Analysis of the cancer hallmark pathway revealed that epithelial–mesenchymal transition (EMT), hypoxia, and notch signaling pathways were significantly more activated in the relapsed group (supplementary Fig. 2C), while the primary group had more pronounced induction of immune-related pathways, including complement, inflammatory response, TNFA signaling via NFKB, and fatty acid metabolism pathway (supplementary Fig. 2D). Here, TNF is linked to cancer.