A four-m6A methylation regulator risk score was an independent prognostic biomarker for adrenocortical carcinoma

N6-methyladenosine (m6A) is crucial in cancer prognosis, yet its role in adrenocortical carcinoma (ACC) is not well understood. This study investigates the prognostic value of m6A RNA methylation regulators in ACC using mRNA data and clinical information from the TCGA-ACC database. Patients were divided into two clusters based on the expression of 13 m6A genes. Univariate and LASSO Cox regression analyses identified four key prognostic m6A regulators (METTL14, RBM15, HNRNPC, WTAP), leading to the construction of a risk score (RS) model: RS = (-0.1828 × METTL14) + (0.3292 × RBM15) + (0.0219 × HNRNPC) + (0.0010 × WTAP). Kaplan-Meier survival analysis showed significant differences between high and low RS groups, with an AUC of 0.787, indicating good predictive accuracy. Univariate and multivariate Cox regression analyses revealed that T stage and RS were independent prognostic factors. RS was also closely correlated with stage and N status. High RS was associated with higher expression levels of RBM15, HNRNPC, and WTAP, and lower expression of METTL14. This study highlights the prognostic significance of m6A RNA methylation regulators in ACC, presenting a four-gene RS model as an independent prognostic biomarker. These results provide new insights into ACC prognosis, emphasizing the potential of targeting m6A RNA methylation in future therapeutic strategies and enhancing patient management through more accurate prognostic tools. Furthermore, this research underscores the importance of continued investigation into the molecular mechanisms of m6A RNA methylation and its broader implications in oncology, potentially guiding personalized treatment approaches for ACC patients.