Tumor and Peritoneum-Associated Macrophage Gene Signature as a Novel Molecular Biomarker in Gastric Cancer

A spectrum of immune states resulting from tumor resident macrophages and T-lymphocytes in the solid tumor microenvironment correlates with patient outcomes. We hypothesized that in gastric cancer (GC), macrophages in a polarized immunosuppressive transcriptional state would be prognostic of poor survival. We derived transcriptomic signatures for M2 (M2_TS, MRC1; MS4A4A; CD36; CCL13; CCL18; CCL23; SLC38A6; FGL2; FN1; MAF) and M1 (M1_TS, CCR7; IL2RA; CXCL11; CCL19; CXCL10; PLA1A; PTX3) macrophages, and cytolytic T-lymphocytes (CTL_TS, GZMA; GZMB; GZMH; GZMM; PRF1). Primary GC in a TCGA stomach cancer dataset was evaluated for signature expressions, and a log-rank test determined overall survival (OS) and the disease-free interval (DFI). In 341 TCGA GC entries, high M2_TS expression was associated with histological types and later stages. Low M2_TS expression was associated with significantly better 5-year OS and DFI. We validated M2_TS in prospectively collected peritoneal fluid of a GC patient cohort (n = 28). Single-cell RNA sequencing was used for signature expression in CD68⁺CD163⁺ cells and the log-rank test compared OS. GC patients with high M2_TS in CD68⁺CD163⁺ cells in their peritoneal fluid had significantly worse OS than those with low expression. Multivariate analyses confirmed M2_TS was significantly and independently associated with survival. As an independent predictor of poor survival, M2_TS may be prognostic in primary tumors and peritoneal fluid of GC patients.