Research Paper Volume 13, Issue 13 pp 17734—17767

Clinical significance and prognostic role of an immune-related gene signature in gastric adenocarcinoma

Rui Mao1,3, *, , Kehao Liu1, *, , Nana Zhao2, *, , Pengsen Guo1, , Yingxin Wu1, , Zheng Wang4, , Yanjun Liu1,3, , Tongtong Zhang1,3,5, ,

  • 1 Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University and The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610031, China
  • 2 Department of Operating Room, The Third People’s Hospital of Chengdu, Chengdu 610031, China
  • 3 Affiliated Hospital of Southwest Jiaotong University, Chengdu 610036, China
  • 4 Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • 5 Medical Research Center, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, The Second Chengdu Hospital Affiliated to Chongqing Medical University, Chengdu 610031, China
* Equal contribution

Received: November 19, 2020       Accepted: May 11, 2021       Published: July 11, 2021
How to Cite

Copyright: © 2021 Mao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Limited progress has been made in the treatment of gastric adenocarcinoma (GAC) in recent years, but the potential of immunotherapy in GAC is worthy of consideration. The purpose of this study was to develop a reliable, personalized signature based on immune genes to predict the prognosis of GAC. Here, we identified two groups of patients with significantly different prognoses by performing unsupervised clustering analysis of The Cancer Genome Atlas (TCGA) database based on 881 immune genes. The immune signature was constructed with a training set composed of 350 GAC samples from the TCGA and subsequently validated with 431 samples from GSE84437, 432 samples from GSE26253, and 145 GAC samples from real-time quantitative reverse transcription polymerase chain reaction data. This classification system can also be used to predict prognosis in different clinical subgroups. Further analysis suggested that high-risk patients were characterized by low immune scores, distinctive immune cell proportions, different immune checkpoint profiles, and a low tumor mutational burden. Ultimately, the signature was identified as an independent prognostic factor. In general, the signature can accurately predict recurrence and overall survival in patients with GAC and may serve as a powerful prognostic tool to further optimize cancer immunotherapy.


GAC: gastric adenocarcinoma; TCGA: The Cancer Genome Atlas; GEO: Gene Expression Omnibus; ROC: receiver operating characteristic; OS: overall survival; AUC: area under the curve; KEGG: Kyoto Encyclopedia of Genes and Genomes; qRT-PCR: quantitative real-time reverse transcription polymerase chain reaction.