Transcriptomic Evidence of Immune-Tumor Uncoupling Defines a High-Risk State in Uterine Corpus Endometrial Carcinoma.

This study aimed to develop and validate a transcriptomic risk signature for uterine corpus endometrial carcinoma (UCEC) and to investigate whether the identified prognostic program reflects immune-tumor uncoupling within the tumor microenvironment. Using transcriptomic data from The Cancer Genome Atlas (TCGA) UCEC cohort, we identified a 28-gene transcriptomic signature defining a high-risk state. The derived risk score robustly stratified patients into distinct survival groups and remained an independent predictor of overall survival after adjustment for clinical covariates. Functional analyses revealed that high-risk tumors are characterized by a distinct immune-tumor uncoupling phenotype, in which interferon-gamma (IFNG)-associated inflammatory signaling is preserved but fails to translate into effective antitumor immune activity. Specifically, effector immune programs, including CD8 T cell-related signatures and cytotoxic activity, were consistently reduced despite elevated IFNG-associated signaling, indicating a functional discordance between immune activation and immune execution rather than classical T cell exhaustion. In parallel, high-risk tumors exhibited consistently elevated cell cycle and DNA repair-associated transcriptional programs, suggesting that proliferative and stress-adaptive mechanisms represent dominant drivers of poor prognosis. External assessment in an independent GEO cohort (GSE17025) demonstrated consistent associations between signature activity, tumor status, and histological grade, supporting the reproducibility of the underlying transcriptional program at the biological and clinicopathological level. Collectively, this study provides transcriptomic evidence for a previously underappreciated immune-tumor uncoupling state in UCEC and highlights the importance of integrating immune signaling and tumor-intrinsic programs to understand disease progression.