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<p>The fight against lung adenocarcinoma (LUAD) is challenged by tumor microenvironment (TME)-mediated drug resistance, which limits effective treatment. This study examines the LUAD TME and identifies four distinct subtypes through multi-omics profiling: immune-rich, immune-exhausted, stromal-dominant, and TME-desert. Each subtype has unique molecular features, tumor diversity, and links to clinical outcomes. Immune-rich subtypes respond better to immune checkpoint inhibitors, while stromal-dominant and TME-desert subtypes show resistance to treatment and poor prognosis. Molecular analysis uncovers subtype-specific mutations, chromosomal instability, and altered signaling pathways, pointing to potential therapeutic targets. In silico drug screening identifies promising treatments for resistant subtypes. These findings, validated in independent cohorts, highlight the critical role of the TME in drug resistance and treatment response, providing insights for personalized treatment strategies in LUAD.</p>

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Tumor microenvironment and drug resistance in lung adenocarcinoma: molecular mechanisms, prognostic implications, and therapeutic strategies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月25日

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  • Qianqian Cao,
  • Chenxuan Li,
  • Ying Li,
  • Xiangjing Kong,
  • Shoushi Wang,
  • Jun Ma

摘要

The fight against lung adenocarcinoma (LUAD) is challenged by tumor microenvironment (TME)-mediated drug resistance, which limits effective treatment. This study examines the LUAD TME and identifies four distinct subtypes through multi-omics profiling: immune-rich, immune-exhausted, stromal-dominant, and TME-desert. Each subtype has unique molecular features, tumor diversity, and links to clinical outcomes. Immune-rich subtypes respond better to immune checkpoint inhibitors, while stromal-dominant and TME-desert subtypes show resistance to treatment and poor prognosis. Molecular analysis uncovers subtype-specific mutations, chromosomal instability, and altered signaling pathways, pointing to potential therapeutic targets. In silico drug screening identifies promising treatments for resistant subtypes. These findings, validated in independent cohorts, highlight the critical role of the TME in drug resistance and treatment response, providing insights for personalized treatment strategies in LUAD.