Exploring Fecal Microbiota Signatures Associated with Immune Response and Antibiotic Impact in NSCLC: Insights from Metagenomic and Machine Learning Approaches

Wenjie Han^1,2Yuhang Zhou^1,2Wang Yiwen^1,2Xiaolin Liu³Tao Sun^1,4Junnan Xu^1,2,4*

• ¹Department of Breast Medicine 1, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, Liaoning Province, China
• ²Department of Pharmacology, Liaoning Cancer Hospital, China Medical University, Shenyang, Liaoning Province, China
• ³Department of Bioinformatics, Kanghui Biotechnology Co., Ltd.,, Shenyang, Liaoning Province, China
• ⁴Department of Breast Medicine, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital, Shenyang, Liaoning Province, China

Background: Substantial interstudy heterogeneity in cancer immunotherapy-associated biomarkers has hindered their clinical applicability. To address this challenge, we performed a comprehensive integration of publicly available global metagenomic datasets. By leveraging metagenomic profiling and machine learning approaches, this study aimed to elucidate gut microbial signatures associated with immune response in lung cancer (LC) and to evaluate the modulatory effects of antibiotic exposure.Methods: A systematic literature search was conducted to identify relevant datasets, resulting in the inclusion of 209 fecal metagenomic samples: 154 baseline samples (45 responders, 37 non-responders, and 72 healthy controls) and 55 longitudinal samples collected during immunotherapy. We performed taxonomic and functional characterization of gut microbiota (GM) differentiating responders from non-responders, delineated microbiome dynamics during treatment, and assessed the impact of antibiotics on key microbial taxa. Among eight machine learning algorithms evaluated, the optimal model was selected to construct a predictive framework for immunotherapy response.Results: Microbial α-diversity was significantly elevated in responders compared to non-responders, with antibiotic administration further amplifying this difference—most notably at the species level. Integrative multi-omics analysis identified two pivotal microbial biomarkers, s_Bacteroides caccae and s_Prevotella copri, which were strongly associated with immunotherapy efficacy. A random forest-based classifier achieved robust predictive performance, with area under the curve (AUC) values of 0.82 and 0.79 at species and genus levels, respectively. Notably, P.copri was further enriched in responders with poor progression-free survival (PFS < 3 months), indicating a potential deleterious role. Antibiotic exposure significantly influenced the abundance and functional potential of these key taxa. KEGG-based functional analysis revealed enrichment of amino acid metabolism pathways in responders. Additionally, CARD database annotation demonstrated that the majority of antibiotic resistance genes were associated with Bacteroidetes and Proteobacteria, implicating these taxa in shaping microbial-mediated therapeutic responses.Conclusions: This study represents the first large-scale, cross-cohort integration of metagenomic data to identify reproducible GM signatures predictive of immune checkpoint inhibitor efficacy in LC. The findings not only underscore the prognostic relevance of specific taxa, but also establish a foundation for developing microbiome-informed, personalized immunotherapeutic strategies.