Construction of an Extracellular Matrix-related Gene Model for Predicting Prognosis and Immune Features in Gastric...

The extracellular matrix (ECM) critically shapes the gastric cancer (GC) microenvironment and influences tumor initiation, proliferation, invasion, and angiogenesis. However, the prognostic significance of ECM-related genes in GC has not been systematically elucidated.

Differentially expressed genes (DEGs) between GC and adjacent normal tissues were extracted from The Cancer Genome Atlas. ECM-related DEGs were identified and incorporated into a prognostic model using LASSO Cox regression. Risk scores were calculated for each patient, and a nomogram integrating clinical variables was developed. Model performance was assessed by receiver operating characteristic (ROC) analysis and validated in two independent external cohorts.

The ECM-based risk model stratified GC patients into high- and low-risk groups with significantly different overall survival. ROC analysis demonstrated strong predictive accuracy, and the nomogram showed good concordance between predicted and observed outcomes. Importantly, patients in the high-risk group exhibited elevated expression of immune checkpoint molecules.

The ECM-related prognostic model provides a novel framework for risk assessment in GC. Beyond prognostication, the model highlights an immunological link: the high-risk group demonstrated upregulation of immune checkpoints. These findings suggest the model not only predicts survival but may also identify subgroups of patients more likely to benefit from immunotherapy.

We established and validated a robust ECM-related prognostic model and nomogram for GC. This tool provides clinically relevant prognostic information and may inform personalized treatment strategies, particularly in identifying patients who could benefit from immunotherapy.