Innate immune cell barrier-related genes inform precision prognosis in pancreatic cancer

Introduction: Pancreatic cancer (PC) remains a lethal malignancy with limited treatment options. The role of innate immune cell barrier-related genes in PC prognosis is poorly defined. This study aimed to identify prognostic biomarkers, develop a predictive model, and uncover novel targets for personalized therapy. Methods: Innate immune cell barrier-related genes were curated from KEGG, ImmPort, MSigDB, and InnateDB. Differential expression analysis was performed using TCGA and GTEx datasets. Univariate Cox regression identified survival-associated genes. Prognostic modeling of PC was developed using 14 machine learning algorithms, with performance validated through long-term survival metrics, functional enrichment, immune infiltration analysis, and drug sensitivity profiling. Core genes were prioritized via the "mime1" package, and single-cell RNA sequencing (scRNA-seq) data explored UBASH3B's functional role. Results: 352 differentially expressed genes of Innate immune cell barrier-related were identified, with NK cell pathways linked to PC immunity. Univariate Cox analysis revealed 8 protective and 84 risk genes. The RSF model (trained on risk genes) showed strong 3- and 5-year survival prediction. High-risk patients exhibited elevated tumor mutation burden (TMB), reduced NK/CD8+ T cell infiltration, and resistance to Erlotinib/Oxaliplatin but sensitivity to 5-Fluorouracil. Five key genes (ITGB6, COL17A1, MMP28, DIAPH3, UBASH3B) were highlighted. UBASH3B, a novel marker, correlated negatively with NK cell activation and mediated immune signaling and drug resistance. Discussion: This study established the CDRG-RSF model, a robust prognostic tool leveraging innate immune genes. UBASH3B's dual role in immune suppression and drug resistance highlights its potential for stratifying PC patients into tailored treatment groups. The findings underscore the importance of integrating machine learning with immune profiling to advance precision oncology for PC.