Kosj Yamoah, Shivanshu Awasthi, Brandon A Mahal, Shuang G Zhao, G Daniel Grass, Anders Berglund, Julieta Abraham-Miranda, Travis Gerke, Robert J Rounbehler, Elai Davicioni, Yang Liu, Jong Park, John L Cleveland, Julio M Pow-Sang, Daniel Fernandez, Javier Torres-Roca, R Jeffrey Karnes, Edward Schaeffer, Stephen J Freedland, Daniel E Spratt, Robert B Den, Timothy R Rebbeck, Felix Feng
PMID: 33303244 DOI: 10.1016/j.eururo.2020.11.038
Grade group 4 and 5 (GG-45) prostate cancer (PCa) patients are at the highest risk of lethal outcomes, yet lack genomic risk stratification for prognosis and treatment selection. Here, we assess whether transcriptomic interactions between tumor immune content score (ICS) and the Decipher genomic classifier can identify most lethal subsets of GG-45 PCa. We utilized whole transcriptome data from 8071 tumor tissue (6071 prostatectomy and 2000 treatment-naïve biopsy samples) to derive four immunogenomic subtypes using ICS and Decipher. When compared across all grade groups, GG-45 samples had the highest proportion of most aggressive subtype-ICSHigh/DecipherHigh. Subsequent analyses within the GG-45 patient samples (n = 1420) revealed that the ICSHigh/DecipherHigh subtype was associated with increased genomic radiosensitivity. Additionally, in a multivariable model (n = 335), ICSHigh/DecipherHigh subtype had a significantly higher risk of distant metastasis (hazard ratio [HR] = 5.41; 95% confidence interval [CI], 2.76-10.6; p ≤ 0.0001) and PCa-specific mortality (HR = 10.6; 95% CI, 4.18-26.94; p ≤ 0.0001) as compared with ICSLow/DecipherLow. The novel immunogenomic subtypes establish a very strong synergistic interaction between ICS and Decipher in identifying GG-45 patients who experience the most lethal outcomes. PATIENT SUMMARY: In this analysis, we identified a novel interaction between the total immune content of prostate tumors and genomic classifier to identify the most lethal subset of patients with grade groups 4 and 5. Our results will aid in the subtyping of aggressive prostate cancer patients who may benefit from combined immune-radiotherapy modalities.
Keywords: Aggressive prostate cancer; Decipher score; Genomic risk; Grade group 4; Grade group 5; High-grade prostate cancer; Immune content; Immunogenomics; Lethal outcomes.
Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Full text: https://doi.org/10.1016/j.eururo.2020.11.038
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