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. 2023 Apr 13:14:1156322.
doi: 10.3389/fgene.2023.1156322. eCollection 2023.

An effective prognostic model for assessing prognosis of non-small cell lung cancer with brain metastases

Affiliations

An effective prognostic model for assessing prognosis of non-small cell lung cancer with brain metastases

Rong Wang et al. Front Genet. .

Abstract

Background: Brain metastasis, with an incidence of more than 30%, is a common complication of non-small cell lung cancer (NSCLC). Therefore, there is an urgent need for an assessment method that can effectively predict brain metastases in NSCLC and help understand its mechanism. Materials and methods: GSE30219, GSE31210, GSE37745, and GSE50081 datasets were downloaded from the GEO database and integrated into a dataset (GSE). The integrated dataset was divided into the training and test datasets. TCGA-NSCLC dataset was regarded as an independent verification dataset. Here, the limma R package was used to identify the differentially expression genes (DEGs). Importantly, the RiskScore model was constructed using univariate Cox regression analysis and least absolute shrinkage and selection operator (LASSO) analysis. Moreover, we explored in detail the tumor mutational signature, immune signature, and sensitivity to treatment of brain metastases in NSCLC. Finally, a nomogram was built using the rms package. Results: First, 472 DEGs associated with brain metastases in NSCLC were obtained, which were closely associated with cancer-associated pathways. Interestingly, a RiskScore model was constructed using 11 genes from 472 DEGs, and the robustness was confirmed in GSE test, entire GSE, and TCGA datasets. Samples in the low RiskScore group had a higher gene mutation score and lower immunoinfiltration status. Moreover, we found that the patients in the low RiskScore group were more sensitive to the four chemotherapy drugs. In addition, the predictive nomogram model was able to effectively predict the outcome of patients through appropriate RiskScore stratification. Conclusion: The prognostic RiskScore model we established has high prediction accuracy and survival prediction ability for brain metastases in NSCLC.

Keywords: NSCLC; RiskScore model; brain metastases; chemotherapy drugs; lung cancer; prognosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Changes in the transcriptome of brain metastases in NSCLC [GSE200563]. (A) Top 10 Gene Ontology (GO) terms at the biological process level. (B) Top 10 GO terms at the cellular component level. (C) Top 10 GO terms at the molecular function level. (D) Significantly enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway.
FIGURE 2
FIGURE 2
Protein–protein interaction (PPI) network of genes involved in regulating brain metastases in NSCLC [GSE200563]. (A–D) PPI network in clusters 1, 2, 3, and 7.
FIGURE 3
FIGURE 3
Identification of RiskScore model prognostic genes [GSE200563]. (A) Totally 11 promising candidates were identified through the survival analysis of the genes of the blue module. (B) Trajectory of candidate genes changes as lambda changes. (C) Confidence intervals for different lambda values. (D) Distribution of LASSO coefficients of the prognostic gene signature.
FIGURE 4
FIGURE 4
Validation of the RiskScore model. (A) Forest diagram of multivariate Cox analysis of the model genes. (B) ROC and KM curves of RiskScore using GSE training data. (C) Verifying ROC curve and KM curve of RiskScore in “my data queue” in GSE. (D) ROC and KM curves of RiskScore in the GSE cohort. (E) ROC and KM curves of RiskScore in TCGA cohort.
FIGURE 5
FIGURE 5
Immune features between RiskScore groupings. (A) ssGSEA evaluated the subtypes of 28 immune cell scores in TCGA cohort. (B) MCP-counter evaluated subtype comparison of 10 immune cell scores in TCGA cohort. (C) ESTIMATE subtype comparison of StromalScore, ImmuneScore, and ESTIMATEScore in TCGA cohort. (D) Subtype comparison of 28 immune cell scores assessed in the GSE cohort with ssGSEA. (E) Subtype comparison of 10 immune cell scores assessed in the GSE cohort with MCP-counter. (F) Subtype comparison of StromalScore, ImmuneScore, and ESTIMATEScore in the GSE cohort with ESTIMATE.
FIGURE 6
FIGURE 6
Immunotherapy/chemotherapy sensitivity analysis. (A) Immunological checkpoint of differential expression between different groups in TCGA cohort. (B) Difference in TIDE analysis results among different groups in TCGA queue. (C) Box plots of the estimated IC50 for sorafenib, pyrimethamine, Akt inhibitor VIII, and embelin in TCGA cohort. (D) Differentially expressed immune checkpoints between different subgroups in the GSE cohort. (E) Differences in TIDE analysis results among different groups in GSE queues. (F) Box plots of the estimated IC50 for sorafenib, pyrimethamine, Akt inhibitor VIII, and embelin in GSE.
FIGURE 7
FIGURE 7
Relationship between RiskScore and KEGG pathways. (A) Heat map showing the correlation between RiskScore and KEGG pathways. (B) Heat map demonstrating normalized enrichment scores of Hallmark pathways calculated by comparing high RiskScore with low RiskScore.
FIGURE 8
FIGURE 8
Optimization of the RiskScore model. (A) Patients with full-scale annotations including RiskScore, stage, gender, and age were used to build a survival decision tree to optimize risk stratification. (B) Significant differences in overall survival were observed among the three risk subgroups. (C, D) Comparative analysis among the different groups. (E, F) Univariate and multivariate Cox analysis of RiskScore and clinicopathological features. (G) Compared with other clinicopathological features, the nomogram exhibited the most powerful capacity for survival prediction. (H) Alignment diagram showing the influence of different factors on the prediction results; the top panel shows scores, the middle panel shows different factors, and the bottom panel shows predictive efficiency. (I) Calibration curves of the 1, 3, and 5 years of the line chart. (J) Decision curve of the line graph.

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Grants and funding

This work was supported by Shenzhen Technology R&D Fund (JSGG20180508152646606).

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