Abstract PO067: The immune cell infiltration and landscape predicts clinical outcomes in gynecologic cancers
Authors: Chen Wai Chung , Hu Tuo , He Chunbo 
Published: February 2021

Abstract
Introduction: Immunotherapy has changed the standard of treatment for many cancers. However, only a small number of gynecologic cancer patients benefit from immunotherapy. The intratumoral immune landscapes are suggested as a predictor of the response to immunotherapies. However, there are no studies that provide a comprehensive immune characterization for gynecologic cancers. Aims: To characterize cellular compositions of the immune infiltrates and investigate if the immune landscape is a predictor for patient prognosis in gynecologic cancers.
Methods: Clinical data for ovarian cancer, cervical cancer, and uterine cancer were downloaded via TCGA. RNA data are download from http://gdac.broadinstitute.org. Immune cell infiltration was analyzed using QuanTIseq and EPIC. Immune subtype clusters of patients were identified by Graph-based consensus clustering. Statistical analysis was conducted by GraphPad Prism.
Results: Ovarian cancer had the highest percentage of total immune cells (approximately 21%, including CD4 T-Cells, Monocytes, CD8 T-Cells, Dendritic Cells, Macrophages, Neutrophils, NK Cells, B-Cells). Cervical cancer and uterine corpus endometrial carcinoma have lower percentages of immune cells with 17% and 16%, respectively. Furthermore, ovarian cancer had a significantly higher Monocyte and M2-liked Macrophage percentage, but lower percentage for CD8 T cells and Neutrophils compared to cervical cancer and uterine cancer. Cervical cancer had the highest percentage for M1-liked Macrophages and lowest CD4 T cells. Uterine cancer had the highest percentage of dendritic cells. In cervical cancer, higher cell infiltration of CD8 T-Cells and M2-liked Macrophages was associated with a better prognosis. In uterine cancer, patients with higher number of dendritic cells and CD8 T-Cells had significantly better clinical outcomes. However, higher CD4 T-cell infiltration was associated with poor prognosis in uterine cancer. Interestingly, patient’s survival was not affected by the infiltration of any individual immune cells which we analyzed in ovarian cancer. We identified and validated four immune subtypes associated with distinct immune cell infiltration in gynecologic cancers. Cervical and uterine cancer patients from an immune-desert subtype that had the least amount of lymphocyte infiltration and a high level of Monocyte had the worst prognosis. By contrast, Cervical and uterine cancer patients from an immune-warm subtype that had higher infiltration of CD8 T-cell, NK Cell, and dendritic cells had the best prognosis. However, the survival rate of ovarian cancer patients is similar among four different subtypes.
Conclusion: Our study provides a conceptual framework to understand the tumor immune microenvironment of different gynecologic cancers. This work also suggests that the immune microenvironment should be considered for the design of combination treatment strategies and guiding the optimal selection of patients for immunotherapy.
Citation Format: Wai Chung Chen, Tuo Hu, Chunbo He. The immune cell infiltration and landscape predicts clinical outcomes in gynecologic cancers [abstract]. In: Abstracts: AACR Virtual Special Conference: Tumor Immunology and Immunotherapy; 2020 Oct 19-20. Philadelphia (PA): AACR; Cancer Immunol Res 2021;9(2 Suppl):Abstract nr PO067.