Novel Efferocytosis-Related Prognostic Signature for Hepatocellular Carcinoma Patients Undergoing Transarterial Chemoembolization.

Transarterial chemoembolization (TACE) is a key treatment for hepatocellular carcinoma (HCC). However, patient outcomes after TACE are heterogeneous, and robust prognostic biomarkers are needed. This study aimed to develop an efferocytosis-related prognostic signature to stratify HCC patients and others undergoing TACE treatment. Liver cancer data were obtained from The Cancer Genome Atlas, and the GSE14520 dataset was used for validation. Differential analysis identified five efferocytosis-related genes associated with response to TACE. Consensus clustering of HCC samples revealed molecular subtypes, and differences in immune cell infiltration were analyzed. A prognostic model was developed using univariate Cox regression, least absolute shrinkage and selection operator, and multivariate Cox regression, and a nomogram was constructed. Gene expression was validated via quantitative polymerase chain reaction and immunohistochemistry. Single-sample gene set enrichment analysis was performed, a competing endogenous RNA network was constructed, and immune and drug sensitivity differences between risk groups were analyzed. A prognostic signature consisting of TYRO3, CD14, and TREM2 was established and validated for HCC patients, including those who underwent TACE treatment. High-risk patients exhibited significantly lower survival rates than low-risk patients. High-risk patients also exhibited distinct immune characteristics, including differences in immune checkpoint expression, immune cell infiltration, and immune function scores. Additionally, the high-risk group showed higher sensitivity to four drugs, with CD14 expression negatively correlated with sensitivity to vandetanib and cabozantinib. This study developed a model based on efferocytosis-associated characteristics to predict the prognosis of HCC patients and those undergoing TACE treatment, thereby facilitating the formulation of personalized treatment plans.