Identification of an Anoikis-associated LncRNA Signature to Predict the Clinical Prognosis and Immune Function of Patients with Endometrial Cancer

<b>Background:</b> Endometrial cancer is a highly heterogeneous malignancy in women with high mortality, and patients diagnosed with advanced endometrial cancer have a poor prognosis. Anoikis is a form of programmed cell death that is important for cancer development and metastasis. Long non-coding RNAs (lncRNAs) are considered critical regulators of gene expression and key players in cancer biology; however, the effects of anoikis-associated lncRNAs on the prognosis and treatment of patients with endometrial cancer remain unclear. <b>Methods:</b> Using transcriptome sequencing data and clinical information from The Cancer Genome Atlas database, we developed a novel prognostic signature for endometrial cancer based on anoikis-related lncRNAs by combining multivariate regression analysis and least absolute shrinkage and selection operator regression. The signature was validated by receiver operating characteristic (ROC) curve and Kaplan-Meier analyses. After analyzing the relationships between the seven lncRNAs in the signature and tumor progression through gene set enrichment analysis (GSEA), we further explored the differences in immune function and drug sensitivity. Additionally, to investigate the functions of these lncRNAs in the occurrence and development of endometrial cancer, we selected <i>CFAP58-DT</i> to conduct a series of <i>in vitro</i> and <i>in vivo</i> experiments to verify its partial functions. <b>Results:</b> Seven anoikis-associated lncRNAs (<i>CFAP58-DT, AC004585.1, AC103563.9, AL121895.2, AC004596.1, AC010761.4,</i> and <i>AC087564.1</i>) with prognostic value were identified for signature construction. The analysis showed excellent predictive accuracy of the signature (the largest area under the ROC curve = 0.757). GSEA indicated that these lncRNAs may regulate diverse cellular processes, including intercellular interactions, cell proliferation, differentiation, apoptosis, angiogenesis, glucose and fatty acid metabolism, immune responses, and inflammatory regulation. Furthermore, immune analysis revealed a high likelihood of immune evasion and poor immunotherapy efficacy in high-risk patients. However, there were distinct differences in the immune checkpoints and anticancer drug sensitivity between the two patient groups, which may aid in guiding treatment. Finally, our experiments showed that silencing <i>CFAP58-DT</i> significantly affected cell proliferation, promoted apoptosis, and reduced tumor malignancy. <b>Conclusion:</b> Our study highlights the significance of anoikis-associated lncRNAs in endometrial cancer progression and their potential as prognostic markers and therapeutic targets. The signature constructed using these lncRNAs may offer new avenues for endometrial cancer treatment and immunotherapy. The function of <i>CFAP58-DT</i> has been validated <i>in vitro</i> and <i>in vivo</i>, consistent with our previous analysis; however, further research into its upstream and downstream mechanisms is warranted.