Identification of ribosomal protein S21 as a potential prognostic and immunotherapy biomarker for hepatocellular carcinoma

Background: Recent studies show that ribosomal protein S21 (RPS21) plays a role in the development and progression of various malignancies. However, the biological value of RPS21 in hepatocellular carcinoma (HCC) and its association with immunotherapy remain unknown.

Methods: Here, we examined the differential expression of RPS21 between HCC and normal liver tissues, using the TCGA, ICGC and GEO databases, followed by verification by reverse-transcription quantitative polymerase chain reaction (RT-qPCR) in LO2, SMMC7721, HepG2, and MHCC-97H cell lines. Kaplan-Meier and Cox regression analyses were applied to investigate how RPS21 expression influenced overall survival, and a nomogram was established to predict prognosis among HCC patients. We further analyzed how RPS21 expression was related to tumor immune microenvironment, immunotherapy efficiency, and genomic alterations, and investigated potential underlying mechanisms.

Results: RPS21 upregulation was observed in HCC tissues and cell lines, compared to normal controls. Survival analysis revealed that RPS21 overexpression was significantly associated with poor clinical outcomes (all p < 0.05). Functional enrichment analyses indicated that differentially expressed genes relative to RPS21 expression were mainly involved in tumor response, proliferation, and metabolism. Additionally, RPS21 expression was positively correlated with the infiltration of activated CD4⁺ T cells and tumor mutational burden (all p < 0.05). Moreover, RPS21 was co-expressed with immune-related genes and immune checkpoint genes. Analyses of drug sensitivity predict that HCC patients with low RPS21 expression were more sensitive to targeted immunotherapy.

Conclusions: The present results suggested that RPS21 might be a promising prognostic marker and a potential immunotherapy target for patients with HCC.