# Identification of Novel Subtypes in Lung Adenocarcinoma: Evidence from Gene Set Variation Analysis in Tumor and Adjacent Nontumor Samples

Authors: Feng Li; Bin Wan; Xuan He; Xiaoqing Li
Journal: Disease Markers
 (2022)

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## Abstract

In patients with lung adenocarcinoma (LUAD), the prognostic role of adjacent nontumor tissues is still unknown. Alterations in the activity of immunologic and hallmark gene sets in adjacent nontumor tissues may have a potential influence on cell proliferation of normal lung cell after pulmonary lobectomy. We sought to discover LUAD subgroups and prognostic gene sets based on changes in gene set activity in tumor and adjacent nontumor tissues. Firstly, we used gene set variation analysis (GSVA) to characterize the activity changes of 4922 gene sets in LUAD and nontumor samples. Luckily, we identified three novel LUAD subtypes using the nonnegative matrix factorization (NMF) algorithm. In detailed, patients with subtype-3 had a favorable prognosis, but subtypes 1 and 2 had a bad prognosis. In addition, patients with subtype-3 in the validation cohort also lived longer. Meanwhile, using the LASSO-Cox algorithm, we discovered 15 prognostic gene sets in tumors (T gene sets) and two prognostic gene sets in adjacent nontumors (N gene sets). Interestingly, genes from N gene sets were related with immune response in nontumor tissues, but genes from T gene sets were correlated with DNA damaging and repairing in tumor tissues. These findings highlighted the possibility of a stronger immune response in nearby nontumor tissues. In conclusion, our study established a theoretical foundation for selecting therapy strategy for LUAD patients that should be guided by changes in activity in tumor and adjacent nontumor tissues, particularly after pulmonary lobectomy.


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## Body

## 1. Introduction

According to the World Health Organization (WHO) reports, lung cancer will continue to be one of the most lethal types of cancer globally by 2020 [1], with a 5-year survival rate of just 19% [2]. Non-small-cell lung cancer (NSCLC) accounts for 85 percent of all lung cancers patients, with lung adenocarcinoma (LUAD) being a subset of NSCLC (NSCLC) [3]. Unfortunately, the majority of LUAD patients diagnosed are already at an advanced stage [4]. Moreover, LUAD is highly heterogeneous on a clinical, cellular, and molecular level [5]. Therefore, personalized treatment programs may be used to enhance patient prognosis by identifying subtypes and prognostic gene sets.Previous bioinformatic studies have focused on LUAD tissues, differentiating subtypes or risk stratifying based on the integration of whole gene expression profiles in LUAD tissues and according to specific gene expression (ferroptosis-related genes [6], pyroptosis-related genes [7], immune-related genes [8], glycolysis-related genes [9]), but have grossly underestimated the role of adjacent nontumor tissues in HCC subtypes. Additionally, investigations of pathway activity alterations in LUAD have tended to concentrate on particular pathways rather than systematically evaluating plenty of pathways in tumor and nontumor samples. Importantly, in some LUAD patients after pulmonary lobectomy, the remaining cells will proliferate or repair and may sometimes become cancerous again [10]. Meanwhile, circulating tumor cells (CTCs) in the blood may effectively colonize the lung lobes, resulting in recurrence [11]. As a result, adjacent nontumor tissues may also play a role in determining the prognosis of LUAD.To our knowledge, subtypes or prognostic gene sets in LUAD patients based on the activity of gene sets in tumor and nontumor tissue have yet been found. In this study, we revealed 3 subtypes of LUAD by exploring changes in the activity of immunologic and hallmark gene sets in LUAD and nontumor samples and discovered 15 prognostic gene sets in tumors (T gene sets) and two prognostic gene sets in adjacent nontumors (N gene sets). Meanwhile, GO and KEGG enrichment analyses revealed that in nontumor tissues, genes were related with immune response, but genes in tumor tissues were correlated with DNA damaging and repairing. Moreover, for N gene sets, the hub genes were PDCD1, PRF1, IL2RA, CD8A, TNF, IL1B, TAPBP, PSMB10, and PSMB9. For T gene sets, the hub genes were CCNB1, CDC20, AURKB, DDX18, DKC1, GRWD1, MRRF, MRPS9, and MRPS7. Our study established a theoretical foundation for selecting therapy strategy for LUAD patients that should be guided by changes in activity in tumor and adjacent nontumor tissues, particularly after pulmonary lobectomy.


## 2. Materials and Methods

### 2.1. Datasets

The transcriptome data from TCGA-LUAD (Level-3 HTseq-FPKM) and GSE72094 (GPL15048) were downloaded from GEO [12] and TCGA [13] database. TCGA cohort included adjacent 59 nontumor and 535 tumor samples, and GEO cohort included 398 tumor samples. A total of 4922 immunologic and hallmark genes sets were downloaded from MSigDB [14] for gene set variation analysis (GSVA) algorithm. In addition, patients with no follow-up information or a survival period of less than one day were excluded and leaving 509 LUAD patients in TCGA cohort and 398 patients in GEO cohort.


### 2.2. Gene Set Variation Analysis

Gene set variation analysis (GSVA) may be used to determine the relative enrichment of a gene set of interest within a sample population, which can be used to monitor changes in the activity of a group of genes associated with a specific biological state [15]. We used enrichment score (ES) as the activation degree of the gene sets. All LUAD patients were divided into 3 subconsensuses by NMF package [16] in R software based on the ES.


### 2.3. Enrichment Analysis

GO enrichment analysis [17] is a commonly used bioinformatic method to search for comprehensive information on large-scale genetic data. In addition, KEGG pathway enrichment analysis [18] is widely used to understand biological mechanisms and functions. The results of GO and KEGG analysis are visualized using the clusterprofile and GOplot packages.


### 2.4. Screening of Prognostic Gene Sets

Firstly, we used univariate Cox regression analysis to screen gene sets from 4922 immunologic and hallmark genes sets (p value <0.1). Subsequently, the prognostic gene sets were further screened by LASSO analysis [19] using 10-fold crossvalidation (glmnet package). The risk score based on gene sets were calculated as follows: ∑i=1nCoefi×xi. Coef is the coefficient in Cox regression analysis.


### 2.5. Statistical Analysis

All statistical analyses were performed using theR software (v.4.0.1). Detailed statistical methods about RNA-seq processing are covered in the above section.


## 2.1. Datasets

The transcriptome data from TCGA-LUAD (Level-3 HTseq-FPKM) and GSE72094 (GPL15048) were downloaded from GEO [12] and TCGA [13] database. TCGA cohort included adjacent 59 nontumor and 535 tumor samples, and GEO cohort included 398 tumor samples. A total of 4922 immunologic and hallmark genes sets were downloaded from MSigDB [14] for gene set variation analysis (GSVA) algorithm. In addition, patients with no follow-up information or a survival period of less than one day were excluded and leaving 509 LUAD patients in TCGA cohort and 398 patients in GEO cohort.


## 2.2. Gene Set Variation Analysis

Gene set variation analysis (GSVA) may be used to determine the relative enrichment of a gene set of interest within a sample population, which can be used to monitor changes in the activity of a group of genes associated with a specific biological state [15]. We used enrichment score (ES) as the activation degree of the gene sets. All LUAD patients were divided into 3 subconsensuses by NMF package [16] in R software based on the ES.


## 2.3. Enrichment Analysis

GO enrichment analysis [17] is a commonly used bioinformatic method to search for comprehensive information on large-scale genetic data. In addition, KEGG pathway enrichment analysis [18] is widely used to understand biological mechanisms and functions. The results of GO and KEGG analysis are visualized using the clusterprofile and GOplot packages.


## 2.4. Screening of Prognostic Gene Sets

Firstly, we used univariate Cox regression analysis to screen gene sets from 4922 immunologic and hallmark genes sets (p value <0.1). Subsequently, the prognostic gene sets were further screened by LASSO analysis [19] using 10-fold crossvalidation (glmnet package). The risk score based on gene sets were calculated as follows: ∑i=1nCoefi×xi. Coef is the coefficient in Cox regression analysis.


## 2.5. Statistical Analysis

All statistical analyses were performed using theR software (v.4.0.1). Detailed statistical methods about RNA-seq processing are covered in the above section.


## 3. Results

### 3.1. The Activity Changes of Gene Sets in Different Samples

To elucidate the changed biological states or processes in LUAD and nontumor samples, we conducted an indepth analysis of RNA-seq data from the TCGA-LUAD cohort, which included 59 nontumor and 535 tumor samples. To begin, the GSVA method was used to determine the enrichment scores (ES) of 4922 gene sets in various tissues, and the variations in ES were shown using a heat map (Figure1); curiously, several gene sets seemed to split the samples into many groups. Following that, patients with no follow-up information or a survival period of less than one day were eliminated, and leaving 509 LUAD patients were classified using the NMF algorithm into distinct subtypes. The Cox regression analysis (p<0.0001) was used to filter throughout the feature selection process for gene sets, as well as to determine the ideal cluster size and silhouette width. Finally, 509 LUAD patients were categorized into three subgroups based on k=3 (Figures 2(a)–2(c)) and silhouettewidthvalue=0.98 (Figure 2(d)), and overall survival rates varied significantly across subtypes. In particular, patients with subtype-1 had a lower rate of survival than those with subtypes 2 and 3 (Figure 2(e)).Figure 1
Enrichment scores for gene sets in different samples are shown as a heat map.Figure 2
Identification of subtypes. (a) Determine the ideal number ofK. (b) Cluster plot of 3 subtypes. (c) Heat map of LUAD samples. (d) The CancerSubtypes package was used to generate silhouette width. (e) Survival analysis of distinct subtypes.
(a)(b)(c)(d)(e)


### 3.2. Clinicopathological Features of LUAD Subtypes

Further investigation was conducted on the correlation between clinicopathological features and LUAD subtypes. These findings indicated that individuals with subtype-1 are more likely to die than other subtypes. Additionally, correlation analysis revealed substantial variations between three subtypes in terms of gender, T-staging, N-staging, pathological stage, and age (Table1). The composite heat map illustrated the distribution of clinical characteristics within each sample (Figure 3(a)). Meanwhile, we estimated the difference in ES and overlapped them to determine representative gene sets for each subtype. Ultimately, 71 representative gene sets were discovered (Figure 3(b)). The heat map illustrated the distribution of representative gene sets across subtypes (Figure 4): subtype-2 has a larger ES than other subtypes for three gene sets in nontumor samples, including N_GSE7218_UNSTIM_VS_ANTIGEN_STIM_THROUGH_IGG_BCELL_DN, N_GSE7509_UNSTIM_VS_IFNA_STIM_IMMATURE_DC_DN, and N_GSE7509_UNSTIM_VS_FCGRIIB_STIM_DC_DN. In addition, subtype-1 had a large number of gene sets in tumor tissues, such as T_HALLMARK_E2F_TARGETS. To investigate the accuracy of novel subtypes on survival prediction, we needed to test our results using another gene expression profile (GSE72094). Interestingly, these representative gene sets also yielded similar subgroups, and Kaplan-Meier analysis also indicated that subtype-1 had a poorer prognosis (Figure.S1).Table 1
The correlation between clinical characteristics and subtypes.
TotalC1 (n=169)C2 (n=202)C3 (n=129)p valueGender (%)0.0039Female270 (54%)74 (43.79%)117 (57.92%)79 (61.24%)Male230 (46%)95 (56.21%)85 (42.08%)50 (38.76%)Age (%)0.0003<60146 (29.2%)65 (38.46%)59 (29.21%)22 (17.05%)> =60354 (70.8%)104 (61.54%)143 (70.79%)107 (82.95%)TNM staging (%)0.0103I268 (53.6%)73 (43.2%)112 (55.45%)83 (64.34%)II119 (23.8%)46 (27.22%)51 (25.25%)22 (17.05%)III80 (16%)36 (21.3%)30 (14.85%)14 (10.85%)IV25 (5%)12 (7.1%)7 (3.47%)6 (4.65%)Unknown8 (1.6%)2 (1.18%)2 (0.99%)4 (3.1%)T staging (%)0.0001T1167 (33.4%)38 (22.49%)67 (33.17%)62 (48.06%)T2267 (53.4%)103 (60.95%)118 (58.42%)46 (35.66%)T345 (9%)20 (11.83%)12 (5.94%)13 (10.08%)T418 (3.6%)7 (4.14%)5 (2.48%)6 (4.65%)Unknown3 (0.6%)1 (0.59%)0 (0%)2 (1.55%)M staging (%)0.0765M0332 (66.4%)119 (70.41%)135 (66.83%)78 (60.47%)M124 (4.8%)12 (7.1%)7 (3.47%)5 (3.88%)Unknown144 (28.8%)38 (22.49%)60 (29.7%)46 (35.66%)N staging (%)0.0012N0324 (64.8%)96 (56.8%)129 (63.86%)99 (76.74%)N194 (18.8%)38 (22.49%)41 (20.3%)15 (11.63%)N269 (13.8%)33 (19.53%)27 (13.37%)9 (6.98%)N32 (0.4%)0 (0%)2 (0.99%)0 (0%)Unknown11 (2.2%)2 (1.18%)3 (1.49%)6 (4.65%)Figure 3
Correlation of gene sets and clinical characteristics. (a) The association between ES and clinical characteristics. (b) We computed and intersected differential gene sets between subgroups.
(a)(b)Figure 4
Heat map of represented immunologic and hallmark gene sets in three subtypes.


### 3.3. Exploring of Prognostic Gene Sets

Using the LASSO-Cox analysis, we sought to discover the prognostic gene sets for LUAD and ultimately identified 17 gene sets (Figures5(a) and 5(b)). Among these gene sets, two were in nontumor tissues (N gene sets: N_GSE7218_UNSTIM_VS_ANTIGEN_STIM_THROUGH_IGG_BCELL_DN, N_GSE7509_UNSTIM_VS_IFNA_STIM_IMMATURE_DC_DN), and 15 were in tumor tissues (T gene sets: T_GSE21546_ELK1_KO_VS_SAP1A_KO_AND_ELK1_KO_DP_THYMOCYTES_DN, T_GSE22886_UNSTIM_VS_IL15_STIM_NKCELL_DN, T_GSE21063_CTRL_VS_ANTI_IGM_STIM_BCELL_NFATC1_KO_8H_DN, T_GSE22886_UNSTIM_VS_IL2_STIM_NKCELL_DN, T_GSE21546_WT_VS_ELK1_KO_ANTI_CD3_STIM_DP_THYMOCYTES_DN, T_GSE17974_CTRL_VS_ACT_IL4_AND_ANTI_IL12_24H_CD4_TCELL_DN, T_GSE2770_UNTREATED_VS_IL4_TREATED_ACT_CD4_TCELL_48H_DN, T_GSE19888_ADENOSINE_A3R_ACT_VS_A3R_ACT_WITH_A3R_INH_PREREATMENT_IN_MAST_CELL_UP, T_GSE15930_NAIVE_VS_24H_IN_VITRO_STIM_INFAB_CD8_TCELL_DN, T_GSE25088_WT_VS_STAT6_KO_MACROPHAGE_IL4_STIM_DN, T_HALLMARK_MYC_TARGETS_V2, T_GSE16450_IMMATURE_VS_MATURE_NEURON_CELL_LINE_DN, T_GSE25088_WT_VS_STAT6_KO_MACROPHAGE_DN, T_GSE45365_HEALTHY_VS_MCMV_INFECTION_CD11B_DC_DN, T_GSE24634_TEFF_VS_TCONV_DAY7_IN_CULTURE_UP). Finally, we revealed different survival risk based on integration ES of the above gene sets for each LUAD patient. The results showed that in different data sets (TCGA and GEO cohort), high-risk patients had a lower survival possibility (Figures 5(c) and 5(d)).Figure 5
Prognostic gene sets in LUAD. (a, b) Least absolute shrinkage and selection operator (LASSO) coefficient profiles via 10-fold crossvalidation. (c) Kaplan-Meier survival analysis in TCGA cohort. (d) Kaplan-Meier survival analysis in GEO cohort.
(a)(b)(c)(d)


### 3.4. Function and Pathway Enrichment Analyses

To elucidate the mechanism by which the 17 prognostic gene sets contribute to prognosis, we extracted the genes present in each gene set and conducted GO and KEGG enrichment analyses on tumor and nontumor tissues. Interestingly, for tumor samples, genes from the T gene sets were mainly associated with DNA, such as DNA replication, cell cycle DNA replication, nuclear DNA replication, DNA replication origin binding, single-stranded DNA binding, and DNA helicase activity in GO analysis (Figure6(a)). Meanwhile, KEGG analysis based on T gene sets also revealed that cell cycle, base excision repair, and mismatch repair may affect prognosis (Figure 6(b)). For nontumor samples, genes in the N gene sets were associated with T cell activation, leukocyte cell-cell adhesion, regulation of T cell activation, T cell receptor signaling pathway, natural killer cell mediated cytotoxicity, PD-L1 expression, PD-1 checkpoint pathway in cancer, etc. (Figures 6(c) and 6(d)). This may reminded us that there may be a better immune response within the adjacent nontumor tissues. Subsequently, we discovered hub genes in the N and T gene sets and conducted protein-protein interaction networks in the STRING database. Subsequently, we classified each network using the MCODE plug-in into three clusters. Meanwhile, TOP3 genes were screened based on their topological degree in various clusters. For N gene sets, the top three hub genes from cluster 1 were PDCD1, PRF1, and IL2RA (Figure 7(a)), cluster 2 was CD8A, TNF, and IL1B (Figure 7(b)), and cluster 3 was TAPBP, PSMB10 and PSMB9 (Figure 7(c)). For T gene sets, the top three hub genes from cluster 1 were CCNB1, CDC20, and AURKB, cluster 2 was DDX18, DKC1, and GRWD1, and cluster 3 was MRRF, MRPS9, and MRPS7 (Figure.S2).Figure 6
Analysis of GO and KEGG enrichment. (a) KEGG enrichment analysis in T gene sets. (b) GO enrichment analysis in T gene sets. (c) KEGG enrichment analysis in N gene sets. (d) GO enrichment analysis in N gene sets.
(a)(b)(c)(d)Figure 7
The protein-protein interaction network in N gene sets. (a) Cluster 1. (b) Cluster 2. (c) Cluster 3.
(a)(b)(c)


## 3.1. The Activity Changes of Gene Sets in Different Samples

To elucidate the changed biological states or processes in LUAD and nontumor samples, we conducted an indepth analysis of RNA-seq data from the TCGA-LUAD cohort, which included 59 nontumor and 535 tumor samples. To begin, the GSVA method was used to determine the enrichment scores (ES) of 4922 gene sets in various tissues, and the variations in ES were shown using a heat map (Figure1); curiously, several gene sets seemed to split the samples into many groups. Following that, patients with no follow-up information or a survival period of less than one day were eliminated, and leaving 509 LUAD patients were classified using the NMF algorithm into distinct subtypes. The Cox regression analysis (p<0.0001) was used to filter throughout the feature selection process for gene sets, as well as to determine the ideal cluster size and silhouette width. Finally, 509 LUAD patients were categorized into three subgroups based on k=3 (Figures 2(a)–2(c)) and silhouettewidthvalue=0.98 (Figure 2(d)), and overall survival rates varied significantly across subtypes. In particular, patients with subtype-1 had a lower rate of survival than those with subtypes 2 and 3 (Figure 2(e)).Figure 1
Enrichment scores for gene sets in different samples are shown as a heat map.Figure 2
Identification of subtypes. (a) Determine the ideal number ofK. (b) Cluster plot of 3 subtypes. (c) Heat map of LUAD samples. (d) The CancerSubtypes package was used to generate silhouette width. (e) Survival analysis of distinct subtypes.
(a)(b)(c)(d)(e)


## 3.2. Clinicopathological Features of LUAD Subtypes

Further investigation was conducted on the correlation between clinicopathological features and LUAD subtypes. These findings indicated that individuals with subtype-1 are more likely to die than other subtypes. Additionally, correlation analysis revealed substantial variations between three subtypes in terms of gender, T-staging, N-staging, pathological stage, and age (Table1). The composite heat map illustrated the distribution of clinical characteristics within each sample (Figure 3(a)). Meanwhile, we estimated the difference in ES and overlapped them to determine representative gene sets for each subtype. Ultimately, 71 representative gene sets were discovered (Figure 3(b)). The heat map illustrated the distribution of representative gene sets across subtypes (Figure 4): subtype-2 has a larger ES than other subtypes for three gene sets in nontumor samples, including N_GSE7218_UNSTIM_VS_ANTIGEN_STIM_THROUGH_IGG_BCELL_DN, N_GSE7509_UNSTIM_VS_IFNA_STIM_IMMATURE_DC_DN, and N_GSE7509_UNSTIM_VS_FCGRIIB_STIM_DC_DN. In addition, subtype-1 had a large number of gene sets in tumor tissues, such as T_HALLMARK_E2F_TARGETS. To investigate the accuracy of novel subtypes on survival prediction, we needed to test our results using another gene expression profile (GSE72094). Interestingly, these representative gene sets also yielded similar subgroups, and Kaplan-Meier analysis also indicated that subtype-1 had a poorer prognosis (Figure.S1).Table 1
The correlation between clinical characteristics and subtypes.
TotalC1 (n=169)C2 (n=202)C3 (n=129)p valueGender (%)0.0039Female270 (54%)74 (43.79%)117 (57.92%)79 (61.24%)Male230 (46%)95 (56.21%)85 (42.08%)50 (38.76%)Age (%)0.0003<60146 (29.2%)65 (38.46%)59 (29.21%)22 (17.05%)> =60354 (70.8%)104 (61.54%)143 (70.79%)107 (82.95%)TNM staging (%)0.0103I268 (53.6%)73 (43.2%)112 (55.45%)83 (64.34%)II119 (23.8%)46 (27.22%)51 (25.25%)22 (17.05%)III80 (16%)36 (21.3%)30 (14.85%)14 (10.85%)IV25 (5%)12 (7.1%)7 (3.47%)6 (4.65%)Unknown8 (1.6%)2 (1.18%)2 (0.99%)4 (3.1%)T staging (%)0.0001T1167 (33.4%)38 (22.49%)67 (33.17%)62 (48.06%)T2267 (53.4%)103 (60.95%)118 (58.42%)46 (35.66%)T345 (9%)20 (11.83%)12 (5.94%)13 (10.08%)T418 (3.6%)7 (4.14%)5 (2.48%)6 (4.65%)Unknown3 (0.6%)1 (0.59%)0 (0%)2 (1.55%)M staging (%)0.0765M0332 (66.4%)119 (70.41%)135 (66.83%)78 (60.47%)M124 (4.8%)12 (7.1%)7 (3.47%)5 (3.88%)Unknown144 (28.8%)38 (22.49%)60 (29.7%)46 (35.66%)N staging (%)0.0012N0324 (64.8%)96 (56.8%)129 (63.86%)99 (76.74%)N194 (18.8%)38 (22.49%)41 (20.3%)15 (11.63%)N269 (13.8%)33 (19.53%)27 (13.37%)9 (6.98%)N32 (0.4%)0 (0%)2 (0.99%)0 (0%)Unknown11 (2.2%)2 (1.18%)3 (1.49%)6 (4.65%)Figure 3
Correlation of gene sets and clinical characteristics. (a) The association between ES and clinical characteristics. (b) We computed and intersected differential gene sets between subgroups.
(a)(b)Figure 4
Heat map of represented immunologic and hallmark gene sets in three subtypes.


## 3.3. Exploring of Prognostic Gene Sets

Using the LASSO-Cox analysis, we sought to discover the prognostic gene sets for LUAD and ultimately identified 17 gene sets (Figures5(a) and 5(b)). Among these gene sets, two were in nontumor tissues (N gene sets: N_GSE7218_UNSTIM_VS_ANTIGEN_STIM_THROUGH_IGG_BCELL_DN, N_GSE7509_UNSTIM_VS_IFNA_STIM_IMMATURE_DC_DN), and 15 were in tumor tissues (T gene sets: T_GSE21546_ELK1_KO_VS_SAP1A_KO_AND_ELK1_KO_DP_THYMOCYTES_DN, T_GSE22886_UNSTIM_VS_IL15_STIM_NKCELL_DN, T_GSE21063_CTRL_VS_ANTI_IGM_STIM_BCELL_NFATC1_KO_8H_DN, T_GSE22886_UNSTIM_VS_IL2_STIM_NKCELL_DN, T_GSE21546_WT_VS_ELK1_KO_ANTI_CD3_STIM_DP_THYMOCYTES_DN, T_GSE17974_CTRL_VS_ACT_IL4_AND_ANTI_IL12_24H_CD4_TCELL_DN, T_GSE2770_UNTREATED_VS_IL4_TREATED_ACT_CD4_TCELL_48H_DN, T_GSE19888_ADENOSINE_A3R_ACT_VS_A3R_ACT_WITH_A3R_INH_PREREATMENT_IN_MAST_CELL_UP, T_GSE15930_NAIVE_VS_24H_IN_VITRO_STIM_INFAB_CD8_TCELL_DN, T_GSE25088_WT_VS_STAT6_KO_MACROPHAGE_IL4_STIM_DN, T_HALLMARK_MYC_TARGETS_V2, T_GSE16450_IMMATURE_VS_MATURE_NEURON_CELL_LINE_DN, T_GSE25088_WT_VS_STAT6_KO_MACROPHAGE_DN, T_GSE45365_HEALTHY_VS_MCMV_INFECTION_CD11B_DC_DN, T_GSE24634_TEFF_VS_TCONV_DAY7_IN_CULTURE_UP). Finally, we revealed different survival risk based on integration ES of the above gene sets for each LUAD patient. The results showed that in different data sets (TCGA and GEO cohort), high-risk patients had a lower survival possibility (Figures 5(c) and 5(d)).Figure 5
Prognostic gene sets in LUAD. (a, b) Least absolute shrinkage and selection operator (LASSO) coefficient profiles via 10-fold crossvalidation. (c) Kaplan-Meier survival analysis in TCGA cohort. (d) Kaplan-Meier survival analysis in GEO cohort.
(a)(b)(c)(d)


## 3.4. Function and Pathway Enrichment Analyses

To elucidate the mechanism by which the 17 prognostic gene sets contribute to prognosis, we extracted the genes present in each gene set and conducted GO and KEGG enrichment analyses on tumor and nontumor tissues. Interestingly, for tumor samples, genes from the T gene sets were mainly associated with DNA, such as DNA replication, cell cycle DNA replication, nuclear DNA replication, DNA replication origin binding, single-stranded DNA binding, and DNA helicase activity in GO analysis (Figure6(a)). Meanwhile, KEGG analysis based on T gene sets also revealed that cell cycle, base excision repair, and mismatch repair may affect prognosis (Figure 6(b)). For nontumor samples, genes in the N gene sets were associated with T cell activation, leukocyte cell-cell adhesion, regulation of T cell activation, T cell receptor signaling pathway, natural killer cell mediated cytotoxicity, PD-L1 expression, PD-1 checkpoint pathway in cancer, etc. (Figures 6(c) and 6(d)). This may reminded us that there may be a better immune response within the adjacent nontumor tissues. Subsequently, we discovered hub genes in the N and T gene sets and conducted protein-protein interaction networks in the STRING database. Subsequently, we classified each network using the MCODE plug-in into three clusters. Meanwhile, TOP3 genes were screened based on their topological degree in various clusters. For N gene sets, the top three hub genes from cluster 1 were PDCD1, PRF1, and IL2RA (Figure 7(a)), cluster 2 was CD8A, TNF, and IL1B (Figure 7(b)), and cluster 3 was TAPBP, PSMB10 and PSMB9 (Figure 7(c)). For T gene sets, the top three hub genes from cluster 1 were CCNB1, CDC20, and AURKB, cluster 2 was DDX18, DKC1, and GRWD1, and cluster 3 was MRRF, MRPS9, and MRPS7 (Figure.S2).Figure 6
Analysis of GO and KEGG enrichment. (a) KEGG enrichment analysis in T gene sets. (b) GO enrichment analysis in T gene sets. (c) KEGG enrichment analysis in N gene sets. (d) GO enrichment analysis in N gene sets.
(a)(b)(c)(d)Figure 7
The protein-protein interaction network in N gene sets. (a) Cluster 1. (b) Cluster 2. (c) Cluster 3.
(a)(b)(c)


## 4. Discussion

We gained a comprehensive understanding of the changes in activity of 4092 gene sets in LUAD and adjacent nontumor tissues in our research, which reminded us to focus on the crosstalk between tumor and adjacent nontumor samples in LUAD rather than only on the changes in the tumor tissues itself. In this study, we identified three novel subtypes using the NMF algorithm. For detailed, patients with subtype-3 had a favorable prognosis, but subtypes 1 and 2 had a bad prognosis. In addition, patients with subtype-3 in the GSE72091 cohort also lived longer. Meanwhile, using the LASSO-Cox algorithm, we discovered 15 prognostic gene sets in tumors and two prognostic gene sets in adjacent nontumors. Subsequently, GO and KEGG enrichment analyses revealed that in nontumor tissues, genes were related with immune response, but genes in tumor tissues were correlated with DNA damaging and repairing.Most studies on LUAD subtypes classification only focused on tumors itself and greatly underestimated the role of nontumors. For example, based on the differently expression genes in GSE18842, GSE75037, GSE101929, and GSE19188, a risk signature was identified [20]; Ma et al. developed two subgroups based on the tumor microenvironment in LUAD tissues [21]; Wang et al. discovered two distinct LUAD subtypes that they could guide implications for immune checkpoint blockade therapy [22]; Zhang et al. identified a nomogram for predicting recurrence in LUAD [23]. In contrast, we developed three subtypes based on activity changes of 4922 gene sets for guiding prognosis, and patients with subtype-3 had a favorable survival time.There are still some limitations in this study. Firstly, our primary analysis was performed in TCGA-LUAD cohort, but included small adjacent nontumor samples (59 cases) and could not be fully matched with LUAD samples. The optimal selection for bioinformatic processing in this study would have been to fully pair each sample—the same patient source. Additionally, prognostic gene sets have not been validated in samples from our institution. In conclusion, although there are still some unavoidable limitations, our study reveals a theoretical foundation for selecting therapy strategy for LUAD patients that should be guided by changes in activity in tumor and adjacent nontumor tissues, particularly after pulmonary lobectomy.



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*Source: 2602812-2022-01-19.xml*