What this is
- This research analyzes the role of m6A-related long non-coding RNAs () in gastric cancer (GC).
- It explores how these influence () and patient prognosis.
- A risk model based on lncRNA expression patterns is developed to predict responses to immunotherapy.
Essence
- m6A-related significantly impact the prognosis of gastric cancer by shaping the and influencing responses to immunotherapy.
Key takeaways
- Two distinct subtypes of gastric cancer patients were identified based on m6A-related lncRNA expression patterns. These subtypes showed significant differences in overall survival (OS) and immune cell infiltration.
- A risk model constructed from eight effectively stratified patients into high-risk and low-risk groups, correlating with their prognosis and response to immune checkpoint inhibitors (ICIs).
- Patients in the low-risk group exhibited higher tumor mutation burden (TMB) and were more likely to benefit from ICIs therapy compared to those in the high-risk group.
Caveats
- The model's efficacy requires validation in larger external cohorts to confirm its prognostic value.
- Functional experiments are needed to elucidate the roles of selected m6A-related in gastric cancer.
- The complex regulatory interactions between m6A and in shaping warrant further investigation.
Definitions
- m6A modification: A common RNA modification that affects the stability and translation of mRNAs and non-coding RNAs.
- lncRNAs: Long non-coding RNAs that regulate gene expression and play roles in cancer progression.
- tumor immune microenvironment (TIME): The cellular environment surrounding a tumor, including immune cells that can influence tumor behavior and treatment responses.
Simplified
Introduction
Gastric cancer (GC) is the fifth most lethal tumor and estimated to be the third most common cause of cancer-related death [1, 2]. Accumulating researches have suggested that epigenomic alterations acted as a crucial role through activation of oncogenes or tumor suppressor genes in the gastric carcinogenesis [3, 4]. Presently, N6-methyladenosine (m6A) is the most common RNA modifications, which was found not only in mRNAs, but also in ncRNAs, such as microRNAs (miRNAs), long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs) through modulating the splicing, stability and translation of ncRNAs [5]. Intriguingly, non-coding RNAs were also demonstrated to have regulatory role for the expression of m6A regulatory proteins. Therefore, the interaction between m6A and noncoding RNAs exerts a synergistic effect on carcinogenesis and provides novel cancer treatment strategies [6–8]. To note, according to the previous researches, the interplay models between m6A modification and lncRNAs in tumor were diverse and complex. For instance, miR503HG promoted the degradation of HNRNPA2B to inhibit HCC migration via reducing the stability of p52 and p65 mRNA [9]. GATA3-AS acted as a guide lncRNA promoting the m6A modification of GATA3 pre-mRNA by KIAA 1429, thereby down-regulating the expression of GATA3, which contributed to the growth and the metastasis of HCC [10]. Recently, with the increased understanding of the diversity of tumor microenvironment (TME), cross-talk between tumor cells and surrounding cells plays a crucial role in the tumor progression [11]. Meanwhile, m6A modification was reported to be critically associated with tumor immune microenvironment (TIME) pattern and PD-L1 expression in GC, colon cancer and head and neck squamous cell carcinoma [12–14]. However, the underlying regulatory biological process between m6A and lncRNAs in GC, especially their clinical applications in predicting prognosis and immune therapy response remain elusive.
In the present study, we attempted to comprehensively evaluate the correlations of m6A-related lncRNAs with prognosis, immune cell infiltrating level and response to immune checkpoint inhibitors (ICIs) therapy in GC patients. These associations were analyzed multidimensionally, patients with GC were clustered into distinct subtypes characterized by different expression patterns of m6A-related lncRNAs, and then patients were also categorized into high-risk group or low-risk group with the construction of prognostic model. Moreover, our study revealed that m6A-related lncRNAs played a non-negligible role in shaping TIME and predicting responses to ICIs therapy.
Materials and methods
Data collection and processing
| Characteristics | Total TCGA(= 371)N | |
|---|---|---|
| Age (years) | ≦65 | 159 |
| > 65 | 208 | |
| unknown | 4 | |
| Gender | Male | 134 |
| Female | 237 | |
| Stage | Stage I-II | 164 |
| Stage III-IV | 184 | |
| unknown | 23 | |
| Grade | Grade 1–2 | 146 |
| Grade 3 | 126 | |
| unknown | 9 | |
| T | T1–2 | 99 |
| T3–4 | 264 | |
| unknown | 8 | |
| M | M0 | 327 |
| M1 | 26 | |
| unknown | 18 | |
| N | N0 | 114 |
| N1–3 | 242 | |
| unknown | 15 |
Identification of the prognostic m6A-related lncRNAs
Based on previous publications, expression matrixes of 23 m6A-related genes were extracted according to the mRNA expression data in TCGA, including expression data on writers (METTL3, METTL14, METTL16, WTAP, VIRMA, ZC3H13, RBM15 and RBM15B), readers (YTHDC1, YTHDC2, YTHDF1, YTHDF2, YTHDF3, HNRNPC, FMR1, LRPPRC, HNRNPA2B1, IGFBP1, IGFBP2, IGFBP3 and RBMX) and erasers (FTO and ALKBH5). Subsequently, m6A-related lncRNAs were first filtered using Pearson correlation analysis with correlation coefficient > 0.4 and p < 0.001 based on the transformed TPM values (log2 (TPM + 1)) of 14,086 lncRNAs and 23 m6A-related genes. Co-expression network graph was plotted by the “igraph” R package. Then univariate Cox regression analysis was conducted to screen the prognostic m6A-related lncRNAs with the criterion of false discovery rate (FDR) < 0.05. Wilcoxon test was applied to examine the expression differences of lncRNAs between GC tissue and normal adjacent tissues.
Identification of m6A-related lncRNAs subgroups by consensus clustering method
To further explore the underlying biological characteristics of the m6A-related lncRNAs, 371 GC patients were clustered into different subtypes using the “ConsensusClusterPlus” R package with iterations of 50 and resample rate of 0.8 based on the transformed TPM data of the selected m6A-related lncRNAs after conducting univariate Cox regression analysis. The optimal k value (k = 2) was determined to obtain stable clusters. Kaplan Meier survival method and log rank test were used for subgroup analysis of clinicopathological factors between two clusters.
Analysis of the correlations of different clusters with TIME
Scores of immune, stromal and ESTIMATE were calculated using ESTIMATE algorithm by the “estimate” R package. Immune, stromal and ESTIMATE scores were compared between 2 clusters by Wilcoxon test. MIXTURE algorithm with LM22 signature [16] was implemented to estimate the immune infiltrate with TPM value. We conducted Wilcoxon test to compare the abundance of immune infiltrating cells between 2 clusters.
GSEA was conducted to investigate the biological pathways that patients in cluster1 enriched in compared with those in cluster2 with random sampling of 1000 permutations, setting the criteria of FDR < 0.05.
Construction and validation of the risk model and its association with clinicopathological features and immune infiltrating cells
The least absolute shrinkage and selection operator (LASSO) COX regression algorithm was implemented to further select the m6A-related lncRNAs most associated with OS in the training cohort using the “glmnet” R package. Thereafter, the expression level of the identified lncRNAs and their corresponding coefficients obtained from the LASSO regression algorithm were used to establish the risk model. The risk score calculating formula is: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$Risk\ score=\sum_{k=1}^n{coef}_k\ast {x}_k$$\end{document} R i s k s c o r e = * ∑ k = 1 n coef k x k
Where Coefk refers to the coefficient of each lncRNA and Xk refers to the TPM value of each m6A-related lncRNA.
Patients were divided into high-risk group and low-risk group in both training and testing groups according to the median risk score. To evaluate the prognosis prediction accuracy of the risk model, receiver operating characteristic (ROC) was applied in both training and validation cohorts. Kaplan Meier survival method and log rank test were implemented to detect the OS difference between low-risk group and high-risk group. Subsequently, subgroup survival analysis of clinicopathological features were utilized in different risk groups. Univariate and multivariate Cox regression analysis were conducted to evaluate whether the risk score was independent prognostic factor. Wilcoxon test was implemented to further explore the risk score differences with regard to clinicopathological factors, immune score, TMB scores, IPS and two clusters. Pearson correlation test was implemented to evaluate the relationship of risk scores with the abundance of immune infiltrating cells and TMB scores.
Null distribution analysis
To verify the robustness of classification of GC patients with different prognostic outcomes, we performed additional classifications based on randomly selected genes and tested whether the randomly generated molecular signatures were also correlated with OS of GC patients. A set of 50 genes were extracted from transcript data of GC samples in TCGA, the samples were classified into 2 categories based on principal component analysis (PCA). Finally, we selected a random subset of samples to match the number of samples in classifications based on m6A-related lncRNAs. This process was repeated 5000 times. Hazard ratio and p value were generated each time. The detailed method of null distribution analysis can be referred to Rocha et al. [17].
Calculation of TMB scores
We calculated the mutation frequency with number of variants/the length of exons (38 million) for each sample via Perl scripts based on the JAVA platform. To acquire of somatic mutation data, we downloaded “Masked Somatic Mutation” data and used VarScan software to process it. We implemented “maftools” R package to analyze and visualize the Mutation Annotation Format (MAF) of somatic variants. Wilcoxon test and Pearson correlation analysis were conducted to analyze the relationship between TMB and risk score.
Construction of the ceRNA network
The miRcode database was used to predict the potential target miRNAs with which the 15 candidate lncRNAs might interact [18]. Thereafter, target mRNAs of these miRNAs were retrieved based on miRTarBase [19], miRDB [20], and TargetScan database [21]. Next, the lncRNA-miRNA-mRNA ceRNA network was established and visualized with the Cytoscape v.3.5.1 [22]. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of the target mRNAs was performed using the “clusterProfiler” R package.
External validation in clinical samples
We collected tumor samples and adjacent normal samples from 35 GC patients with surgical resection from the Affiliated Hospital of Nantong University. Fresh tumor and adjacent normal tissue were stored at − 80 °C. This research was approved by the Clinical Research Ethics Committee of the Affiliated Hospital of Nantong University (2021-L018). For evaluating the expression level of the selected 8 m6A-related lncRNAs, total RNA from 35 gastric cancer samples and their adjacent normal tissues were extracted by using MolPure Cell RNA Kit (YEASEN Biotech Co., Ltd). cDNA synthesis was carried out by using Hifair III 1st Strand cDNA Synthesis SuperMix for qPCR (YEASEN Biotech Co., Ltd). The relative lncRNA expression levels were calculated with 2–ΔΔCT method, GAPDH was served as an internal control, the sequences of qPCR primers were presented at Table S1. Risk score was calculated by the above constructed formula, median risk score was determined as the cut-off value. Then univariate and multivariate Cox regression analysis, Kaplan Meier analysis, time-dependent ROC curve and calibration curve were conducted for the validation of prognosis value in the external cohort (N = 35).
Results
Identification of m6-related lncRNAs in GC patients
Study flow chart of this study
The lncRNAs significantly correlated with m6A-related genes.Co-expression network of m6A-related genes and lncRNAs.Forest plot of the prognostic ability of the 15 m6A-related lncRNAs with FDR < 0.05.,Heatmap () and expression value () of the 15 m6A-related lncRNAs in 32 normal tissues and 375 tumor tissues. *< 0.05, **< 0.01, ***< 0.001. FDR: False Discovery Rate A B C D C D p p p
Consensus clustering identified two clusters of GC samples with distinct prognoses based on m6A-related lncRNAs
The association of the two clusters and GC patients’ prognoses was further explored by comparing the OS of the two clusters in different clinical subgroups. The survival plots were drawn (Fig. S2A-G) and the results showed that the OS of 2 clusters had significant differences in age > 65 (p < 0.001), female (p = 0.003), G1–2 (p = 0.003), M0 (p = 0.010), N1–3 (p = 0.043), stage III-IV (p = 0.038) and T3–4 (p = 0.012). More importantly, the consensus clustering method performed better than 83% of the classifications based on random sets of genes, suggesting that the classification based on m6A-related lncRNAs could serve as a robust prognostic indicator.
Differential survival outcomes of GC in cluster 1/2 subtypes.Consensus score matrix of all samples when k = 2.The cumulative distribution functions (CDF) for k = 2 to 9.Relative change in area under CDF area for k = 2 to 9.Kaplan-Meier curves for OS (), DSS (), DFI () and PFI () in cluster 1/2 subtypes. OS: overall survival, DSS: disease specific survival, DFI: disease-free interval, PFI: progression-free interval A B C D-G D E F G
Tumor immune microenvironment (TIME) and mutation profile of two clusters
For investigating the biological mechanism of contributing the heterogeneity of the two clusters, GSEA was implemented. We found that several tumor hallmarks were dynamically enriched in the cluster1 compared with cluster2, including cell cycle pathway (normalized enrichment score [NES] = 2.01, FDR q value = 0.006), citrate cycle (TCA cycle) pathway (NES = 2.18, FDR q value = 0.013), and P53 signaling pathway (NES = 1.91, FDR q value = 0.001) (Fig. 4D-F) [23–25]. Aforementioned multiple signaling differences between the two clusters indicated the potential role of m6A-related lncRNAs in gastric carcinogenesis.
Finally, we evaluated the association between mutation profiles and two clusters. The mutation profiles of each sample in 2 clusters (cluster1: 84.59%, cluster2: 91.21%) were presented respectively (Fig. 6E and F). We found that the mutated genes had substantially different frequencies in two clusters.
ESTIMATE analysis and GESA in cluster 1/2 subtypes.Comparison of immune score (), stromal score () and ESTIMATE score () in two subtypes.GSEA showed that cell cycle, citrate cycle (TCA cycle) and P53 signaling pathway are differentially enriched in cluster1. NES, normalized enrichment score; NOM-val, normalizedvalue; FDR q value: False Discovery Rate q value A-C A B C D-F p p
The fraction of 22 types of infiltrating immune cells in cluster 1/2 subtypes
Frequently mutated genes and expression of immune related genes in cluster 1/2 subtypes.The gene expression pattern of PD1, CTLA4, TIM-3 and CD69 in cluster 1/2.,Waterfall plots display the frequently mutated genes in 2 clusters of gastric cancer. The left panel shows the genes ordered by their mutation frequencies. The right panel shows different mutation types A-D E F
Construction of the ceRNA network and functional enrichment analysis
Construction of ceRNA network.The ceRNA network of the six m6A-related lncRNAs (orange) and their target miRNAs (green) and mRNAs (blue).KEGG pathway enrichment of target mRNAs A B
Construction and validation of a risk score model for GC patients based on m6A-related lncRNAs
Construction of the GC prognostic risk model based on 8 m6A-related lncRNAs.,Least absolute shrinkage and selection operator (LASSO) regression was performed, the penalization coefficient λ in the LASSO model was tuned using 10-fold cross-validation and minimum criterion for the selection of m6A-related lncRNAs.Barplot of the coefficients of selected lncRNAs.,Kaplan Meier analysis showed that high-risk group exhibited worse survival outcome than low-risk group in the training () and validation cohort ().,Receiver operating characteristic (ROC) curves of risk model for predicting survival in the training () and validation cohort ().,Distribution of risk score, survival statuses of GC patients and expression levels of the 8 m6A-related lncRNAs in high-risk group and low-risk group in the training () and validation cohort () A B C D E D E F G F G H I H I
Risk score based on the m6A-related lncRNAs was an independent prognostic factor for GC patients
| Risk factor | Training cohort in TCGA (= 260)N | Validation cohort in TCGA (= 111)N | External cohort (= 35)N | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis | |||||||
| Hazard ratio (95% CI) | -valueP | Hazard ratio (95% CI) | -valueP | Hazard ratio (95% CI) | -valueP | Hazard ratio (95% CI) | -valueP | Hazard ratio (95% CI) | -valueP | Hazard ratio (95% CI) | -valueP | |
| Age | 1.048 (1.021–1.075) | < 0.001 | 1.058 (1.031–1.086) | < 0.001 | 1.002 (0.977–1.028) | 0.89 | 1.013 (0.985–1.042) | 0.36 | 1.214 (0.321–2.312) | 0.235 | 1.032 (0.231–2.913) | 0.451 |
| Gender | 1.240 (0.772–1.993) | 0.374 | 1.411 (0.858–2.319) | 0.175 | 1.304 (0.728–2.335) | 0.371 | 1.202 (0.667–2.169) | 0.54 | 1.152 (0.489–2.182) | 0.552 | 0.924 (0.451–3.521) | 0.461 |
| Grade | 1.638 (1.031–2.601) | 0.037 | 1.754 (1.080–2.846) | 0.023 | 1.117 (0.676–1.845) | 0.665 | 1.104 (0.655–1.861) | 0.711 | 3.456 (1.224–5.050) | 0.024 | 2.341 (0.219–7.121) | 0.034 |
| Stage | 1.457 (1.099–1.933) | 0.009 | 1.483 (1.085–2.027) | 0.014 | 1.671 (1.209–2.308) | 0.002 | 1.813 (1.281–2.565) | < 0.001 | 2.341 (0.512–5.641) | 0.235 | 1.425 (0.248–7.214) | 0.81 |
| riskScore | 1.674 (1.395–2.008) | < 0.001 | 1.798 (1.484–2.179) | < 0.001 | 1.513 (1.102–2.731) | 0.007 | 1.872 (1.723–2.098) | 0.04 | 2.424 (1.516–3.124) | 0.013 | 1.915 (1.529–2.942) | 0.04 |
Prognostic risk score was associated with clinicopathological factors and immune infiltrating cells
Prognostic risk score correlated with clinicopathological features and cluster1/2 subtype.Heatmap of clinicopathological features, immune score and different lncRNAs expression pattern in high/low risk group.Comparison of risk score distribution in the cluster1/2 (), T1–2/T3–4 (), stage I-II/III-IV () and G1–2/G3 (). *< 0.05, ***< 0.001. G1–2: Grade1–2, G3: Grade3 A B-E B C D E p p
Risk score was associated with biomarkers for predicting response to ICIs therapy
Immunophenoscore was a predictor of response to anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) and anti-programmed cell death protein 1 (anti-PD-1), the relationship between risk score and immunophenoscore was explored. The results showed that different risk groups tended to have different ICIs therapies (anti-CTLA-4 therapy, anti-PD-1 therapy or combination of both therapy) responses (Fig. 10I-L). Our findings strongly indicated that m6A-related lncRNAs had superior values in optimizing patients selection for ICIs therapy and predicting patients’ outcomes of ICI therapy.
The associations between risk score and immunotherapy.The expression levels of tumor mutation burden in low-risk group and high-risk group.The correlation of risk score and tumor mutation burden.The distribution of microsatellite status in different risk groups.The risk score in patients with different microsatellite statuses.The abundance of M2 macrophages infiltration and CD8 T cells infiltration in high-risk group and low-risk group.The expression pattern of CD69 and TIM-3 in high-risk group and low-risk group.The relationship between different risk groups and immunophenoscores A B C D E-F G-H I-L
External validation of the 8 m6A-related lncRNAs based risk model in the clinical dataset
External validation the expression levels of the 8 m6A-related lncRNAs and their prognostic values in 35 GC patients.The heatmap showed the expression pattern of 8 m6A-related lncRNAs in 35 GC tissues and adjacent normal tissues.The heatmap showed the expression pattern of immune related genes in different risk groups.Survival analysis of 35 GC patients in different risk groups.Receiver operating characteristic (ROC) curves of risk model for predicting survival in 35 GC patients.Time dependent AUC analysis where the solid and dashed lines depict the AUC and its 95% CI respectively.The calibration curves of risk score for the prediction of survival A B C D E F
| Characteristics | High risk (= 17)n | Low risk (= 18)n | valueP |
|---|---|---|---|
| Age | 0.642 | ||
| ≦65 | 6 | 9 | |
| > 65 | 9 | 11 | |
| Gender | 0.862 | ||
| Male | 7 | 10 | |
| Female | 10 | 8 | |
| Stage | 0.021 | ||
| Stage I | 2 | 6 | |
| Stage II | 4 | 7 | |
| Stage III | 6 | 3 | |
| Stage IV | 5 | 2 | |
| Grade | 0.034 | ||
| Grade 1–2 | 2 | 8 | |
| Grade 3 | 7 | 7 | |
| Grade 4 | 8 | 3 | |
| Risk score | 5.3 + 1.7 | 2.5 + 1.2 | < 0.001 |
Discussion
The interaction pattern between m6A and lncRNAs can be separated into two subtypes. On one hand, m6A modification on lncRNA acted as a structural switch to facilitate RNA-protein interactions. M6A could also mediate the function of lncRNAs by increasing the stability of the transcript of lncRNAs via ceRNA model [7, 26]. For instance, HNRNPC could bind to MALAT1, which was a conserved lncRNA whose upregulation was correlated with carcinogenesis, thereby influencing RNA expression and alternative splicing [27]. On the other hand, IncRNAs could also regulate the m6A regulatory proteins to promote their functions. It was recently reported that in glioblastoma stem-like cells (GSCs), ALKBH5 as a m6A eraser could demethlyse FOXM1 nascent transcripts and enhanced FOXM1 expression. Meanwhile, the FOXM1-AS which was a lncRNA antisense to FOXM1 acted as a promoter for the interaction of ALKBH5 and FOXM1, contributing to the overly expressed FOXM1 and GSC proliferation [28]. Collectively, the sophisticated regulatory network between m6A and lncRNAs provides new possibility in exploring the biological features of carcinogenesis and clinical application roles. In our study, we found that the m6A-related lncRNAs were closely associated with the prognosis of gastric cancer through participating in multiple signaling pathways. Among these signaling pathways, cAMP and cGMP-PKG signaling pathways were reported to be aberrantly regulated in the multiple cancers [29–32]. A recent study found that FTO as a m6A regulator could inhibit the self-renewal of ovarian cancer stem cell through blocking cAMP pathway [33]. cAMP is also known to suppress the T-cell immune function [34], which may explain the mechanism of m6A modification in shaping the immune environment of GC. Our results provide new insights that m6A modification may mainly modulate cAMP and cGMP-PKG signaling pathways in the tumorogenesis of gastric cancer through the interaction between m6A and lncRNAs. The exploration of epigenetic reprogramming in gastric cancer gives us some clues for designing new drugs.
We additionally explored the relationships of m6A-related lncRNAs and clinical characteristics in GC patients, indicating that two subtypes characterized by distinct expression patterns of lncRNAs had significantly different OS outcomes. Besides, the risk score constructed by 8 prognostic m6A-related lncRNAs were also remarkably related with OS outcome. In this regard, it’s not surprising to find that cluster 1 were correlated with high-risk group. This demonstrated that the risk model constructed based on m6A-related lncRNAs was a robust and reliable GC clinical indicator. More importantly, the risk score model was satisfactorily validated in the external cohort, which confirmed its prognostic value.
Several studies have revealed that m6A modification had diverse functions in shaping TIME. YTHDF1 depletion in dendritic cells could enhance the cross-presentation of tumor antigens and cross-priming of CD8+ T cells [35]. In melanoma, FTO could not only promote tumor progression but also lead to anti-PD1 resistance. LncRNAs are also crucial in mediating the development of diverse immune cells [36]. For example, LncRNA UCA1 elevated the expression of PD-L1 via direct interaction with miRNAs in GC [37]. Recently, a new method called ImmLnc pipeline was invented to identify critical lncRNAs involved in TIME, and this method exhibited satisfactory performance in non-small cell lung cancer [38]. Together, although many studies have indicated the separate biological function of m6A or lncRNA enrolling in the TIME, the integrated analysis of regulatory network of them in TIME is still obscure. In our study, we divided GC samples from TCGA into two classes based on the expression pattern of m6A-related lncRNAs. Despite high immune score usually being associated with better survival outcomes in multiple cancer types [39, 40], the subpopulation we identified here showed the opposite trend. This contradictory result may be explained by the varying characteristics of immune cells. The cluster2 we identified here had higher CD8 T cell infiltration and M0 macrophages infiltration, more intriguingly, we also found that cluster2 had more activated T cells status. In this regard, cluster2 might be more sensitive to immunotherapy.
Immunotherapy has revolutionized the oncology landscape, especially the ICIs therapy has gained enormous success in multiple solid tumors [41]. However, only a subset of GC patients can benefit from this novel therapy due to the heterogeneity of immune microenvironment [42]. Therefore, comprehensive analysis of TIME is mandatory for recruiting patients for ICIs therapy. TIME plays a pivotal role in mediating tumor progression by inducing epithelial mesenchymal transition (EMT) in the tumor cells. Stromal cells in the surrounding environment are recruited to the area where the tumor cells localize and promote the distant metastasis [11, 43]. Previous studies investigated the correlation of immune cells in the TIME with GC prognosis. They found that memory T cells, cytotoxic CD8+ and Natural Killer (NK) cells were associated with better survival outcome [44, 45]. It is worth noting that stromal cells secreted growth factors responsible for the activation of Wnt signaling in the nucleus. Wnt ligands secreted by tumor cells would drive the phenotype of tumor associated macrophage towards M2 subtype which is considered anti-inflammatory via the Wnt signaling pathway, resulting in the tumor progression [46]. Consistent with the above descripted tumor-stromal-immune cell cross-talk, we found cluster1 with worse prognosis enriched in M2 subtype which is considered anti-inflammatory, furthermore, the expression level of M2 subtype was positively correlated with the risk score. Previous study reported tryptase-positive mast cells contributed in angiogenesis in the primary tumor of GC [47], however, our study found that resting mast cell was associated with worse prognosis. This opposite trend reflected that the ability of producing cytotoxic cytokines leading to the tumor degradation might also be stimulated [48]. To further unveil the potential role of m6A-related lncRNAs in guiding ICI therapy, we investigated the relationship of various biomarkers including TMB, MSI and IPS with our constructed risk model. TMB has evolved as an effective biomarker for recruiting patients who possibly respond to ICI therapy and patients with high TMB could gain better survival outcome from immunotherapy. MSI is a molecular indicator of defective DNA mismatch repair (MMR). MSI-H was correlated with favorable survival outcomes compared with MSS and MSI-L in GC [49]. MSI was demonstrated to be a robust indicator for immune checkpoint blockade therapy in the KEYNOTE studies [50, 51]. In our study, patients with low risk had higher TMB and accounted for larger proportion of MSI-H subtypes, which is consistent with the research conducted by Chalmers et al. [52]. Thus, the result suggested that patients in low-risk group more likely benefited in ICI therapy.
However, there are several limitations in our study. First, the efficacy of our model needs to be further validated in the external cohort with larger patient numbers. Second, since these selected m6A-related lncRNAs have never been reported in GC, the functions of these selected m6A-related lncRNAs should be confirmed further with functional experiments. Finally, the specific regulatory network between m6A and lncRNA, and their mutual roles of shaping TIME should be further unveiled.
Conclusion
We conducted an in-depth bioinformatic analysis of the regulatory mechanisms of m6A-related lncRNAs in GC. M6A-related lncRNAs were screened out when integrating prognosis information. Two subtypes of GC patients (cluster1 and cluster2) based on different lncRNAs expression pattern were distinct in TIME characteristics, gene variants and OS. Moreover, prognostic m6A-related lncRNAs based risk score were highly associated with two subtypes, clinicopathological features and immune infiltrating cells. In addition, patients from cluster2 or low risk group were more likely to benefit from ICI therapy. The prognostic value of the risk model was validated in the external clinical cohort. These results provided new insights in GC evolutionary and development of immunotherapy.
Supplementary Information
Additional file 1.