Development and validation of a combined hypoxia and ferroptosis prognostic signature for breast cancer

Jianxin Zhong; Xi Shen; Junjie Zhou; Heping Yu; Birong Wang; Jianbin Sun; Jing Wang; Feng Liu

doi:10.3389/fonc.2023.1077342

Development and validation of a combined hypoxia and ferroptosis prognostic signature for breast cancer

Front Oncol. 2023 Mar 14:13:1077342. doi: 10.3389/fonc.2023.1077342. eCollection 2023.

Authors

Jianxin Zhong¹, Xi Shen², Junjie Zhou³, Heping Yu⁴, Birong Wang⁴, Jianbin Sun⁴, Jing Wang⁵, Feng Liu⁴

Affiliations

¹ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
² Department of Head and Neck Oncology and Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
³ Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴ Department of Thyroid and Breast Surgery, Wuhan Fourth Hospital, Wuhan, China.
⁵ Department of Thoracic Surgery, Wuhan Fourth Hospital, Wuhan, China.

Abstract

Background: Hypoxia is involved in tumor biological processes and disease progression. Ferroptosis, as a newly discovered programmed cell death process, is closely related to breast cancer (BC) occurrence and development. However, reliable prognostic signatures based on a combination of hypoxia and ferroptosis in BC have not been developed.

Method: We set The Cancer Genome Atlas (TCGA) breast cancer cohort as training set and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) BC cohort as the validation set. Least Absolute Shrinkage and Selection Operator (LASSO) and COX regression approaches were used to construct ferroptosis-related genes (FRGs) and hypoxia-related genes (HRGs) prognostic signature (HFRS). The CIBERSORT algorithm and ESTIMATE score were used to explore the relationship between HFRS and tumor immune microenvironment. Immunohistochemical staining was used to detect protein expression in tissue samples. A nomogram was developed to advance the clinical application of HFRS signature.

Results: Ten ferroptosis-related genes and hypoxia-related genes were screened to construct the HFRS prognostic signature in TCGA BC cohort, and the predictive capacity was verified in METABRIC BC cohort. BC patients with high-HFRS had shorter survival time, higher tumor stage, and a higher rate of positive lymph node. Moreover, high HFRS was associated with high hypoxia, ferroptosis, and immunosuppression status. A nomogram that was constructed with age, stage, and HFRS signature showed a strong prognostic capability to predict overall survival (OS) for BC patients.

Conclusion: We developed a novel prognostic model with hypoxia and ferroptosis-related genes to predict OS, and characterize the immune microenvironment of BC patients, which might provide new cures for clinical decision-making and individual treatment of BC patients.

Keywords: breast cancer; ferroptosis; hypoxia; prognostic model; tumor microenvironment.