Importance of metabolic and immune profile as a prognostic indicator in patients with diabetic clear cell renal cell carcinoma

BACKGROUND: ccRCC, also known as clear cell renal cell carcinoma, is a cancer that is highly metabolically active and has a strong connection with the immune system. The objective of this research was to investigate the correlation between pathways associated with metabolism, diabetes, immune infiltration, and their impact on the prognosis of ccRCC. METHOD: We conducted an extensive examination utilizing ssGSEA, ESTIMATE algorithm, WGCNA, and GSVA for gene set enrichment analysis, gene co-expression network analysis, and gene set variation analysis. An established prognostic model, utilizing immune-related WGCNA findings, was evaluated for its association with clinical characteristics and the tumor microenvironment (TME). RESULT: The ssGSEA effectively categorized ccRCC into groups based on low and high metabolism. Strong associations were observed between scores related to metabolism and immune scores, ESTIMATE scores, stromal scores, and gene expression related to HLA. The analysis conducted by WGCNA revealed a module called the ‘yellow module’ that exhibited a significant correlation with the infiltration of immune cells and the survival rates of patients. A risk model was developed, demonstrating reliable predictive performance for patient survival outcomes. The risk model also correlated significantly with immune scores and HLA-related gene expressions, suggesting potential immune evasion mechanisms. The analysis of mutations in TCGA data revealed the mutational patterns of ccRCC, and there was a significant correlation between the risk score and clinical characteristics. The GSVA analysis revealed a notable enrichment of pathways associated with cancer in patients at high risk. Finally, in order to evaluate the role of CX3CL1 in renal cell carcinoma cells, we then performed the cell proliferation assays. The results demonstrated that the over expression of CXCL1 could promote the cell proliferation ability in renal cell carcinoma cells. CONCLUSION: Our findings provide a novel perspective on the interactions between diabetes, metabolic pathways, and the immune landscape in ccRCC. The predictive value of the prognostic model established in this research has the potential to guide the development of new therapeutic and prognostic approaches for patients with ccRCC.