A fuzzy neural network (FNN) using gene expression profile data can select combinations of genes from thousands of genes, and is applicable to predict outcome for cancer patients after chemotherapy. However, wide clinical heterogeneity reduces the accuracy of prediction. To overcome this problem, we have proposed an FNN system based on majoritarian decision using multiple noninferior models. We used transcriptional profiling data, which were obtained from "Lymphochip" DNA microarrays (http:// llmpp.nih.gov/DLBCL), reported by Rosenwald (N Engl J Med 2002; 346: 1937-47). When the data were analyzed by our FNN system, accuracy (73.4%) of outcome prediction using only 1 FNN model with 4 genes was higher than that (68.5%) of the Cox model using 17 genes. Higher accuracy (91%) was obtained when an FNN system with 9 noninferior models, consisting of 35 independent genes, was used. The genes selected by the system included genes that are informative in the prognosis of Diffuse large B-cell lymphoma (DLBCL), such as genes showing an expression pattern similar to that of CD10 and BCL-6 or similar to that of IRF-4 and BCL-4. We classified 220 DLBCL patients into 5 groups using the prediction results of 9 FNN models. These groups may correspond to DLBCL subtypes. In group A containing half of the 220 patients, patients with poor outcome were found to satisfy 2 rules, i.e., high expression of MAX dimerization with high expression of unknown A (LC_26146), or high expression of MAX dimerization with low expression of unknown B (LC_33144). The present paper is the first to describe the multiple noninferior FNN modeling system. This system is a powerful tool for predicting outcome and classifying patients, and is applicable to other heterogeneous diseases. (Cancer Sci 2003; 94: 906-913) iffuse large B-cell lymphoma (DLBCL) is the largest category of lymphoid malignancy, accounting for 30 to 40% of non-Hodgkin's lymphomas. 1) From 35 to 40% of DLBCL patients can be cured by current chemotherapeutic regimens; the remaining 60 to 65% eventually succumb to this disease. Marked clinical heterogeneity of DLBCL has been reported by many researchers.2-5) Some patients are not correctly diagnosed, and diagnostic categories have not been defined molecularly. [6][7][8][9][10] Molecular analyses of clinical heterogeneity in DLBCL have been conducted using microarray technologies. Various computational analyses using small numbers of DLBCL patients have been presented. [11][12][13][14] Previously, we used a fuzzy neural network (FNN) model to identify several genes with which we constructed noninferior prognostic models of DLBCL, and we achieved accuracy greater than 90% using these models. 13,14) The FNN model is a relatively advanced artificial neural network (ANN) model. The FNN model has the advantages of extremely high prognostic accuracy and the ability to explicitly describe causality between input and output variables as linguistic IF-THEN rules.15) We extracted prognostic rules based on the expression profiles of only 4 genes. I...