Artificial intelligence prediction model for overall survival of clear cell renal cell carcinoma based on a 21-gene molecular prognostic score system.

We developed and validated a new prognostic model for predicting the overall survival in clear cell renal cell carcinoma (ccRCC) patients. In this study, artificial intelligence (AI) algorithms including random forest and neural network were trained to build a molecular prognostic score (mPS) system. Afterwards, we investigated the potential mechanisms underlying mPS by assessing gene set enrichment analysis, mutations, copy number variations (CNVs) and immune cell infiltration. A total of 275 prognosis-related genes were identified, which were also differentially expressed between ccRCC patients and healthy controls. We then constructed a universal mPS system that depends on the expression status of only 21 of these genes by applying AI-based algorithms. Then, the mPS were validated by another independent cohort and demonstrated to be applicable to ccRCC subsets. Furthermore, a nomogram comprising the mPS score and several independent variables was established and proved to effectively predict ccRCC patient prognosis. Finally, significant differences were identified regarding the pathways, mutated genes, CNVs and tumor-infiltrating immune cells among the subgroups of ccRCC stratified by the mPS system. The AI-based mPS system can provide critical prognostic prediction for ccRCC patients and may be useful to inform treatment and surveillance decisions before initial intervention.