The ceRNA mechanism, involving genes like TENM4, XRCC2, HDAC5, CDKN1A, ARFGEF3, SNAP25-AS1, RP11-58O9.2, LINC01164, VLDLR-AS1, and RP11-14I17.2, may play a role in lung adenocarcinoma (LUAD) development linked to tumor hypoxia. Here, TENM4 is linked to lung adenocarcinoma.