Crit Rev Oncol Hematol. 2026 Sep;225:105483. doi: 10.1016/j.critrevonc.2026.105483. Epub 2026 Jul 10.

ABSTRACT

Low-dose CT (LDCT) lung cancer screening significantly reduces mortality but has dramatically increased the detection of pulmonary nodules. Most of these nodules are benign, leading to a high false-positive rate that triggers unnecessary invasive procedures and patient anxiety, underscoring the need for more precise noninvasive diagnostic tools. Critically, single-modality liquid biopsy biomarkers, including circulating tumor cells, cell-free DNA mutations, or individual microRNAs, have demonstrated insufficient sensitivity or specificity for independent clinical deployment when used in isolation. This necessitates a paradigm shift toward multimodal molecular integration, wherein complementary biomarker classes are combined to overcome the inherent limitations of any single analyte. Traditional clinical prediction models (Mayo, VA, Brock, Herder) assist in estimating malignancy risk, yet their accuracy remains modest. Emerging approaches harness radiomics and artificial intelligence (AI) to extract high-dimensional imaging features from chest CT scans, improving risk stratification beyond human assessment alone. In parallel, minimally invasive liquid biopsy biomarkers offer complementary avenues to detect occult malignancy signals. Additionally, bronchial airway gene expression classifiers leverage the "field-of-injury" effect in normal respiratory epithelium to help identify lung cancer even when the nodule itself cannot be directly sampled via biopsy. Integrating these radiologic and molecular data streams into a multi-omics framework has the potential to enhance diagnostic precision for indeterminate pulmonary nodules, enabling more confident discrimination between benign and malignant lesions. However, most of these emerging tools have not yet been validated in large prospective trials and face technological barriers as well as challenges in real-world implementation. This review focuses primarily on LDCT screening detected pulmonary nodules, while incorporating evidence from incidentally detected and other indeterminate nodule cohorts when relevant to broader CT based management. By synthesizing advances in radiomics, AI, liquid biopsy, airway classifiers, and multi-omics integration, we highlight the need for prospective validation and multidisciplinary collaboration to translate these approaches into clinically useful pathways that improve early lung cancer detection, reduce unnecessary interventions, and enhance patient outcomes.

PMID:42431477 | DOI:10.1016/j.critrevonc.2026.105483

Stem Cells Int. 2026 May 21;2026:3060138. doi: 10.1155/sci/3060138. eCollection 2026.

ABSTRACT

BACKGROUND: Lung adenocarcinoma (LUAD), a predominant subtype of non-small cell lung cancer (NSCLC), is associated with a high mortality rate. Currently, there are no reliable or sensitive biomarkers or prognostic methodologies available for its early detection or diagnosis. Gamma-aminobutyric acid (GABA), a pivotal inhibitory neurotransmitter within the central nervous system (CNS), primarily exerts its effects through interactions with GABA receptors (GABARs). Recent studies have increasingly highlighted GABA's significant role in mediating the initiation and progression of various tumors beyond the CNS. Nonetheless, research investigating the role of GABA in LUAD is limited, and the specific molecular and cellular mechanisms underlying its interactions remain to be fully elucidated.

METHODS: We developed an innovative machine learning framework designed to screen GABA-related genes (GABARgenes) at both single-cell and large transcriptomic levels. This framework encompasses 10 algorithms and 101 combinatorial pairing patterns, which facilitate the construction of consistent GABA-related features (GABARFs). The framework's performance was assessed using both a training set and an external validation set. To provide a quantitative prognostic tool for clinical application, we established a nomogram that incorporates GABARF. Additionally, we conducted multiomics analyses, including genomics, single-cell transcriptomics, and comprehensive transcriptomics, to derive and consolidate more extensive prognostic features. We also evaluated the response of GABARF-defined risk subgroups to immunotherapy and identified potential personalized therapeutic agents for specific risk categories.

RESULTS: Among the 124 GABARgenes analyzed, 38 demonstrated a significant correlation with overall survival (OS) in patients. Our machine learning-derived GABARF exhibited exceptional performance in predicting prognosis and clinical outcomes, showing promise in forecasting the onset and progression of LUAD. Multivariate analysis confirmed that GABARF serves as an independent prognostic factor for OS in LUAD. Furthermore, distinct GABARF risk subgroups exhibited significant differences in biological function, mutation status, and tumor immune infiltration. Notably, there were significant variations in the immunophenoscore (IPS) across the risk subgroups. GABARF risk stratification aligns with stemness properties of tumor cells, indicating that high-risk patients may harbor tumors with enhanced stemness features that contribute to their poor prognosis and reduced immunotherapy response. Sensitivity analyses of conventional LUAD therapies indicated that patients in the low-risk group may derive greater benefit from immune checkpoint inhibitors (ICIs), while those in the high-risk group may exhibit heightened sensitivity to first-line chemotherapy agents. Furthermore, LDHA overexpression was found to promote proliferation and migration, while inhibiting apoptosis. In addition, overexpression of LDHA can upregulate the expression of stemness markers CD133, SOX2, and OCT4 in LUAD cells, enhancing the malignant phenotype of tumor cells.

CONCLUSION: This study presents a novel machine learning-based model for GABARF, which shows promise as a potential tool to aid in prognostic prediction, targeted prevention, and individualized treatment planning in LUAD. Initial investigations into the interaction mechanisms of GABARF at the molecular, cellular, and tumor immune microenvironment (TIME) levels in LUAD have commenced. The GABARF model not only serves as a prognostic indicator but may also reflect the stemness status of LUAD tumors, offering insights into personalized treatment strategies that account for both neural-immune-stemness interactions.

PMID:42181964 | PMC:PMC13191820 | DOI:10.1155/sci/3060138

Stem Cells Int. 2026 May 21;2026:3060138. doi: 10.1155/sci/3060138. eCollection 2026.

ABSTRACT

BACKGROUND: Lung adenocarcinoma (LUAD), a predominant subtype of non-small cell lung cancer (NSCLC), is associated with a high mortality rate. Currently, there are no reliable or sensitive biomarkers or prognostic methodologies available for its early detection or diagnosis. Gamma-aminobutyric acid (GABA), a pivotal inhibitory neurotransmitter within the central nervous system (CNS), primarily exerts its effects through interactions with GABA receptors (GABARs). Recent studies have increasingly highlighted GABA's significant role in mediating the initiation and progression of various tumors beyond the CNS. Nonetheless, research investigating the role of GABA in LUAD is limited, and the specific molecular and cellular mechanisms underlying its interactions remain to be fully elucidated.

METHODS: We developed an innovative machine learning framework designed to screen GABA-related genes (GABARgenes) at both single-cell and large transcriptomic levels. This framework encompasses 10 algorithms and 101 combinatorial pairing patterns, which facilitate the construction of consistent GABA-related features (GABARFs). The framework's performance was assessed using both a training set and an external validation set. To provide a quantitative prognostic tool for clinical application, we established a nomogram that incorporates GABARF. Additionally, we conducted multiomics analyses, including genomics, single-cell transcriptomics, and comprehensive transcriptomics, to derive and consolidate more extensive prognostic features. We also evaluated the response of GABARF-defined risk subgroups to immunotherapy and identified potential personalized therapeutic agents for specific risk categories.

RESULTS: Among the 124 GABARgenes analyzed, 38 demonstrated a significant correlation with overall survival (OS) in patients. Our machine learning-derived GABARF exhibited exceptional performance in predicting prognosis and clinical outcomes, showing promise in forecasting the onset and progression of LUAD. Multivariate analysis confirmed that GABARF serves as an independent prognostic factor for OS in LUAD. Furthermore, distinct GABARF risk subgroups exhibited significant differences in biological function, mutation status, and tumor immune infiltration. Notably, there were significant variations in the immunophenoscore (IPS) across the risk subgroups. GABARF risk stratification aligns with stemness properties of tumor cells, indicating that high-risk patients may harbor tumors with enhanced stemness features that contribute to their poor prognosis and reduced immunotherapy response. Sensitivity analyses of conventional LUAD therapies indicated that patients in the low-risk group may derive greater benefit from immune checkpoint inhibitors (ICIs), while those in the high-risk group may exhibit heightened sensitivity to first-line chemotherapy agents. Furthermore, LDHA overexpression was found to promote proliferation and migration, while inhibiting apoptosis. In addition, overexpression of LDHA can upregulate the expression of stemness markers CD133, SOX2, and OCT4 in LUAD cells, enhancing the malignant phenotype of tumor cells.

CONCLUSION: This study presents a novel machine learning-based model for GABARF, which shows promise as a potential tool to aid in prognostic prediction, targeted prevention, and individualized treatment planning in LUAD. Initial investigations into the interaction mechanisms of GABARF at the molecular, cellular, and tumor immune microenvironment (TIME) levels in LUAD have commenced. The GABARF model not only serves as a prognostic indicator but may also reflect the stemness status of LUAD tumors, offering insights into personalized treatment strategies that account for both neural-immune-stemness interactions.

PMID:42181964 | PMC:PMC13191820 | DOI:10.1155/sci/3060138