Gynecologic carcinosarcomas beyond epithelial-mesenchymal transition: Morpho-transcriptomic evidence of an immune gradient in the tumor microenvironment
Amel Kime1, Julie Berthet1, Juliette Renard1, Antoine Gaudet Chardonnet2, Pierre Laurent-Puig1, Jerome Alexandre3, Bruno Borghese2, Guillaume Beinse3
1MEPPOT Team, Cordeliers Research Center, Paris, France,2Gynecologic Surgery Unit, APHP - Cochin Port-Royal Hospital, Paris, France,3Oncology Unit, APHP - Cochin Port-Royal Hospital, Paris, France
摘要 Abstract
Introduction: Gynecologic carcinosarcomas (GynCS) are rare, aggressive uterine and ovarian cancers with a median survival under two years. Their biology is marked by epithelial-mesenchymal transition (EMT), driving dissemination and a biphasic carcinoma-sarcoma morphology. However, the molecular drivers of intratumoral heterogeneity beyond EMT remain poorly understood. This study seeks to clarify these mechanisms by characterizing the transcriptomic landscape of GynCS.
Methods: Hematoxylin-eosin-saffron (HES) slides from 35 uterine and ovarian carcinosarcomas were reviewed by a gynecologic pathologist. A total of 251 tumoral tissue sectors, including carcinoma, sarcoma and mixed components, were selected for morphological assessment and bulk RNA sequencing (RNA-seq) using the SMARTer library preparation kit.
Results: Among 35 tumors included in cohort, 33 (94%) were TP53-mutated, 2 (4%) had no specific molecular profile, 1 (2%) was mismatch repair-deficient and none was POLE-mutated. EMT expression signature correlated with histological features despite 26% of histologicaly sarcomatous sectors being reclassified as epithelial based on RNAseq (WISP classifier). Gene set enrichment analysis (GSEA) in all carcinoma sectors compared to all sarcoma sectors revealed a depletion in the response to inflammation and immunity as the main mechanism alongside EMT. Both cell-type deconvolution on RNA-seq data and immunohistochemical CD3 staining on FFPE slides suggest an enrichment in T cells, particularly cytotoxic T cells, in the tumor microenvironment of carcinoma sectors compared to sarcoma sectors. Within-tumor immune gene set analysis in a subset of tumors (n=15) revealed heterogeneous microenvironmental switch across patients, with 53% of tumors (n=8) shifting from a hot-to-cold microenvironment while most others (47%; n=7) remained immune-deprived. Gene expression profiles revealed the sustained activation of non-canonical NFκB pathway by cGAS-STING as a potentially leading cause of immune exhaustion and associated with EMT. Spatial RNAseq (Visium2) of 4 representative cases confirmed inflammation response as among most spatially variable features.
Conclusion: This study suggests that chromosomal instability, acting through the cGAS-STING pathway, plays a dual role in driving immune exhaustion and promoting EMT as key biological features, despite notable inter-tumor variability in this process. These findings are consistent with existing literature on the non-canonical NFκB pathway. This work highlights potential therapeutic opportunities, including the emerging STING-targeted treatments and personalized immunotherapeutic strategies tailored to the unique immune landscape of each tumor.
利益披露 Disclosure
A. Kime, None..
J. Berthet, None..
J. Renard, None..
A. Gaudet Chardonnet, None..
P. Laurent-Puig, None..
J. Alexandre, None..
B. Borghese, None..
G. Beinse, None.