Integrated multi-omics and experimental approaches identify fascin actin-bundling protein 1 as an unfavorable prognostic biomarker in adrenocortical carcinoma

• FSCN1 is identified as an independent risk factor for poor prognosis in adrenocortical carcinoma (ACC) through integrated multi-omics analysis. • ATAC-seq reveals higher chromatin accessibility of FSCN1 in ACC patients with progressive disease, suggesting epigenetic regulation. • Functional assays demonstrate that FSCN1 promotes tumor invasion and proliferation, and its expression correlates with reduced CD8+ T-cell infiltration in the tumor microenvironment. • FSCN1 emerges as a promising novel biomarker and potential therapeutic target for ACC, offering clinical utility in risk stratification and management.