Multi-Omics Integration of Lactylation- and PANoptosis-Based Signatures in Lung Adenocarcinoma: Prognostic Stratification and Immune Response.

Lactylation and PANoptosis are emerging modes of tumor progression regulation; however, their interplay and effect on the prognosis for lung adenocarcinoma (LUAD) remain unclear. This research analyzed both bulk and single-cell transcriptomic profiles of LUAD and identified 506 potential markers related to lactylation and PANoptosis. Employing 117 machine learning approaches and 5 LUAD datasets, lactylation and PANoptosis-related signatures (LAPRS) and further predictive nomograms were constructed with 85 prognostic genes. The performance of LAPRS was validated with multifaceted validation, including Kaplan-Meier analysis, time-dependent ROC curves and comparison with 55 existing LUAD models. LAPRS enabled the stratification of LUAD patients into high- and low-risk subgroups. Through additional investigation, high-risk individuals showed elevated genomic alterations, reduced immune infiltration, and poorer immunotherapy response, while low-risk individuals showed better drug sensitivity and a higher tumor mutation burden. Further analysis via 18 models and experimental validation revealed APOL1 as a poor prognostic factor, potentially interacting with the lactylation-related gene VIM through TNF signaling. This research clarifies the mechanistic roles of lactylation and PANoptosis in LUAD and proposes APOL1 as a novel prognostic marker, offering insights for therapeutic stratification.