Integrated Multi-Omics Analysis for Molecular Subtyping in NSCLC: A Cohort Study

Lung cancer remains the leading cause of cancer-related morbidity and mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of cases. Current histopathological classification and driver gene testing provide limited prognostic and therapeutic guidance due to intra-tumoral heterogeneity and incomplete characterization of the tumor microenvironment (TME). Here, we constructed single- and multi-omics molecular classification systems for NSCLC by integrating transcriptomic, genomic, epigenomic, proteomic, and TME data from TCGA LUAD and LUSC cohorts. Single-omics analyses revealed distinct molecular patterns, including DNA methylation subtypes associated with sex and histology. Multi-omics integration identified five consensus subtypes closely corresponding to histology, with three immune-activated (CS2-CS4) and two immunosuppressive (CS1, CS5) subtypes. While overall survival did not differ significantly, progression-free survival analysis highlighted CS4 as a high-risk subtype with KRAS-driven genomic alterations. These findings provide a framework for NSCLC molecular stratification and highlight molecular and immune features that could guide future research on targeted therapies and immunotherapy.