# Cell division cycle 20 promotes tumor progression and predicts poor clinical outcome in childhood and adult adrenocortical carcinoma

## TL;DR

High CDC20 levels in adrenocortical carcinoma are linked to worse outcomes, and low CDC20 may improve response to immunotherapy.

## Contribution

CDC20 is identified as a novel prognostic biomarker and potential therapeutic target in adrenocortical carcinoma.

## Key findings

- CDC20 overexpression correlates with poor prognosis in adrenocortical carcinoma patients.
- Reducing CDC20 inhibits tumor cell proliferation and migration in laboratory experiments.
- Low CDC20 expression is associated with better anti-PD-1 immunotherapy response.

## Abstract

•CDC20 overexpression in pediatric/adult adrenocortical carcinomas links to worse prognosis.•CDC20 silencing inhibits tumor cell proliferation, migration, and invasion in vitro.•Low CDC20 expression enhances anti-PD-1 immunotherapy sensitivity in patients.

CDC20 overexpression in pediatric/adult adrenocortical carcinomas links to worse prognosis.

CDC20 silencing inhibits tumor cell proliferation, migration, and invasion in vitro.

Low CDC20 expression enhances anti-PD-1 immunotherapy sensitivity in patients.

Adrenocortical carcinoma (ACC) is an uncommon and highly aggressive tumor with a grim prognosis. Numerous investigations have elucidated a close association between the dysregulated expression of multiple genes within tumors and the initiation as well as progression of neoplasms. These dysregulated genes not only exert pivotal roles in tumorigenesis but also harbor significant potential as prognostic biomarkers.

This study utilized transcriptomic data from public databases of ACC and normal tissue samples to screen for differentially expressed genes (DEGs). Subsequently, univariate Cox regression and receiver operating characteristic (ROC) curve were employed to identify potential prognostic biomarkers for ACC. Immunohistochemistry and in vitro cell experiments were conducted to validate the expression and potential functions of Cell division cycle 20 (CDC20) in ACC cells. Additionally, we analyzed the relationship between CDC20 and CD8+ T cells, immunotherapy response, somatic mutations, and copy number variations.

CDC20 has emerged as an independent adverse prognostic factor in ACC, with significantly elevated expression levels. In vitro cell experiments have demonstrated that downregulation of CDC20 expression suppresses proliferation and migration of ACC cells. Notably, our study has identified CDC20 expression as most closely associated with TP53 mutation. Additionally, CDC20 expression levels exhibit a negative correlation with infiltration of CD8+ T cells. Patients with low CDC20 expression may show improved response to anti-PD-1 immunotherapy.

CDC20 serves as a reliable and robust biomarker in ACC, playing a crucial role in predicting survival outcomes and assessing immunotherapy response in adult and childhood ACC patients.