Abstract
BACKGROUND: The pathogenesis and progression of renal cell carcinoma (RCC) involve complex programmed cell death (PCD) processes. As the powerhouse of the cell, mitochondria can influence cell death mechanisms. However, the prognostic significance of the interplay between mitochondrial function (MF) and PCD remains unclear. METHODS: We collected sets of genes related to PCD and MF. Using a powerful machine learning algorithm framework, we investigated the relationship between MF and PCD in different cohorts of patients and developed a machine learning-derived prognostic signature (mpMLDPS) related to MF and PCD. Finally, the most appropriate prognostic markers for RCC were screened by survival analysis and clinical correlation analysis, and the effects on renal cancer cells were analysed in vitro. RESULTS: mpMLDPS was significantly correlated with the prognosis of RCC patients, and the prognosis was worse in the high mpMLDPS group, and this result was also validated in external independent cohorts. There were associations between mpMLDPS and immune checkpoints, tumour microenvironment, somatic mutations, and drug sensitivity. Finally, a novel RCC prognostic marker PIF1 was identified in model genes. The knockdown of PIF1 in vitro inhibited the progression of renal carcinoma cells. CONCLUSION: mpMLDPS has great potential to serve as a reliable clinical signature to improve the accuracy and reliability of prognostic assessment in RCC patients, thereby choosing the appropriate therapeutic regimen in clinical practice. PIF1 is also expected to be a novel target for the clinical treatment of RCC.