PD24-11 HOT CLEAR CELL RENAL CELL CARCINOMA IMMUNE STATUS: ILLUSION OR REALITY?

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD24-11 HOT CLEAR CELL RENAL CELL CARCINOMA IMMUNE STATUS: ILLUSION OR REALITY? Yi Lu and Hongjun Li Yi LuYi Lu More articles by this author and Hongjun LiHongjun Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003302.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The drivers and resistors of the anti-tumor response remain incompletely elucidated. High tumor mutation burden (TMB) and increased infiltration by T cells are associated with the answer to immune checkpoint inhibitors ICIs. We conducted the bioinfomatic study to better understand immunotherapy resistance in clear cell renal cell carcinoma (ccRCC). METHODS: The patients and sequencing data were selected from The Cancer Genome Atlas KIRC (TCGA-KIRC), and a clinical trial dataset. To classify worse-survival ccRCC resistant to immunotherapy, immune prognosis model (IPM) risk score classifier was constructed with prognostic costimulatory molecule genes through survival analysis and validated as well. For function analysis, ESTIMATE, ImmuCellAI, TIDE, and Gene Oncology (GO) were used. RESULTS: The 366 Co-expressed genes (CEGs) correlated with IPM risk score were enriched with p<0.05 and correlation |R-value|>0.5. GO analysis indicated CEGs were enriched within immune-associated gene sets, such as T cell homeostasis. TIDE algorithm predicted all the patients' response to ICIs, and non-responders were enriched in higher IPM risk scores and a real-world ICIs-treated ccRCC cohort validated it with a consistent finding with p=0.028 in chi-square test. ESTIMATE algorithm showed the ESTIMATE, and immune scores of high-risk patients, markedly increased compared with low-risk patients. Nevertheless, tumor purity was thinner than low-risk patients. Besides, TMB and cytolytic activity were higher in high-risk patients. ImmuCellAI algorithm revealed the levels of CD8+ T cells, CD4+ T cells, dendritic cells, and MAIT, together with macrophages, increased in the tumor microenvironment of high-risk patients. The TIDE T cell function estimate was used to test the T cell dysfunction of high-risk patients, which was markedly worse compared with low-risk patients. Meanwhile, immune inhibiting cells, namely exhausted T cells, nTreg cells, iTreg cells, and cancer associated fibroblast (CAF), had an increased fraction in high-risk ccRCC. Remarkably, the microsatellite instability (MSI) score was lower in high-risk ccRCC. Interestingly, IPM risk level was independent from MSI level in prognostic influence. CONCLUSIONS: We found a subtype of refractory ccRCC (IPM high risk), and subsequent function analysis indicated the reason for its insensitivity to immune blockades was T cell dysfunction. In IPM high-risk ccRCC, T cells' high infiltration, hot immune status, is an illusion. The reality is the increased infiltration of dysfunctional CD8+ and CD4+ T cells, immunosuppressive cells (i.e., iT-regs, nT-regs, and CAFs) as well as low MSI. Source of Funding: This work is supported by the grant from National Population Health Science Data Sharing Service Platform Clinical Medical Science Data Center (NCMI-ABD02-201906) to Hongjun Li © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e727 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yi Lu More articles by this author Hongjun Li More articles by this author Expand All Advertisement PDF downloadLoading ...