A palmitoylation signature for prognosis immune infiltration and drug sensitivity in esophageal carcinoma

Esophageal carcinoma (ESCA) has a poor prognosis. This study aimed to develop a palmitoylation-related signature (PRS) for ESCA prognosis and therapy prediction. Using scRNA-seq and bulk RNA-seq data from public databases, we constructed a signature via Cox and LASSO regression. It was validated internally and externally. Associations with clinical features, immune infiltration, tumor mutational burden (TMB), and drug sensitivity were analyzed. A 7-gene PRS was established, stratifying patients into risk groups with distinct outcomes (1–3 years AUCs: 0.698–0.805). High-risk patients showed altered immune infiltration, TMB, and drug sensitivity. The gene PAH was highly expressed in ESCA and promoted proliferation, migration, and invasion via PI3K/AKT pathway activation. Furthermore, this tumorigenic effect depends on its palmitoylation modification. In conclusion, the PRS can serve as an independent prognostic biomarker for ESCA, effectively predict prognosis and treatment response, and may represent a potential therapeutic target.