Pan-cancer, multi-omic correlates of survival transcending tumor lineage across 11,019 patients reveal targets and pathways

Molecular correlates of cancer patient overall survival (OS) can provide new insights. Here, we systematically cataloged pan-cancer, multi-omic correlates of OS transcending tumor lineage across 11,019 patients, involving multiple cancer types while correcting for cancer-type-intrinsic OS differences. Significant fractions of genes with mRNA associated with OS in pan-cancer analyses showed concordant associations at the levels of DNA copy number alteration or methylation. Pan-cancer gene signatures of T-cell and macrophage tumor infiltrates were associated with better and worse OS, respectively. Pathways implicated by molecular OS associations included metabolism, PI3K/Akt, Wnt, and TGF-beta receptor. Significant fractions of worse OS-associated genes were essential for cell growth. A pan-cancer RNA signature of aggressive cancers associated with greater sensitivity in vitro to inhibitors of MEK1/2, glycolysis pathway, and HSP90, and with chemotherapy response in patient breast tumors. With therapeutic implications, pan-cancer molecular associations with patient survival reveal genes and pathways underlying more aggressive diseases.