<b>Identification and validation of the transcription factor RFX1 as a biomarker for prognosis and inflammatory infiltration in colon cancer</b>

Purpose: The difficulty in targeting colon cancer may be attributed to the plastic regulation of transcription factors. The transcription factor RFX1 exhibits a high degree of plasticity in inducing cancer cells with environment-dependent properties such as drug resistance, immunosuppression, or metastasis. However, the exploration of the relevance of RFX1 in the tumor microenvironment of colon cancer is still in its infancy. Methods: We have gradually focused our attention from pan-cancer to the molecular characterisation of RFX1 in colon cancer. We classified colon cancers into subgroups with high and low RFX1 expression and characterised their immune profiles, mutational profiles, cancer immunotherapy and drug sensitivity. Combining RFX1 expression and persistent tumor mutation burden, we innovatively propose a novel nomogram clinical prediction model and validate its function, and the correlation between high expression and poorer prognosis. Results: Compared to TMB, pTMB is an independent predictor of prognosis in colon cancer patients. Innovatively, the predictive efficacy of the combination of RFX1 and pTMB expression was more robust and sensitive compared to the effect of RFX1 combined with TMB. Among them, patients in the RFX1high/pTMBhigh subgroup had the worst quality of survival and prognosis, whereas patients in the RFX1low/pTMBlow subgroup had a relatively better prognosis. Clinical tumor samples and immunohistochemical microarray results strongly validate the robust predictive potential of nomogram clinical models dependent on RFX1 and pTMB expression. Conclusion: A nomogram model based on the transcription factor RFX1 combined with pTMB provides an alternative approach to the diagnosis and treatment of colon cancer.