It is clear from Table 10 that the variation amongst models generated with these random input subsets is small, suggesting that a randomly generated model is able to predict sample class to accuracies in the region of 64% for blind data. These models will very rarely predict significantly higher than this value, which is highlighted in  FIG. 17 , which details the distribution of the model performance across the various models. The data follows a normal distribution, and therefore it is unlikely that a random model would generate a subset of inputs capable of very high classification accuracies, indicating that the stepwise ANN approach to modelling described here is selecting inputs which are discriminating between the groups of interest in a biologically relevant manner. 
         [0149]      FIG. 18(   a )-( c ) highlights the significance between the performance of the randomly generated models and those developed with the stepwise approach for the van&#39;t Veer and West gene expression datasets (van&#39;t Veer, et al., 2002; West, et al., 2001). 
         [0150]    These results show that a random classifier would indeed as expected lead to classification accuracies close to random, and therefore it can be said that the stepwise approach truly identifies subsets of inputs which predict well on unseen data. 
         [0151]    Now it was necessary to investigate whether this stepwise approach would identify the same inputs if the analysis was run several different occasions, starting over each time with the same dataset. To achieve this, the stepwise analysis was run and trained on the van&#39;t Veer dataset with samples randomly split into training, test, and validation subsets 10, 20, 50 and 100 times and subsequently trained. This was then repeated five times to calculate how consistent the ranking of the individual inputs was with regards to model performance. This consistency was calculated for the top fifty most important inputs, and was the ratio of actual ranking based upon the average error of the model, to the average ranking over the multiple runs. These are summarised in Table 11. 
         [0000]    
       
         
               
             
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 10 
               
             
             
               
                   
               
               
                 Summary results of random input selection 
               
             
          
           
               
                   
                   
                 Validation 
                 Validation 
               
               
                   
                 Summary Statistic 
                 data accuracy 
                 data error 
               
               
                   
                   
               
             
          
           
               
                   
                 Average 
                 64% 
                 0.495 
               
               
                   
                 Standard Deviation 
                 0.024 
                 0.014 
               
               
                   
                 Standard Error 
                 0.0000245 
                 0.0000141 
               
               
                   
                 95% confidence interval 
                 0.0000489 
                 0.0000282 
               
               
                   
                 Median 
                 64% 
                 0.495 
               
               
                   
                 Inter Quartile Range 
                 62-66% 
                 0.485-0.504 
               
               
                   
                   
               
             
          
         
       
     
         [0000]    
       
         
               
             
               
               
               
             
               
               
               
             
           
               
                 TABLE 11 
               
             
             
               
                   
               
               
                 Summary of the consistency of inputs identified as importance 
               
               
                 using varying random sample cross validation data splits in 
               
               
                 step 1 of the analysis. 
               
             
          
           
               
                 Number of RSCV 
                 Mean Group 
                   
               
               
                 datasplits 
                 Consistency 
                 95% ci 
               
               
                   
               
             
          
           
               
                 10 
                 0.547 
                 0.009 
               
               
                 20 
                 0.708 
                 0.009 
               
               
                 50 
                 0.859 
                 0.010 
               
               
                 100 
                 0.880 
                 0.013 
               
               
                   
               
             
          
         
       
     
         [0152]    There was a significant increase in consistency amongst the performance of inputs when increasing from 10 to 20 (p=0.000), and 20 to 50 RSCV datasplits (p=0.000), but not from 50 to 100 (p=0.2213). Interestingly, for all analyses, the same two inputs were ranked as first and second every time, with the majority of the variation in rankings appearing towards the bottom of the top 50 list, which accounts for the 14 and 12% variability in the 50 and 100 RSCV event models respectively. This showed step 1 to be extremely consistent in important input identification across multiple analyses. 
         [0153]    The same procedure was then carried out for step 2, with the input identified as the most important across all the models in step 1 used to form the basis of this second step. Table 12 shows the average consistency ratios for step 2. 
         [0154]    It is clear that consistency across multiple repeats of the analysis showed a dramatic decline, with only the 100 RSCV model retaining its consistency in input identification, and the improvement in consistent input performance was statistically significant (p=0.000) at each increment. The 50 and 100 RSCV models both identified the same input as number one ranked, and it therefore appears evident that a minimum of 50 RSCV datasplits is preferable to ensure that the same inputs are consistently identified as important multiple times in 80-90% of analyses. 
         [0000]    
       
         
               
             
               
               
               
             
               
               
               
             
           
               
                 TABLE 12 
               
             
             
               
                   
               
               
                 Summary of the consistency of inputs identified as importance 
               
               
                 using varying random sample cross validation data splits in 
               
               
                 step 2 of the analysis. 
               
             
          
           
               
                 Number of RSCV 
                 Mean Group 
                   
               
               
                 datasplits 
                 Consistency 
                 95% ci 
               
               
                   
               
             
          
           
               
                 10 
                 0.140 
                 0.004 
               
               
                 20 
                 0.487 
                 0.011 
               
               
                 50 
                 0.657 
                 0.009 
               
               
                 100 
                 0.811 
                 0.009 
               
               
                   
               
             
          
         
       
     
       Conclusions 
       [0155]    The present example demonstrates one aspect of the novel stepwise ANN approaches of the invention as utilised in data mining of biomarker ions representative of disease status applied to different datasets. This ANN based stepwise approach to data mining offers the potential for identification of a defined subset of biomarkers with prognostic and diagnostic potential. These biomarkers are ordinal to each other within the data space and further markers may be identified by examination of the performance of models for biomarkers at each step of the development process. In order to assess the potential of this methodology in biomarker discovery, three datasets were analysed. These were all from different platforms which generate large amounts of data, namely mass spectrometry and gene expression microarray data. 
         [0156]    The present technology is able to support clinical decision making in the medical arena, and to improve the care and management of patients on an individual basis (so called “personalised medicine”). It has also been shown that gene expression profiles can be used as a basis for determining the most significant genes capable of discriminating patients of different status in breast cancer. In agreement with van&#39;t Veer et al. (West, et al., 2001) it has been demonstrated that whilst single genes are capable of discriminating between different disease states, multiple genes in combination enhance the predictive power of these models. In addition to this, the results provide further evidence that ER+ and ER− tumours display gene expression patterns which are significantly different, and can even be discriminated between without the ER gene itself. This suggests that these phenotypes are not only explained by the ER gene, but a combination of other genes not necessarily primarily involved in the response of ER, but which may be interacting with, and modulating ER expression in some unknown fashion. Unlike some analysis methods, the present ANN stepwise approach takes each and every gene into account for analysis, and does not use various cut-off values to determine significant gene expression, which overcomes previous data analysis limitations. These models can then form a foundation for future studies using these genes to develop simpler prognostic tests, or as candidate therapeutic targets for the development of novel therapies, with a particular focus being the determination of the influence that these genes may have upon ER expression and development of lymph node metastasis. Given the relevance of the genes identified by this method and the applicability of these to a wider population this approach is a valid way of identifying subsets of gene markers associated with disease characteristics. Confidence in the identified genes is increased further still in that many of these genes have known associations with cancer. 
         [0157]    To conclude, the present example demonstrates that by using novel ANN methodologies, it is possible to develop a powerful tool to identify subsets of biomarkers that predict disease status in a variety of analyses. The potential of this approach is apparent by the high predictive accuracies as a result of using the biomarker subsets identified. These biomarker subsets were then shown to be capable of high classification accuracies when used to predict for additional validation datasets, and were even capable of being applied to predict the ER and LN status of a dataset very different in origin from the one used in the identification of the important gene subsets. This in combination with the various validation exercises that have been conducted suggests that these biomarkers have biological relevance and their selection is not arbitrary or an artefact of the high dimensionality of the system as they were shown to be robust to cope with sampling variability and reproducible across different sample studies. 
       Example 2 
     Breast Cancer Prognostic Method and Panel Using a Continuous Output from the ANN 
     Introduction 
       [0158]    Molecular diagnostics for the diagnosis of disease are becoming increasingly important in the early diagnosis and management of disease, the stratification of patients in clinical trials and the identification of patients who should receive certain therapies. 
         [0159]    Before the advent of molecular diagnostics, clinicians categorized cancer cells according to their pathology, that is, according to their appearance under a microscope. Now taking data from new disciplines such as, genomics and proteomics; molecular diagnostics categorizes cancer using technology such as mass spectrometry and transcriptomic gene chips. Molecular diagnostics have been used most extensively in the field of cancer but increasingly are also being used in most clinical indications of disease. 
         [0160]    Molecular diagnostics determines how genes and proteins are interacting in a cell. It focuses upon patterns of gene and protein activity in different types of cancerous or precancerous cells. Molecular diagnostics uncovers these sets of changes and captures this information as expression patterns. Also called “molecular signatures,” these expression patterns are improving the clinicians&#39; ability to diagnose cancer. Molecular signatures include specific sets of genes whose expression patterns are correlated to a specific phenotypic output. Whilst the expression of each individual gene in isolation is not indicative of a defined phenotype it is the combination of all the genes within the panel that together provides a reliable and defined correlation to a pathological condition. Increasingly in bioinformatics and genomic analysis it has been recognised that a key step in recognising and predicting susceptibility to disease is through the identification of these molecular signatures in tissues taken from a patient. Whereas single gene target tests are crude and can often miss larger scale changes in cellular biology, detection and analysis of distinct molecular signatures can provide accurate prognosis of disease states within individuals earlier than was previously thought possible. 
         [0161]    A diagnostic test known commercially as Mammaprint™ (Agendia, Amsterdam, Netherlands) for use in oncology is based on the original van&#39;t Veer dataset (Nature, 2002) in fresh frozen tissue. The Mammaprint™ test predicts low and high risk of distant metastasis (Ishitobi et al., Jpn J Clin Oncol, Jan. 27, 2010). This test is based on a 70 gene signature, which has a median sensitivity of 86% and currently markets at around US$3,000 per test placing it out of the spending range of most health service providers. The stratification defines “low risk patients” as having a 10% chance of recurrence within years whilst “high risk” patients have a 20% chance of recurrence within 10 years. Hence, the overall predictive accuracy is low. The diagnostic test can be used further to classify patients into oestrogen receptor (ER) and BRCA1 positive or negative as described in U.S. Pat. No. 7,514,209. 
         [0162]    U.S. Pat. No. 7,081,340 describes a test which stratifies patients into broad categories of low, medium and high risk with a view to identifying patients who would most benefit from chemotherapy. 
         [0163]    Other types of RNA expression analysis to diagnose breast cancer have focussed on combinations of genes identified by a variety of screening methods. Such methods include Veridex™ as set out in US patent publication no. 2009/0298052, which describes a breast cancer diagnostic for use intra-operatively to predict the presence of micrometastasis. The Ipsogen™ test, as set out in International Patent publication no. WO-2009/083780, describes a diagnostic segregating patients into basal or luminal breast cancer and further good or poor prognosis of the luminal breast cancer subtypes based upon the expression analysis of 16 different kinase genes. In US Patent Publication no. 2008/0206769 an analysis is made of 14 genes to derive a metastasis score, which is compared with a threshold comparator to give patients a risk of developing metastasis. The Diadexus™ test as set out in International Patent publication no. WO06121991 describes some 70 genes whose expression levels were used to provide for a differential diagnosis of good or poor prognostic outcome. 
         [0164]    Currently there are no prognostic tests for breast cancer that are able to define the precise time to a given event in disease progression, such as projected time to death, progression of the disease to a later stage, and likelihood of recurrence or metastasis. The only tests currently available, as described above, predict broadly defined classes, such as poor or good prognostic group, without consideration of the individual&#39;s actual prognosis. One example of this is the well-established Nottingham Prognostic Index (Galea MH, et al. Breast Cancer Res Treat. 1992; 22(3):207-19). 
         [0165]    In general the use of expression analysis has been used to provide a classification of good or poor prognosis in patients, or the classification of groups comprising individuals with similar risk of developing metastasis. The analysis of gene expression levels has not been used to provide a time to an event diagnosis that would guide clinical management of the disease or the timing of clinical intervention. 
         [0166]    The present invention, for the first time, describes a method and apparatus that predicts a time to a given disease progression outcome, hereafter referred to as an “event”. 
         [0167]    In the present example of the present invention in use, the inventors have analysed data from three public breast cancer gene expression microarray datasets with longitudinal follow up, to predict an event: the distant metastasis-free survival (DMFS) interval (n=530, ER+ cases). A gene signature has been incorporated into a decision support model comprising 31 genes that predict actual DMFS with high accuracy (Spearman&#39;s r=0.86). This signature has been validated on blind data from a fourth set, where it has shown good predictive results. 
         [0168]    This novel test provides a more accurate diagnosis for the individual, moving away from the group based statistics or prognostic classes that are currently employed in the art. The 31 gene signature disclosed herein in Table 13 may be translated to a quantitative PCR test and used to diagnose the time to distant metastasis on fresh frozen [FF] material or formalin fixed paraffin embedded [FFPE] material, through an associated decision support tool. Alternatively the 31 gene signature can be translated to a gene microarray in format of a small bespoke array specifically for the purpose of analysing and providing a time to an event diagnostic. Further refinement allows for the 31 gene signature to be incorporated into a next-generation sequencing format—such as using Solexa™ deep sequencing technology. 
         [0169]    The potential advantage for the diagnostic described herein is that it provides a time to an event prognosis to each patient that enables clinicians and patients to plan appropriate therapies and thus subsequent patient management. For those patients with a shorter predicted time to an event, a clinical approach prescribing aggressive chemo- and radio-therapy followed with Tamoxifen, for instance, may be deemed appropriate. On the other hand, patients with a mid- to late time to an event could benefit from Tamoxifen for several years with regular check ups. A significant part of the clinical validation exercise is to look very carefully at the mid- to late time to event groups identify subgroups within this cohort that would further allow differential treatment strategies to be identified. 
         [0170]    The inventions described herein through the use of the gene expression panel coupled with ANN data mining and interrogation and the novel application of a continuous output from the ANN provide for a diagnostic or prognostic that predicts the time to an event, in this specific embodiment the development of distant metastasis. 
       General Description of the Present Embodiment of the Invention 
       [0171]    Artificial Neural Networks (ANNs) have been selected as they provide a non-linear basis for identification of genes associated with particular clinical questions. It is well known that this type of ANN is a powerful tool for the analysis of complex data (Wei et al, 1998; Ball et al, 2002; Khan et al, 2001). A number of studies have indicated the approach can produce generalised models with a greater accuracy than conventional statistical techniques in medical diagnostics (Tafeit and Reibnegger, 1999; Reckwitz et al, 1999) without relying on predetermined relationships as in other modelling techniques. The application of these approaches has been presented in Lancashire et al (2009). The approaches have been developed since early application by Ball et al (2002). 
         [0172]    A number of other methods may be developed for the purposes of developing disease and clinical classifiers. These in clued various forms of genetic algorithm, support vector machine, decision tress (extending to random forests) and Bayesian methodologies. The vast majority of these are applied to data mining and classifier development in a recursive fashion, resulting in extremely large panels of markers. The ANN algorithm mentioned above has shown an improvement in performance over these methods and has identified much smaller panels of genes with higher classification performance. 
       Experimental Design and Statistical Considerations 
       [0173]    One of the major hurdles to the analysis of the data types described above is the high dimensionality and complexity of the data. This has been termed “the curse of dimensionality” (Bellman, 1961, Bishop, 1995) and often leads to an input space with many irrelevant or noisy inputs, subsequently causing predictive algorithms to behave badly as a result of them modelling extraneous portions of the space. Conventional statistical theory would indicate that for a valid representation of the population one should have at least twice as many replicates as the number of dimensions in the data. Clearly a data set requiring hundreds of thousands of samples is not feasible due to sample availability. It is estimated that to achieve power for transcriptomic micro array data based on conventional analyses (T test for example) in the order of 105 replicates would be required (Ponder pers con). In practice the powering issues associated with high dimensional data sets can be overcome by modelling individual components of the parameters in the array and applying a robust cross validation approach (Michiels et al, 2007). Furthermore, to validate panels of markers a secondary data set is beneficial. This approach has been incorporated into the algorithms described previously herein. 
         [0174]    Power analysis was conducted using a multivariate regression model (which has less power than a non linear ANN based approach) for an r 2  of 0.81 at an alpha value of 0.05 for 31 regressor variables 38 cases are required to give a power of 0.8. Analysis was conducted according to Lenth, R. V. (2006-9) Java Applets for Power and Sample Size [Computer software], retrieved from www.stat.uiowa.edu/˜rlenth/Power. 
         [0175]    This approach also addresses the question of the applicability and validity of the biomarker panel to predictions for a broader population. When analyzing a particular data set one has to be careful to prevent over-fitting. The impact of over fitting is that the signature or pattern identified may be applicable for the data set (group) being modelled but as soon as the pattern is applied to a blind independent data set the signature ceases to be predictive. Any approach is particularly sensitive to this over-fitting when the population numbers are low. The problem with over fitting can be overcome by analysing a large number of replicates to achieve statistical power. 
         [0176]    Using the logistic function, ANNs may be trained to predict against a continuous output variable, which in specific scenarios can be more intuitive than the use of a step-function to separate two classes. Here, a single layered network would be identical to the logistic regression model. However this logistic regression approach has several disadvantages including the requirement of large numbers of data points per predictor, inter-correlations amongst predictors, and perhaps most importantly the predictor variables are usually required to be linearly related to the output measurement. 
         [0177]    Introduction of ANNs with one or more hidden layers allows for the estimation of non-linear functions. Universal approximation theorem states that every continuous function that maps intervals of real numbers to some output interval of real numbers can be approximated arbitrarily closely by a multi-layered perceptron ANN with a single hidden layer. This offers advantages over other machine learning classifiers (e.g. SVMs, Random Forest) where it may be difficult to approximate continuous output data. 
         [0178]    This multi-layered perceptron ANN forms the basis of the present example and is referred to as “Risk Distiller”, a novel algorithm utilising a stepwise modelling approach to identify the key components of a system in predicting against a continuous output variable. 
         [0179]    Potential uses for Risk Distiller in the medical arena include predicting actual time to event including progression, relapse, metastases or death in disease based scenarios, thus generating prognostic models with a view to tailoring therapies in a patient specific manner. This approach can be used in event data, and also may be adopted for predicting combined cohorts of censored and time to event data. Other biological uses include (but are not limited to) climate change prediction, prediction of weather patterns including ocean current measurements, predicting the effect of stresses on the productivity of crops with a view to forecasting crop yield. Other potential uses include financial forecasting and time series predictions, risk management and credit evaluation. 
       Specific Description of the Present Embodiment of the Invention 
       [0180]    One of the criticisms of previous studies deriving biomarker signatures relating to clinical characteristics has been that the training and validation sets have come from single studies carried out in individual centres. To address this the present inventors have used three publications Chin et al (Cancer Cell 2006), Miller et al (PNAS 2005) and Desmedt et al (Clin Canc Res 2007) to initially derive a gene signature which for the first time predicts time to an event, in this case the event is distant metastasis-free survival [DMFS], through a decision support model. Examples of other suitable events include, but are not limited to, disease occurrence or recurrence, drug therapy failure, or more broadly time to the development of any specific phenotype defined by gene expression, gene silencing or similar molecular events. 
         [0181]    Furthermore, existing signatures tend to be based on broad categories or classes or groups of individuals in the population. For example the van&#39;t Veer study (Nature 2002) found correlates of good or poor prognostic outcome groups. These were defined using a cut-off off of 5 years with the good group developing metastasis after 5 years and the poor group developing metastasis before 5 years. Clearly the selection of these cut-offs is somewhat arbitrary and an individual who develops metastasis at 4 years 11 months may have a very different profile from an individual who develops metastasis at 6 months. This definition of classes also introduces errors to the classification tool due to the within class heterogeneity. For example even in the Good Prognostic Group of the Nottingham Prognostic Index individuals may die at 6 months or 120 months. To date there has been little focus on the individual&#39;s prognosis or on non class based decision support models using a continuous output. A further aspect of this invention is the prediction of an event for an individual based on a molecular profile that is specific for the individual and not based on a class, such as good or poor prognosis. 
         [0182]    The approach adopted in this example has progressed the characterisation of individual cases by utilisation of the aforementioned ANN based algorithm (see Example 1), but adapted to provide a continuous output (see  FIG. 7(   b )), to analyse three publicly available breast cancer (ER+ n=530) data sets with good clinical follow-up (sources Chin et al (Cancer Cell 2006), Miller et al (PNAS 2005) and Desmedt et al (Clin Canc Res 2007)) and has allowed the inventors to derive a unique gene signature describing time to an event: DMFS (see  FIG. 19) . 
         [0183]    During the analysis of the primary data sets an internal Monte-Carlo cross validation approach was adopted to optimise the signature derived and prevent over-fitting of the decision support system. This approach mitigates the need for vast numbers of cases which Power Analysis indicates when conventional parametric statistics are employed as the solution is driven to a global solution and prediction for unseen cases. To further validate the decision support model, the biomarker signature was tested on a fourth independent dataset (source Sotiriou et al (JNCI 2006)). The ER+ biomarker signature performs well on unseen data used to develop the signature (n=127; r=0.86; p=&lt;0.0001), a separate cohort of patients from the fourth study (n=20; r=0.93; p=&lt;0.0001) and even for cases censored or lost to follow up (n=383; r=0.59; p=0.0001). 
         [0184]    A comparison between the actual and the decision support model predicted Kaplan Meier curves was made by using Log rank tests. These produced a p value of 0.56 indicating equivalence of the model predictions with actual events (predicted median survival compared to actual median survival was 3.7 months versus 3.5 months respectively). 
         [0185]    The genes identified when combined in a panel correlate positively, negatively and in a highly curvilinear fashion with DMFS. This prevents the generation of a simple rule based solution to the prediction of DMFS and requires incorporation of the panel into a decision support model through the model algorithm developed herein. A separate analysis of all of the genes individually showed they were significantly related to the DMFS hazard based on Cox proportional hazard survival models. A specific aspect of this invention is therefore a decision support model, which specifies the positive, negative or cofactorial aspect of the genes within the panel. 
         [0186]    Further, a subset analysis allows output time to event information on individuals to be split into groups of &lt;5 years, &gt;5 years DMFS which reveals a clear and distinct clustering of cases based upon the 31 gene signature (see  FIG. 20 ). These two initial groups can be split further into four groups showing very early, early, late and very late or no development of metastases. This will provide the basis for further analysis of mechanisms of disease. 
       Utility of the Present Embodiment of the Invention 
       [0187]    The invention provides a diagnostic panel, comprising thirty-one genes, which when incorporated into a decision support model such as Risk Distiller predicts time to an event. Conversely, the invention provides a decision support model that when combined with the unique gene signature predicts time to an event, in this case DMFS. This is the first time such a decision tool has been developed for an individual&#39;s prognosis. 
         [0188]    A further embodiment of the invention is the depiction of predicted time of survival of a population based on the use of the diagnostic predicting time to an event. Another embodiment of the invention is the specific predicted Kaplan Meier curve derived from data mining of publications to generate a working model against which individuals&#39; gene expression information may be used to predict time to distant metastasis. A further utility of this invention is the derivation and depiction of the predicted Kaplan Meier curve from use of the Risk Distiller algorithm. 
         [0189]    A further embodiment of this invention is, therefore, a gene panel comprising 1 or more of the thirty-one gene signature that specifies a subset of patients with a time to an event [DMFS] of less than 5 year or more than 5 years. Another embodiment of this invention is a decision support model that works to provide a time to an event for a subset of patients with a time to an event [DMFS] of less than 2 years, or a time to an event of 2.5 to 5 years, 5-10 years or greater than 10 years. 
         [0190]    A further embodiment of this invention is a gene signature predicting a time to an event comprising a gene panel of 31 genes listed in Table 13. Further refinement of the gene panel allows patients to be grouped into 2 groups with DMFS of less than 5 years or more than 5 years and specific gene panels defining these groups are within the remit of the present invention. 
         [0000]    
       
         
               
             
               
               
               
               
             
           
               
                 TABLE 13 
               
             
             
               
                   
               
               
                 Gene names and accession numbers for top 31 genes - breast 
               
               
                 cancer gene panel. 
               
             
          
           
               
                 Probeset ID 
                 Gene Symbol 
                 Accession 
                 Gene Name 
               
               
                   
               
               
                 204822_at 
                 TTK 
                 P33981 
                 TTK protein kinase 
               
               
                 202239_at 
                 PARP4 
                 Q9UKK3 
                 poly (ADP-ribose) polymerase family, 
               
               
                   
                   
                   
                 member 4 
               
               
                 215271_at 
                 TNN 
                 Q9UQP3 
                 tenascin N 
               
               
                 205011_at 
                 VWA5A 
                 O00534 
                 von Willebrand factor A domain 
               
               
                   
                   
                   
                 containing 5A 
               
               
                 209950_s_at 
                 VILL 
                 O15195 
                 villin-like 
               
               
                 214435_x_at 
                 RALA 
                 P11233 
                 v-ral simian leukemia viral oncogene 
               
               
                   
                   
                   
                 homolog A (ras related) 
               
               
                 211714_x_at 
                 TUBB 
                 Q9BUU9 
                 tubulin, beta 
               
               
                 203743_s_at 
                 TDG 
                 Q05CX8 
                 thymine-DNA glycosylase 
               
               
                 211968_s_at 
                 HSP90AA1 
                 Q2VPJ6 
                 heat shock protein 90 kDa alpha 
               
               
                   
                   
                   
                 (cytosolic), class A member 1 
               
               
                 201311_s_at 
                 SH3BGRL 
                 O75368 
                 SH3 domain binding glutamic acid- 
               
               
                   
                   
                   
                 rich protein like 
               
               
                 220751_s_at 
                 C5orf4 
                 Q96IV6 
                 chromosome 5 open reading frame 4 
               
               
                 219494_at 
                 RAD54B 
                 Q9Y620 
                 RAD54 homolog B ( S. cerevisiae ) 
               
               
                 218893_at 
                 ISOC2 
                 Q96AB3 
                 isochorismatase domain containing 2 
               
               
                 219455_at 
                 C7orf63 
                 A5D8W1 
                 chromosome 7 open reading frame 63 
               
               
                 202475_at 
                 TMEM147 
                 A8MWW0 
                 transmembrane protein 147 
               
               
                 207023_x_at 
                 KRT10 
                 P13645 
                 keratin 10 
               
               
                 212526_at 
                 SPG20 
                 Q8N0X7 
                 spastic paraplegia 20 (Troyer 
               
               
                   
                   
                   
                 syndrome) 
               
               
                 203010_at 
                 STAT5A 
                 P42229 
                 signal transducer and activator of 
               
               
                   
                   
                   
                 transcription 5A 
               
               
                 219034_at 
                 PARP16 
                 Q8N5Y8 
                 poly (ADP-ribose) polymerase family, 
               
               
                   
                   
                   
                 member 16 
               
               
                 204542_at 
                 ST6GALNAC2 
                 Q9UJ37 
                 ST6 (alpha-N-acetyl-neuraminyl-2,3- 
               
               
                   
                   
                   
                 beta-galactosyl-1,3)-N- 
               
               
                   
                   
                   
                 acetylgalactosaminide alpha-2,6- 
               
               
                   
                   
                   
                 sialyltransferase 2 
               
               
                 200632_s_at 
                 NDRG1 
                 Q92597 
                 N-myc downstream regulated 1 
               
               
                 203567_s_at 
                 TRIM38 
                 O00635 
                 tripartite motif-containing 38 
               
               
                 218151_x_at 
                 GPR172A 
                 D3DWL8 
                 G protein-coupled receptor 172A 
               
               
                 212021_s_at 
                 MKI67 
                 P46013 
                 antigen identified by monoclonal 
               
               
                   
                   
                   
                 antibody Ki-67 
               
               
                 209832_s_at 
                 CDT1 
                 Q9H211 
                 chromatin licensing and DNA 
               
               
                   
                   
                   
                 replication factor 1 
               
               
                 207961_x_at 
                 MYH11 
                 Q4G140 
                 myosin, heavy chain 11, smooth 
               
               
                   
                   
                   
                 muscle 
               
               
                 211080_s_at 
                 NEK2 
                 P51955 
                 NIMA (never in mitosis gene a)- 
               
               
                   
                   
                   
                 related kinase 2 
               
               
                 200696_s_at 
                 GSN 
                 P06396 
                 gelsolin 
               
               
                 204887_s_at 
                 PLK4 
                 O00444 
                 Serine/threonine-protein kinase 
               
               
                   
                   
                   
                 PLK4 
               
               
                 218173_s_at 
                 WHSC1L1 
                 Q9BZ95 
                 Histone-lysine N-methyltransferase 
               
               
                   
                   
                   
                 NSD3 
               
               
                 209925_at 
                 OCLN 
                 Q16625 
                 occludin 
               
               
                   
               
             
          
         
       
     
         [0191]    It will be understood that the embodiments described above are given by way of example only and are not intended to limit the invention, the scope of which is defined in the appended claims. It will also be understood that the embodiments described may be used individually or in combination. 
       INCORPORATED REFERENCES 
       [0192]    The following are hereby incorporated by reference in their entirety herein.
   1) WO2010/046697 (PCT/GB2009/051412): Data Analysis Method and System, filed Oct. 20, 2008.   2) Attachment A: Compandia: Interpretive Services Driven by a Unique Discovery Engine (12 pages).