An in-depth exploration of four heterogeneity structure-based EGFR mutation subgroups in Chinese non-small cell lung cancer

Abstract Background EGFR mutations have been classified into four functional subgroups (Classical-like, P-loop and αC-helical compressing (PACC), T790M-like, and exon 20 loop insertions) based on their influence on EGFR protein structure, as well as response to various types of EGFR-tyrosine kinase...

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Main Authors: Yongfeng Yu, Fei Yao, Jin Wang, Zhan Huang, Tao Hu, Changbin Zhu, Shun Lu
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Pulmonary Medicine
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Online Access:https://doi.org/10.1186/s12890-025-03774-y
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author Yongfeng Yu
Fei Yao
Jin Wang
Zhan Huang
Tao Hu
Changbin Zhu
Shun Lu
author_facet Yongfeng Yu
Fei Yao
Jin Wang
Zhan Huang
Tao Hu
Changbin Zhu
Shun Lu
author_sort Yongfeng Yu
collection DOAJ
description Abstract Background EGFR mutations have been classified into four functional subgroups (Classical-like, P-loop and αC-helical compressing (PACC), T790M-like, and exon 20 loop insertions) based on their influence on EGFR protein structure, as well as response to various types of EGFR-tyrosine kinase inhibitors (TKIs). However, the differences in molecular phenotypes and clinical outcomes for patients carrying these different forms of EGFR mutations are not fully understood. Here we sought to investigate the distribution of different EGFR structural types in Chinese NSCLC patients and the biological characteristics of each subgroup. Methods 2992 EGFR mutant NSCLC patients with available next-generation sequencing result were collected for mutation analysis. 118 patients with targeted RNA sequencing data were further analyzed to compare transcriptome differences across mutation subgroups. Results Across the entire cohort, 80.82% of patients were Classical-like, 5.92% were PACC, 10.76% were T790M-like, and 2.51% were Ex20ins. TP53 was the most common co-occurring mutation across the four subgroups, occurring in 60% of the T790M-like subgroup. Interestingly, the Ex20ins group exhibited a notable proportion of genomic alterations related to DNA repair processes. Additionally, both the Ex20ins and T790M subgroups demonstrated higher tumor mutational burden (TMB) scores. Furthermore, for the first time, we observed transcriptomic heterogeneity within these four subgroups. Classical-like group displayed enrichment of immune-related pathways, including PD1 signaling, CD28 family, and TCR signaling. Notably, the L858R group showed significant enrichment in immune activation signatures, including effector memory CD8 T cells, natural killer cells, and MHC I/II. This suggests a potentially robust immune response in that group. In contrast, the T790M-like subgroups showed lower anti-tumor immune signatures but were marked by a significant enrichment in tumor proliferation signatures. Conclusion In this study, we have employed a structure-based classification approach for EGFR mutants to comprehensively characterize the mutational landscape and heterogeneous biological traits at the transcriptional and functional levels in Chinese patients with NSCLC.
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spelling doaj-art-5bd4fa38f7434feea9f2d52d7d8ea72b2025-08-20T04:01:24ZengBMCBMC Pulmonary Medicine1471-24662025-07-012511910.1186/s12890-025-03774-yAn in-depth exploration of four heterogeneity structure-based EGFR mutation subgroups in Chinese non-small cell lung cancerYongfeng Yu0Fei Yao1Jin Wang2Zhan Huang3Tao Hu4Changbin Zhu5Shun Lu6Department of Medical Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Medicine, Xiawei Medical Laboratory Co., LtdDepartment of Medicine, Xiawei Medical Laboratory Co., LtdDepartment of Medicine, Xiawei Medical Laboratory Co., LtdDepartment of Medicine, Xiawei Medical Laboratory Co., LtdDepartment of Medicine, Xiawei Medical Laboratory Co., LtdDepartment of Medical Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineAbstract Background EGFR mutations have been classified into four functional subgroups (Classical-like, P-loop and αC-helical compressing (PACC), T790M-like, and exon 20 loop insertions) based on their influence on EGFR protein structure, as well as response to various types of EGFR-tyrosine kinase inhibitors (TKIs). However, the differences in molecular phenotypes and clinical outcomes for patients carrying these different forms of EGFR mutations are not fully understood. Here we sought to investigate the distribution of different EGFR structural types in Chinese NSCLC patients and the biological characteristics of each subgroup. Methods 2992 EGFR mutant NSCLC patients with available next-generation sequencing result were collected for mutation analysis. 118 patients with targeted RNA sequencing data were further analyzed to compare transcriptome differences across mutation subgroups. Results Across the entire cohort, 80.82% of patients were Classical-like, 5.92% were PACC, 10.76% were T790M-like, and 2.51% were Ex20ins. TP53 was the most common co-occurring mutation across the four subgroups, occurring in 60% of the T790M-like subgroup. Interestingly, the Ex20ins group exhibited a notable proportion of genomic alterations related to DNA repair processes. Additionally, both the Ex20ins and T790M subgroups demonstrated higher tumor mutational burden (TMB) scores. Furthermore, for the first time, we observed transcriptomic heterogeneity within these four subgroups. Classical-like group displayed enrichment of immune-related pathways, including PD1 signaling, CD28 family, and TCR signaling. Notably, the L858R group showed significant enrichment in immune activation signatures, including effector memory CD8 T cells, natural killer cells, and MHC I/II. This suggests a potentially robust immune response in that group. In contrast, the T790M-like subgroups showed lower anti-tumor immune signatures but were marked by a significant enrichment in tumor proliferation signatures. Conclusion In this study, we have employed a structure-based classification approach for EGFR mutants to comprehensively characterize the mutational landscape and heterogeneous biological traits at the transcriptional and functional levels in Chinese patients with NSCLC.https://doi.org/10.1186/s12890-025-03774-yComprehensive profilingEGFRStructureSubtyping
spellingShingle Yongfeng Yu
Fei Yao
Jin Wang
Zhan Huang
Tao Hu
Changbin Zhu
Shun Lu
An in-depth exploration of four heterogeneity structure-based EGFR mutation subgroups in Chinese non-small cell lung cancer
BMC Pulmonary Medicine
Comprehensive profiling
EGFR
Structure
Subtyping
title An in-depth exploration of four heterogeneity structure-based EGFR mutation subgroups in Chinese non-small cell lung cancer
title_full An in-depth exploration of four heterogeneity structure-based EGFR mutation subgroups in Chinese non-small cell lung cancer
title_fullStr An in-depth exploration of four heterogeneity structure-based EGFR mutation subgroups in Chinese non-small cell lung cancer
title_full_unstemmed An in-depth exploration of four heterogeneity structure-based EGFR mutation subgroups in Chinese non-small cell lung cancer
title_short An in-depth exploration of four heterogeneity structure-based EGFR mutation subgroups in Chinese non-small cell lung cancer
title_sort in depth exploration of four heterogeneity structure based egfr mutation subgroups in chinese non small cell lung cancer
topic Comprehensive profiling
EGFR
Structure
Subtyping
url https://doi.org/10.1186/s12890-025-03774-y
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