Deciphering a cell death-associated signature for predicting prognosis and response to immunotherapy in lung squamous cell carcinoma

• Published in: Respiratory research Vol. 24; no. 1; p. 176
• Main Authors: Mao, Guangxian, Yang, Dongyong, Liu, Bin, Zhang, Yu, Ma, Sijia, Dai, Shang, Wang, Guoqiang, Tang, Wenxiang, Lu, Huafei, Cai, Shangli, Zhu, Jialiang, Yang, Huaping
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06-07-2023; BioMed Central; BMC
• Subjects: Algorithms; Apoptosis; Autophagy; Biomarkers; Cancer; Cancer therapies; Care and treatment; CD4 antigen; Cell death; Cytokines; Datasets; Dendritic cells; Encyclopedias; Evaluation; Gene expression; Genes; Genomes; Health aspects; Immunological memory; Immunotherapeutic response; Immunotherapy; Infiltration; Leukocytes (neutrophilic); Lung cancer; Lung carcinoma; Lung squamous cell carcinoma; Lungs; Lymphocytes; Lymphocytes T; Medical prognosis; Memory cells; Metastases; Monocytes; Mortality; Necrosis; Pathogens; Patient outcomes; Patients; Performance evaluation; Plasma cells; Prognosis; Prognostic signature; Proteins; Risk; Risk groups; Signatures; Software; Squamous cell carcinoma; Survival analysis; Training; Tumors; China; Prognostic signature; Cytokines; Immunotherapeutic response; Cell death; Lung squamous cell carcinoma
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-023-02402-9

Lung squamous cell carcinoma (LUSC) is a subtype of non-small cell carcinoma, accounting for about 30% of all lung cancers. Yet, the evaluation of prognostic outcome and therapy response of patients with LUSC remains to be resolved. This study aimed to explore the prognostic value of cell death pathways and develop a cell death-associated signature for predicting prognosis and guiding treatment in LUSC.
Transcriptome profiles and corresponding clinical information of LUSC patients were gathered from The Cancer Genome Atlas (TCGA-LUSC, n = 493) and Gene Expression Omnibus database (GSE74777, n = 107). The cell death-related genes including autophagy (n = 348), apoptosis (n = 163), and necrosis (n = 166) were retrieved from the Kyoto Encyclopedia of Genes and Genomes and Gene Ontology databases. In the training cohort (TCGA-LUSC), LASSO Cox regression was used to construct four prognostic signatures of respective autophagy, apoptosis, and necrosis pathway and genes of three pathways. After comparing the four signatures, the cell death index (CDI), the signature of combined genes, was further validated in the GSE74777 dataset. We also investigated the clinical significance of the CDI signature in predicting the immunotherapeutic response of LUSC patients.
The CDI signature was significantly associated with the overall survival of LUSC patients in the training cohort (HR, 2.13; 95% CI, 1.62‒2.82; P < 0.001) and in the validation cohort (HR, 1.94; 95% CI, 1.01‒3.72; P = 0.04). The differentially expressed genes between the high- and low-risk groups contained cell death-associated cytokines and were enriched in immune-associated pathways. We also found a higher infiltration of naive CD4
T cells, monocytes, activated dendritic cells, neutrophils, and lower infiltration of plasma cells and resting memory CD4
T cells in the high-risk group. Tumor stemness indices, mRNAsi and mDNAsi, were both negatively correlated with the risk score of the CDI. Moreover, LUSC patients in the low-risk group are more likely to respond to immunotherapy than those in the high-risk group (P = 0.002).
This study revealed a reliable cell death-associated signature (CDI) that closely correlated with prognosis and the tumor microenvironment in LUSC, which may assist in predicting the prognosis and response to immunotherapy for patients with LUSC.