# Pan-Cancer Analysis Confirms the Prognostic and Immunological Implications of the 1,25-Dihydroxy Vitamin D3 Receptor in Cervical Squamous Cell Carcinoma

## TL;DR

This study explores the role of the vitamin D receptor in cervical cancer, finding it is linked to immune cell activity and cancer stages but not patient survival.

## Contribution

The novel contribution is confirming the VDR's role in immune infiltration and its expression patterns across cancer stages in cervical squamous cell carcinoma.

## Key findings

- VDR expression is significantly upregulated in multiple cancer types, including cervical squamous cell carcinoma.
- VDR correlates with neutrophils and dendritic cells but not with B cells or T cells in cervical cancer.
- VDR mutations are most common in diffuse large B-cell lymphoma, with low amplification and deletion frequencies.

## Abstract

Vitamin D receptor (VDR), specifically the 1,25-dihydroxy form, holds significant importance in various types of cancer, including cervical squamous cell carcinoma (CESC), which poses a significant public health challenge. A pan-cancer analysis was conducted on VDR in CESC, with a focus on its expression and relationship with immune infiltration and genetic alterations.

Bioinformatics databases, including TIMER, GEPIA, UALCAN, cBioportal, and Kaplan-Meier Plotter, have been utilized. VDR expression in CESC has been validated using publicly available data. Results were significantly upregulated (P=0.05) in THCA, BRCA, KICH, LUAD, LIHC, STAD, UCEC, CESC, CHOL, ESCA, and HNSC samples.

We analyzed the correlation between VDR expression and various clinicopathological factors such as age, race, and cancer stage. VDR expression was significantly upregulated across all age groups, with the highest levels observed in older adults followed by young and middle-aged adults. VDR gene expression was significantly elevated across all races, including Caucasians, African-Americans, and Asians, compared to that in the normal group. Furthermore, VDR expression was significantly upregulated in cancer stages 1, 2, 3, and 4, with the highest increase observed in stage 3 compared to that in normal individuals.

We analyzed the expression of the VDR in relation to immune cell type and tumor cell purity in CESC. Our results indicated that VDR expression was positively correlated with neutrophils and dendritic cells and negatively correlated with tumor cell purity in CESC patients. There was no significant correlation between VDR expression and the abundance of B cells, CD8+ T cells, CD4+ T cells, and macrophages.

Our study found no significant effect of VDR expression on patient prognosis, although it was positively correlated with CD4+ T cells. The Cox proportional hazards model indicated that age and immune cells did not significantly affect prognosis. Most VDR mutations are concentrated in diffuse large B-cell lymphoma, with an amplification frequency of 4% and a deep deletion frequency of 2.2%. GEO confirmed VDR expression in CESC, identifying 1515 upregulated and 1877 downregulated genes, with volcano plots showing CESC downregulation in patients.