Research Paper Volume 13, Issue 22 pp 24768—24785

Tumor purity as a prognosis and immunotherapy relevant feature in cervical cancer

Yali Deng1, , Zewen Song2, , Li Huang3, , Zhenni Guo3, , Binghua Tong3, , Meiqing Sun3, , Jin Zhao3, , Huina Zhang3, , Zhen Zhang2, &, , Guoyin Li3,4, ,

  • 1 The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
  • 2 Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  • 3 College of Life Science and Agronomy, Zhoukou Normal University, Zhoukou, Henan, China
  • 4 Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, China

Received: April 30, 2021       Accepted: June 23, 2021       Published: November 29, 2021
How to Cite

Copyright: © 2021 Deng 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.


Background: Tumor purity plays a vital role in the biological process of solid tumors, but its function in gynecologic cancers remains unclear. This study explored the correlation between tumor purity and immune function of gynecological cancers and its reliability as a prognostic indicator of immunotherapy.

Methods: Gynecological cancer-related datasets were downloaded from The Cancer Genome Atlas (TCGA). Tumor purity was calculated by the ESTIMATE algorithm. A LASSO Cox regression analysis was performed to construct the risk score model. A Kaplan–Meier Plotter was used to explore the relationships between tumor purity and cancer prognosis. We performed the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Set Enrichment Analysis (GSEA) to explore the pathways in the subgroups. A nomogram was used to quantitatively assess the cancer prognosis.

Results: Tumor purity was negatively correlated with B cell infiltration in cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC). Approximately 420 genes were positively associated with B cell infiltration and CESC prognosis and were enriched in immune-related signaling pathways. There were 11 key genes used to construct a risk score model. The low-risk group had a higher immune score and better prognosis than the high-risk group. A nomogram based on risk score, T stage, and clinical-stage had good predictive value in quantitatively evaluating CESC prognosis.

Conclusions: This study is the first to reveal the correlation between tumor purity and immunity in CESC and suggests that low-risk patients may be more sensitive to immunotherapy. This provides a theoretical basis for the clinical treatment of CESC.


TCGA: The Cancer Genome Atlas; CESC: cervical squamous cell carcinoma and endocervical adenocarcinoma; OV: ovarian cancer; UCEC: uterine corpus endometrial carcinoma; UCS: uterine carcinosarcoma; HPV: Human papillomavirus infection; LASSO: the least absolute shrinkage and selection operator; TME: Tumor microenvironment; ESTIMATE: Estimation of stromal and immune cells in malignant tumors using expression data; KEGG: Kyoto Encyclopedia of Genes and Genomes; GSEA: Gene set enrichment analysis.