ArticlePloS one2026
A recurrent cancer-associated fibroblast/TGF-beta/endothelial barrier direction is associated with immune exclusion and checkpoint resistance in bladder cancer: a public multi-cohort transcriptomic study.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Immune checkpoint inhibitors benefit only a subset of patients with urothelial carcinoma, and bulk biomarkers may not capture spatially organized stromal and vascular programs that restrict immune access. We performed a retrospective public multi-cohort transcriptomic study to examine whether a cancer-associated fibroblast (CAF)/TGF-beta/endothelial barrier direction is associated with immune exclusion and checkpoint resistance in bladder cancer. GSE171351 was used for spatial discovery, GSE319536 for external spatial recurrence testing, TCGA-BLCA for prognosis-oriented support, and IMvigor210, GSE176307 and GSE328930/DUTRENEO for treatment-response projection. In the four-section discovery cohort, rank-5 non-negative matrix factorization separated an E2 barrier-enriched program from an E4 hypoxic epithelial program, although component assignment was strongly associated with section identity. The external cohort reproduced the direct CAF/TGF-beta/endothelial barrier direction in 22 of 22 sections but did not reproduce E2/E4 mutual exclusivity: projected E2 and E4 were positively correlated (rho = 0.928). In IMvigor210, top-quartile E2-high tumors showed suggestive, but not statistically conclusive, evidence of anti-PD-L1 non-response after full biologic covariate adjustment (OR=2.57, 95% CI 1.00-6.64, p = 0.051; delta AUC = 0.009). A prespecified heuristic barrier-exclusion score was associated with non-response in exploratory fixed- and random-effects summaries (OR=1.52, 95% CI 1.20-1.92), including a sensitivity analysis excluding GSE328930. These results identify a recurrent barrier direction rather than a universal two-niche architecture and support a hypothesis-generating mechanism-to-translation framework that requires prospective spatial and pathology-level validation.
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