1. An integrated multi-omics analysis identifies prognostic molecular subtypes of non-muscle-invasive bladder cancer.
- Author
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Lindskrog SV, Prip F, Lamy P, Taber A, Groeneveld CS, Birkenkamp-Demtröder K, Jensen JB, Strandgaard T, Nordentoft I, Christensen E, Sokac M, Birkbak NJ, Maretty L, Hermann GG, Petersen AC, Weyerer V, Grimm MO, Horstmann M, Sjödahl G, Höglund M, Steiniche T, Mogensen K, de Reyniès A, Nawroth R, Jordan B, Lin X, Dragicevic D, Ward DG, Goel A, Hurst CD, Raman JD, Warrick JI, Segersten U, Sikic D, van Kessel KEM, Maurer T, Meeks JJ, DeGraff DJ, Bryan RT, Knowles MA, Simic T, Hartmann A, Zwarthoff EC, Malmström PU, Malats N, Real FX, and Dyrskjøt L
- Subjects
- Aged, BCG Vaccine administration & dosage, Carcinoma, Transitional Cell immunology, Carcinoma, Transitional Cell mortality, Carcinoma, Transitional Cell therapy, Chromosomal Instability, Cystectomy methods, Denmark epidemiology, Female, Follow-Up Studies, Gene Expression Regulation, Neoplastic, Genomics, Humans, Kaplan-Meier Estimate, Male, Mutation, Neoplasm Recurrence, Local genetics, Prognosis, Progression-Free Survival, RNA-Seq, Urinary Bladder immunology, Urinary Bladder pathology, Urinary Bladder surgery, Urinary Bladder Neoplasms immunology, Urinary Bladder Neoplasms mortality, Urinary Bladder Neoplasms therapy, Biomarkers, Tumor genetics, Carcinoma, Transitional Cell genetics, Neoplasm Recurrence, Local epidemiology, Urinary Bladder Neoplasms genetics
- Abstract
The molecular landscape in non-muscle-invasive bladder cancer (NMIBC) is characterized by large biological heterogeneity with variable clinical outcomes. Here, we perform an integrative multi-omics analysis of patients diagnosed with NMIBC (n = 834). Transcriptomic analysis identifies four classes (1, 2a, 2b and 3) reflecting tumor biology and disease aggressiveness. Both transcriptome-based subtyping and the level of chromosomal instability provide independent prognostic value beyond established prognostic clinicopathological parameters. High chromosomal instability, p53-pathway disruption and APOBEC-related mutations are significantly associated with transcriptomic class 2a and poor outcome. RNA-derived immune cell infiltration is associated with chromosomally unstable tumors and enriched in class 2b. Spatial proteomics analysis confirms the higher infiltration of class 2b tumors and demonstrates an association between higher immune cell infiltration and lower recurrence rates. Finally, the independent prognostic value of the transcriptomic classes is documented in 1228 validation samples using a single sample classification tool. The classifier provides a framework for biomarker discovery and for optimizing treatment and surveillance in next-generation clinical trials.
- Published
- 2021
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