Immune checkpoint inhibitors (ICIs) have fundamentally improved survival from advanced cutaneous melanoma. Significant efforts have been made to understand the ICI response to identify ways to further improve outcomes. One such approach has been to investigate gene expression associated with response to ICI, which has identified various immune-related mRNA signatures, including a 6-gene IFN-γ signature (IFN-γ ), an expanded immune signature (IFN-γ ), an effector T-cell gene signature (T ), and a T -associated and IFN-γ-associated gene signature (T + IFN-γ). Given that these signatures appear to reflect expression from T-cells and the level of tumour-infiltrating immune cells has been associated with survival, we hypothesised that the prognostic value of the signatures is not limited to ICI treatment and investigated if they were associated with survival also in patients who never received ICI. The signatures were not present in melanoma cell lines when compared with tumour samples, confirming that the signatures were likely derived from the samples’ non-tumour (immune) components. We acquired expression and survival data from five melanoma cohorts with a wide range of disease stages, treatments, and metrics for survival, and correlated the expression signatures with survival. All four signatures were significantly associated (P<0.05) with survival in 4/5 cohorts, with hazard ratios ranging from 0.69 to 0.92. We conclude that these immune signatures' association with survival is not specific to ICI-treated patients, but present in a number of settings.
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