Immunological and prognostic impact of NRF2 in high grade serous ovarian cancer
摘要
NRF2 modulates tumor immune microenvironment in several cancers. NRF2 is activated in about 50% of high-grade serous ovarian cancer (HGSOC), the most aggressive type of ovarian cancer. Through analyzing data from scRNA-seq (n = 7), bulk RNA-seq (n = 365), and tumor microarray (TMA) of human HGSOC (n = 240) samples, we demonstrated that NRF2 expression correlated with tumor immune microenvironment in HGSOC. Functional pathway enrichment analysis and transcription factors (TFs) prediction showed the functional relevance of NRF2 expression in shaping the immune phenotype of HGSOC. Pathways such as hedgehog and ROS signaling, and TFs including EGR1, ESRRA, SMAD proteins, and SP-family proteins, are implicated in the immune suppressive microenvironment of NRF2High tumors. Immune differentiation analysis showed patients with NRF2High tumors enriched with CD68 have lower survival (p = 0.038) than those with CD68Low tumors, whereas NRF2Low tumors enriched with immune-activated markers such as CD3E and CD80 exhibit a better prognosis. This study is the first that shows classification of HGSOC based on NRF2 levels, highlights new biomarkers, and suggests IHC-labeling and genomic evaluation of NRF2 and immune markers for better prognosis.