Reviewer #1 (Public review):
The authors aimed to explore the prognostic and therapeutic relevance of immunogenic cell death (ICD)-related genes in bladder cancer, focusing on a risk-scoring model involving CALR, IL1R1, IFNB1, and IFNG. The research indicates that higher expression of certain ICD-related genes is associated with enhanced immune infiltration, prolonged survival, and improved responsiveness to PD1-targeted therapy in bladder cancer patients.
Major strengths:
• The establishment of an ICD-related gene risk model based on publicly available datasets (TCGA and GEO) and further validated through tissue arrays and preliminary single-cell RNA sequencing data provides potential but weak clinical guidance.
• The integration of multi-dimensional data (gene expression, mutation burden, immune infiltration, and treatment responses) strengthens the clinical applicability of the model.
Key limitations and concerns:
(1) Gene Selection and Novelty:
The selection of genes predominantly reflects known regulators of immune responses, somewhat limiting the novelty. Exploring less-characterized ICD markers or extending validation beyond bladder cancer could improve the model's innovative aspect and wider clinical relevance.
(2) Reliance on RNA-Seq for Immune Infiltration:
Immune infiltration analyses based primarily on bulk RNA-Seq data have inherent methodological limitations, such as inability to distinguish cell subsets accurately. Incorporation of robust single-cell sequencing would significantly enhance the reliability of these findings. Although the authors recognize this limitation, future studies should directly address it.
(3) Drug Sensitivity and Immunotherapy Response Data:
While the authors clarify that the drug sensitivity analysis was performed using established databases (TCGA via pRRophetic), the unexpected correlations between ICD-related genes and various targeted therapies need further mechanistic validation. The observed relationships may reflect indirect associations rather than direct biological relevance, which warrants cautious interpretation.
(4) Presentation and Clarity Issues:
Initially noted formatting inconsistencies across figures compromised professional presentation; these have been corrected by the authors. Additionally, the authors have now provided essential methodological details, including clear sample sizes and database versions, enhancing reproducibility.
(5) Immunotherapy Response Evidence:
Conclusions regarding differences in immunotherapy response rates between patient subgroups, although intriguing, remain based on retrospective database analyses with relatively limited demographic and clinical detail. Future prospective studies or more detailed patient characterization would be required to robustly confirm these associations.
(6) Interpretation of ICD Gene Signatures:
The ICD-related gene set includes many genes broadly associated with immune activation rather than specifically ICD. Although this was addressed by the authors, clearly distinguishing ICD-specific versus general immune-response genes in future studies would help clarify biological implications.
Summary and Recommendations for Readers:
Overall, this study presents an interesting and clinically relevant risk-scoring approach to stratify bladder cancer patients based on ICD-related gene expression profiles. It provides useful information about prognosis, immune infiltration, and potential immunotherapy responsiveness. However, readers should interpret the results within the context of its limitations, notably the need for broader validation and careful consideration of the biological significance underlying the observed associations. This work lays a valuable foundation for further investigation into the integration of ICD and immune response signatures in personalized cancer therapy.