Dual Role of PSMB9 Linking Immune Activation and Tumor Adaptation in Hepatocellular Carcinoma With Therapeutic and Prognostic Implications.

[BACKGROUND/AIM] Hepatocellular carcinoma (HCC) is a highly heterogeneous malignancy with poor prognosis. Although multiple treatment modalities are available, reliable biomarkers to stratify tumor immune status and guide prognosis remain limited. Increasing evidence suggests that tumors with an inflamed immune microenvironment exhibit improved therapeutic responsiveness; however, the molecular determinants underlying immune activation and their prognostic implications in HCC are not fully defined.

[MATERIALS AND METHODS] Single-sample Gene Set Enrichment Analysis (ssGSEA) was used to classify TCGA-LIHC tumors into immune-hot and immune-cold subtypes based on immune infiltration profiles. Differentially expressed genes (DEGs) were further screened by integrating an HCC TACE-treated cohort with multiple immunotherapy and targeted-therapy cohorts to assess broader immune relevance. The immune associations of specific biomarkers were validated through bulk RNA-seq correlation analyses, single-cell RNA-seq profiling, and functional assays.

[RESULTS] PSMB9 was identified as a key immune-related biomarker associated with the immune-hot phenotype in HCC, characterized by elevated immune scores, enriched antigen presentation and interferon signaling pathways, and increased expression of immune checkpoints. Its expression was associated with enhanced responsiveness to TACE and potentially to immunotherapy and targeted therapies. Despite its immune-activating role, high PSMB9 expression predicted poorer overall survival, reflecting a paradoxical phenotype combining immune stimulation with malignant adaptation. Single-cell analysis revealed PSMB9 expression in both malignant and immune compartments, while assays confirmed that PSMB9 overexpression enhanced proliferation, migration, and resistance to apoptosis in HepG2 cells.

[CONCLUSION] PSMB9 links immune activation with tumor progression in HCC and delineates a patient subgroup with unfavorable prognosis but increased therapeutic responsiveness. These findings suggest that high PSMB9 expression is associated with benefit from TACE and may serve as a prognostic biomarker to inform combined locoregional and systemic treatment strategies in HCC.