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PubMed · 41094064

Integrating necroptosis and immune landscapes: a multi-omics-derived NecropImmScore stratifies prognosis and therapy in ovarian cancer.

Fangfang Xu·Shufeng Kang·Shaohua Xu
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Abstract

BACKGROUND: Ovarian cancer (OC) remains the deadliest gynecologic malignancy, largely due to its immunosuppressive tumor microenvironment (TME) and resistance to therapy. Necroptosis, a regulated lytic cell death pathway mediated by the RIPK1-RIPK3-MLKL axis, can trigger immunogenic cell death, but its specific role in shaping the OC immune landscape and its clinical translation potential are posorly understood. METHODS: We employed multi-omics analysis (transcriptomics, genomics, clinical data) from TCGA-OV (n&#x2009;=&#x2009;380), ICGC OV-AU, and IMvigor210 cohorts, combined with rigorous in vitro functional validation using OC cell lines (SKOV3, HEY), macrophages (THP-1 derived), and T cells (Jurkat). Computational immunology approaches (ESTIMATE, CIBERSORT, ssGSEA) quantified immune infiltration. We identified MLKL-associated immune genes, performed survival analysis (Kaplan-Meier, Cox regression), and constructed a necroptosis-immune signature (NecropImmScore) using consensus clustering and PCA of 102 prognostic genes. Drug sensitivity was predicted via pRRophetic and CellMiner. RESULTS: MLKL emerged as a protective prognostic biomarker (p&#x2009;=&#x2009;0.018), significantly correlated with enhanced immune infiltration (ImmuneScore, StromalScore, ESTIMATEScore; p&#x2009;<&#x2009;2.22e-16), M1 macrophage polarization (p&#x2009;=&#x2009;0.006), activated CD4&#x2009;+&#x2009;T cells (p&#x2009;=&#x2009;0.003), and elevated immune checkpoint expression (PD-L1, CTLA4, LAG3, TIGIT). In vitro, MLKL overexpression in OC cells promoted M1 polarization (p&#x2009;<&#x2009;0.05), activated Jurkat T cells (upregulated CCR4/5/7/9, CD69, CD3D/E, GZMB; p&#x2009;<&#x2009;0.05), and induced key chemokines (CXCL9/10/11/13) critical for immune cell recruitment. Integration of MLKL-related and immune-related DEGs (n&#x2009;=&#x2009;632) revealed enrichment in T-cell activation, chemokine signaling, and antigen presentation pathways (FDR&#x2009;<&#x2009;0.05). Consensus clustering based on 102 survival-associated genes defined three molecular subtypes (Clusters A-C) with divergent survival (p&#x2009;=&#x2009;0.019), necroptosis activity, and immune infiltration (Cluster C: best prognosis, highest MLKL/ImmuneScore). The derived NecropImmScore robustly stratified patients: high-score correlated with superior overall survival (TCGA: p&#x2009;<&#x2009;0.001; ICGC: p&#x2009;=&#x2009;0.014), inflamed TME phenotype, elevated checkpoint expression, and improved response to anti-PD-L1 in IMvigor210. Critically, high NecropImmScore predicted higher BRCA1 mutation frequency (AUC&#x2009;=&#x2009;0.802), synergy with BRCA1 status for prognosis, higher homologous recombination deficiency (HRD) score, sensitivity to cisplatin (p&#x2009;=&#x2009;0.014), paclitaxel (p&#x2009;=&#x2009;0.016), gemcitabine (p&#x2009;=&#x2009;0.017), and provided superior prognostic stratification when combined with TMB and HRD score (p&#x2009;<&#x2009;0.001). CONCLUSION: This study establishes MLKL as a master regulator of anti-tumor immunity in OC, driving chemokine-mediated immune cell recruitment and TME reprogramming. The novel NecropImmScore is a multifaceted biomarker that effectively predicts prognosis, immunotherapy response, BRCA1 deficiency, and chemosensitivity, offering significant potential for guiding precision therapeutic strategies in OC.

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HumansNecroptosisFemaleOvarian NeoplasmsPrognosisTumor MicroenvironmentBiomarkers, TumorGenomicsCell Line, TumorMultiomicsProtein KinasesImmunotherapyMLKLOvarian cancerTumor microenvironmentJournal Article

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Fangfang Xu, Shufeng Kang, Shaohua Xu. 2025-10-15. Integrating necroptosis and immune landscapes: a multi-omics-derived NecropImmScore stratifies prognosis and therapy in ovarian cancer.. https://doi.org/10.1007/s00262-025-04192-z

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