Prognosis-Related Autophagy Genes in Female Lung Adenocarcinoma

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Prognosis-Related Autophagy Genes in Female Lung Adenocarcinoma Prognosis-Related Autophagy Genes in Female Lung Adenocarcinoma Zhongxiang Liu rst people's hospital of yancheng Haicheng Tang Shanghai Public Health Clinical Center Yongqian Jiang rst people's hospital of yancheng Xiaopeng Zhan Shanghai East Hospital Sheng Kang Shanghai East Hospital Koudong Zhang ( [email protected] ) First People's Hospital of Yancheng Li Lin Shanghai East Hospital Research Keywords: Autophagy genes, Prognosis, Female lung adenocarcinoma, Risk score Posted Date: August 10th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-53994/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/15 Abstract Background: To screen the prognosis-related autophagy genes of female lung adenocarcinoma by the transcriptome data and clinical data from TCGA database. Methods: In this study, Screen meaningful female lung adenocarcinoma differential genes in TCGA, use univariate COX proportional regression model to select genes related to prognosis, and establish the best risk model. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were applied for carrying out bioinformatics analysis of gene function. Results: The gene expression and clinical data of 260 female lung adenocarcinoma patient samples were downloaded from TCGA. 12 down-regulated genes: NRG3, DLC1, NLRC4, DAPK2, HSPB8, PPP1R15A, FOS, NRG1, PRKCQ, GRID1, MAP1LC3C, GABARAPL1. Up-regulated 15 genes: PARP1, BNIP3, P4HB, ATIC, IKBKE, ITGB4, VMP1, PTK6, EIF4EBP1, GAPDH, ATG9B, ERO1A, TMEM74, CDKN2A, BIRC5. GO and KEGG analysis showed that these genes were signicantly associated with autophagy and mitochondria (animals). Multi-factor COX analysis of autophagy-related genes showed that ITGA6, ERO1A, FKBP1A, BAK1, CCR2, FADD, EDEM1, ATG10, ATG4A, DLC1, VAMP7, ST13 were identied as independent prognostic indicators. According to the multivariate COX proportional hazard regression model, there was a signicant difference in the survival rate observed between the high-risk group (n=124) and the low-risk group (n=126) during the 10-year follow-up (p<0.05). Univariate COX analysis showed that tumor stage, T, M and N stages, and risk score were all related to the survival rate of female lung adenocarcinoma patients. Multivariate COX analysis found that autophagy-related risk scores were independent predictors, with an AUC value of 0.842. At last, there are autophagy genes differentially expressed among various clinicopathological parameters: ATG4A, BAK1, CCR2, DLC1, ERO1A, FKBP1A, ITGA6. Conclusion: The risk score can be used as an independent prognostic indicator for female patients with lung adenocarcinoma. The autophagy genes ITGA6, ERO1A, FKBP1A, BAK1, CCR2, FADD, EDEM1, ATG10, ATG4A, DLC1, VAMP7, ST13 were identied as prognostic genes in female lung adenocarcinoma, which may be the targets of treatment in the future. Background Lung cancer is the most common malignancies with high morbidity worldwide, which represents the second leading cause of cancer-related deaths[1]. Data from the National Cancer Registry[2] show a signicant increase in lung cancer incidence in women and a gradual decrease in men, while men have an overall survival advantage in the patients with non-small cell lung cancer (NSCLC)[3]. Although current treatment approaches, including maximum safe resection, chemotherapy, radiotherapy and targeted therapy, have been adopted[4], the survival time has not improved signicantly, and the ve-year survival rate is 4% − 17%[5]. Despite the progress of experimental technologies and therapeutic regimens in the eld, lung cancer remains incurable. It is thus necessary to explore the novel therapeutic targets or treatment methods. Page 2/15 Autophagy is a genetically conserved cellular process and widely exists in eukaryotic cells, which is one of the necessary ways of organelle renewal and metabolism dynamic balance[6], especially for maintaining homeostasis in vivo and tumor growth of lung cancer, thus it prevents the p53 activation, growth arrest, apoptosis, senescence and immune response activation. Autophagy in NSCLC can maintain mitochondrial mass and regulate its abundance, while the genetic deciency of essential autophagy genes in tumors will reduce tumor growth[7]. Even DNA methylation of autophagy genes plays an important role in cancer development, and the epigenetic-mediated aberrant gene silencing has been considered to be closely related to the pathogenesis of cancers, including lung cancer[8].Generally, autophagy is thought to prevent carcinogenesis by eliminating oncogenic protein substrates, misfolded proteins, and damaged organelles[9]. Therefore, more and more studies have shown that autophagy has an important role in NSCLC[10]. Methods Gene expression data, clinical characteristics and survival information of 260 samples from female patients with lung adenocarcinoma were downloaded from TCGA database on June 02, 2020. A total of 221 autophagy-related genes were extracted from Human Autophagy Database (HADb http:/ /www.autop hagy.lu/index.html). Statistical analysis A series of gene function enrichment analysis was performed After screening the differentially expressed autophagy-related genes, to determine the main biological properties. Univariate Cox proportional hazard regression analysis was used to assess the association between overall survival (OS) and the selected autophagy genes. Next, multivariate Cox proportional hazard regression analysis was performed on the identied autophagy genes. Independent prognostic factors were determined by multivariate Cox proportional hazards regression analysis, and regression coecient and risk ratio (HR) were calculated by Cox regression model for establishing an autophagy related model, which can be used as the prognosis model of female lung adenocarcinoma. The risk score of patients was divided into high-risk group and low-risk group according to the median score. Survival curve, risk curve, ROC curve of risk score and other clinical characteristics, and beeswarm of correlation between autophagy gene, the risk score and clinical characteristics were drawn. All the statistical analyses including the different expression of autophagy-related genes in univariate and multivariate Cox regression models, ROC curve and K-M survival were performed using R version 3.6.6 (The R Foundation for Statistical Computing). GO plot software package was used to Gene Ontology (GO) enrichment analysis, and the same tool is also used for the enrichment analysis of Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. P < 0.05 was used as the signicant threshold. Results Page 3/15 Identication analysis of ATGs The expression values of 221 ATGs were integrated from the female patients with lung adenocarcinoma, and 12 downregulated genes and 15 upregulated genes were identied. Boxplots (Figure 1a), Heat maps (Figure 1b), and volcano maps (Figure 1c) were used to reveal the expression patterns of these differentially expressed genes in tumor and non-tumor tissues. Functional enrichment analysis A total of 27 differentially expressed genes were performed functional analysis to provide biological function for these genes. In order to inquire the potential signal pathways related 27 ATGs in female lung adenocarcinoma, we analyzed them with GO and KEGG. GO analysis Figure 2a-cshowed that these ATGs were enriched in some basic biological processes (BP), including the process of autophagy and apoptotic signaling pathways. The cellular components affected those of autophagy and mitochondria. Based on molecular functions, the genes were most enriched in cellular response to oxidative stress, protein phosphatase binding, and phosphatase binding. KEGG analysis Figure 3a,bshowed that the 27 ATGs were signicantly associated with autophagy and mitochondria (animals), and the most scores of enriched pathways were greater than zero, indicating that these pathways were more likely to be enhanced. Construction of prognostic markers in female LUAD 28 ATGs were analyzed by univariate Cox regression. 8 genes were identied as protective factors (HR<1), while another 20 genes were identied as risk factors (HR>1). The 28 genes were further analyzed by multivariate Cox regression analysis, and nally 12 genes ( ITGA6ERO1AFKBP1ABAK1CCR2FADD EDEM1ATG10ATG4ADLC1VAMP7ST13) were identied as independent prognostic indicators, which might be helpful in predicting prognosis. The 12 genes were further analyzed by multivariate Cox regression analysis, the expression coecients of each independent risk gene were obtained and shown in table 1, and nally the model for predicting prognosis based was developed using the following formulas: prognostic index (PI) = (-0.162*ITGA6 expression level) + (0.466*ERO1A expression level) + (0.872*FKBP1A expression level) + (0.373*BAK1 expression level) + (-0.392*CCR2 expression level) + (0.416*The expression level of FADD) + (-0.625*EDEM1) + (0.778*ATG1 0 expression level) + (-0.899*ATG4A expression level) + (0.399*DLC1 expression level) + (0.367*VAMP7 expression level) + (0.572*ST13 expression level). The risk score of each patient was calculated on the basis of the relevant mRNA expression level and risk coecient of each ATG. The risk score is used to predict the prognosis of female LUAD, and the median risk score is the critical value to divide patients into high-risk and low-risk groups (Figure 5b). Heatmap was drawn to show gene expression proles in high-risk and low-risk female LUAD groups (Figure 5c). The genes with HR>1 were
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