Background
Male patients were twice as likely to develop gastric cancer (GC) compared to females, partly due to the protective effect of estrogen. However, the proportion of females increased in the young GC patients. The study was designed to explore comprehensive molecular profiles of younger female GC patients, as well as develop a prognostic gene model for female GC patients.
Methods
Gene expression and clinical data of GC and non-tumor patients were downloaded from the Gene Expression Omnibus (GEO) database. Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA) were used to find molecular characteristics and potential mechanisms of younger female GC patients. The prognostic gene model containing 6 differential expressed genes (DEGs), which were between younger and older female patients, was established using Lasso-Cox regression. Its performance was validated by external validation. Then, receiver operating characteristic (ROC) curve was applied to determine the prognostic value of the prognostic gene model.
Results
Six GEO cohorts with 305 female GC patients (69 younger patients and 236 older patients) and 38 female non-tumor patients were included. A total of 4557 DEGs between female GC patients and non-tumor patients were identified, including 2212 up-regulated genes and 2345 down-regulated genes. Estrogen response early (p < 0.001) and estrogen response late (p < 0.001) were enriched in female GC patients. In KEGG analysis, aldosterone (p = 0.023) and relaxin pathways (p = 0.043) were concentrated in younger group. Moreover, we further used GSE84437 cohort to construct a prognostic gene model containing 6 genes, namely NREP, GAD1, SLCO4A1, KRT17, DEFB1, and P3H2, to predict the overall survival (OS) of female GC patients (AUC = 0.810). Younger female patients, who were related with high-risk at the genetic level, showed worse OS compared with older female patients who showed low-risk (HR = 5.7688, 95%CI: 3.0108–11.0530, P < 0.001).
Conclusions
In conclusion, we provided the comprehensive molecular profiles of younger female GC patients and found that there was a significant difference in enriched hormone-related pathways between younger group and older group. In addition, we found younger female patients showed worse OS compared with older female patients using the prognostic gene model we created.