Multi-cancer analysis of clonality and the timing of systemic spread in paired primary tumors and metastases

Nat Genet. 2020 Jul;52(7):701-708. doi: 10.1038/s41588-020-0628-z. Epub 2020 May 18.

Abstract

Metastasis is the primary cause of cancer-related deaths, but the natural history, clonal evolution and impact of treatment are poorly understood. We analyzed whole-exome sequencing (WES) data from 457 paired primary tumor and metastatic samples from 136 patients with breast, colorectal and lung cancer, including untreated (n = 99) and treated (n = 100) metastases. Treated metastases often harbored private 'driver' mutations, whereas untreated metastases did not, suggesting that treatment promotes clonal evolution. Polyclonal seeding was common in untreated lymph node metastases (n = 17 out of 29, 59%) and distant metastases (n = 20 out of 70, 29%), but less frequent in treated distant metastases (n = 9 out of 94, 10%). The low number of metastasis-private clonal mutations is consistent with early metastatic seeding, which we estimated occurred 2-4 years before diagnosis across these cancers. Furthermore, these data suggest that the natural course of metastasis is selectively relaxed relative to early tumorigenesis and that metastasis-private mutations are not drivers of cancer spread but instead associated with drug resistance.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / genetics
  • Breast Neoplasms / pathology
  • Carcinogenesis
  • Chronology as Topic
  • Clonal Evolution*
  • Colorectal Neoplasms / genetics
  • Colorectal Neoplasms / pathology
  • Exome Sequencing
  • Humans
  • Lung Neoplasms / genetics
  • Lung Neoplasms / pathology
  • Middle Aged
  • Mutation
  • Neoplasm Metastasis*
  • Neoplasm Seeding
  • Neoplasms / genetics
  • Neoplasms / pathology*