Colorectal cancer molecular subtypes and prognostic models based on NET-related genes and oxidative stress-associated signaling

Colorectal cancer (CRC) exhibits marked molecular and microenvironmental heterogeneity, and the TNM staging system alone does not fully explain differences in prognosis or treatment response. Neutrophil extracellular traps (NETs) and oxidative stress participate in inflammatory remodeling, immune regulation, and tumor progression in CRC. However, transcriptomic studies integrating NET-related programs with oxidative stress-associated signaling for molecular stratification and prognostic modeling remain limited. Transcriptome and clinical data from TCGA-COADREAD (training set, 449 tumor and 39 normal samples) and GSE39582 (validation set, 566 tumor and 19 non-tumor samples) were analyzed. Candidate NET-related and oxidative stress-associated genes were collected from GeneCards, Gene Ontology, and published NETosis signatures, and were further restricted by differential expression analysis (|log2FC| > 0.585, adjusted P < .05) and univariate Cox analysis (P < .05). Consensus clustering, survival analysis, immune infiltration analysis, mutation analysis, and oncoPredict-based drug sensitivity modeling were performed. A multigene prognostic model was constructed using LASSO-Cox regression and evaluated in both cohorts. Two molecular subtypes were identified. C1 showed a better prognosis, higher tumor mutational burden, higher immune checkpoint and immunogenicity scores, and an immune-active phenotype. C2 showed poorer survival, enrichment of NET formation and inflammatory pathways, lower relative neutrophil infiltration by CIBERSORT, and predicted sensitivity to JAK, Wnt/β-catenin, proteasome, and cell-cycle checkpoint inhibitors. The prognostic model separated high- and low-risk patients in both the training and validation cohorts, with 1-, 3-, and 5-year area under the curves of 0.698, 0.711, and 0.645 in TCGA-COADREAD and 0.542, 0.578, and 0.569 in GSE39582. This study proposes NET-related CRC molecular subtypes with oxidative stress-associated biological context and develops a transcriptomic risk model with external validation. The findings suggest subtype-specific immune and therapeutic features, while prospective clinical and functional validation is required before clinical translation.