The evolution of non-small cell lung cancer metastases in TRACERx
The evolution of non-small cell lung cancer metastases in TRACERx
Metastatic disease is responsible for the majority of cancer-related deaths1. We report the longitudinal evolutionary analysis of 126 non-small cell lung cancer (NSCLC) tumours from 421 prospectively recruited patients in TRACERx who developed metastatic disease, compared with a control cohort of 144 non-metastatic tumours. In 25% of cases, metastases diverged early, before the last clonal sweep in the primary tumour, and early divergence was enriched for patients who were smokers at the time of initial diagnosis. Simulations suggested that early metastatic divergence more frequently occurred at smaller tumour diameters (less than 8 mm). Single-region primary tumour sampling resulted in 83% of late divergence cases being misclassified as early, highlighting the importance of extensive primary tumour sampling. Polyclonal dissemination, which was associated with extrathoracic disease recurrence, was found in 32% of cases. Primary lymph node disease contributed to metastatic relapse in less than 20% of cases, representing a hallmark of metastatic potential rather than a route to subsequent recurrences/disease progression. Metastasis-seeding subclones exhibited subclonal expansions within primary tumours, probably reflecting positive selection. Our findings highlight the importance of selection in metastatic clone evolution within untreated primary tumours, the distinction between monoclonal versus polyclonal seeding in dictating site of recurrence, the limitations of current radiological screening approaches for early diverging tumours and the need to develop strategies to target metastasis-seeding subclones before relapse.
carcinoma, non-small-cell lung/pathology, clonal evolution, clone cells/pathology, cohort studies, disease progression, evolution, molecular, humans, lung neoplasms/pathology, neoplasm metastasis/diagnosis, neoplasm recurrence, local
534-542
Al Bakir, Maise
76cd014e-a8ae-4443-94c1-dc98f77a18c8
Huebner, Ariana
c2caa06f-4793-4193-a40f-b8a58acea114
Martínez-Ruiz, Carlos
db81e497-74ac-4eaf-ab1e-91f7dcbe3af8
Grigoriadis, Kristiana
8c34d367-6863-473e-a590-116f293be2c0
Watkins, Thomas B.K.
3592c581-be84-4092-9502-36a6cb122e19
Pich, Oriol
4d618449-9c24-41bd-aa40-ba551082d809
Moore, David A.
86236945-d938-4374-8937-96005c3a54f4
Veeriah, Selvaraju
0175b5f1-51bd-4a02-9798-58a8bc06b6e5
Ward, Sophia
e406534e-4ffb-4523-b8bf-45f14d85b12d
Laycock, Joanne
c44714ae-7749-481a-8bc3-b023ac680c58
Johnson, Diana
5144874c-5607-4f68-814a-eabe50a75bd4
Rowan, Andrew
59b38826-fabf-46cc-b360-57a2194ad824
Razaq, Maryam
0929a166-0281-42c1-8fd0-e083ff479c86
Akther, Mita
780a4b1e-2dc7-4660-893f-4003a3f09e81
Naceur-Lombardelli, Cristina
5f85216e-da4f-4644-bfbf-671fbb7236d6
Prymas, Paulina
005f6b72-1ea1-462f-aae6-88ea931a3177
Toncheva, Antonia
d330463d-7e0f-43c1-aa84-70feb5b79d47
Hessey, Sonya
7c9cc3dd-9b8e-487e-bd5e-2fe7f027abc0
Dietzen, Michelle
69a3eb07-60a3-46ae-a20f-93b50b986038
Colliver, Emma
4b8b6e4f-12e2-4418-932b-8ef7aab8c3eb
Frankell, Alexander M.
198fb30c-2780-48c1-b347-d94c2a0e9cf0
Bunkum, Abigail
784f0926-cba8-42ee-a9df-d71fbefb6203
Lim, Emilia L.
8b55c1c6-c262-4bdb-9a6b-0cefd19bd4fd
Karasaki, Takahiro
686fa77a-207f-4afb-bf0b-4dd9ce0ec4ad
Abbosh, Christopher
fa7d12fb-1e6e-4924-ad08-4be6b422278e
Hiley, Crispin T.
c5347550-443f-437e-a7fc-f25476cfac79
Hill, Mark S.
4d17d8a7-ee92-4ae9-980f-d16978efe2d5
Cook, Daniel E.
389581e1-19ed-4c26-9efe-c144ae382b9a
Wilson, Gareth A.
6af36a85-7d05-4989-9ab3-d8adac4d5eb8
Salgado, Roberto
5b1f8832-35cf-4f08-9dd3-a646be7fffc2
Nye, Emma
81d13b33-7d53-45e1-b667-7d1d1539411b
Stone, Richard Kevin
b9f6b801-653b-457f-bd7f-afe42061e002
Fennell, Dean A.
e85713c5-cf7d-4d9c-b0de-f4302baa08ab
Price, Gillian
95361664-f787-4962-b54b-d0842b3fc139
Kerr, Keith M.
c451a140-7a92-449e-97aa-01562a0ca54f
Naidu, Babu
7a60c369-1785-43e9-a6a9-fabea5b3fa3d
Middleton, Gary
31c645ca-3e55-491c-866e-370b6bbd91e5
Summers, Yvonne
408b42eb-9eac-47f4-b445-a5b8ac5331f4
Lindsay, Colin R.
c1761d1e-acf7-4b44-9ad1-88ae096d9c7a
Blackhall, Fiona H.
f6ace7d7-8bf4-4726-849a-5a71ee7d0985
Cave, Judith
60c67e39-121a-49ca-8594-93e8e456464f
Blyth, Kevin G.
a7f8a26d-ca77-4a31-b572-cf7e9384aa6e
Nair, Arjun
a9b6cef1-ccdb-48b2-8c93-659854d90bd5
Ahmed, Asia
da8d8513-8866-43b6-8fc0-6b4150889d5f
Taylor, Magali N.
991b4cca-fbbd-43aa-8d00-89318d194b26
Procter, Alexander James
0237663e-aada-4c59-ac15-721d43fef188
Falzon, Mary
2e408e33-0db5-4025-a229-fe862c0e3d96
Lawrence, David
aed91589-99ec-4fcc-82cb-9cea925d42c6
Navani, Neal
905198d0-88ec-472d-8505-83d30c68ca14
Thakrar, Ricky M.
774af2fa-efc2-40c9-b0d3-4d370251d82f
Janes, Sam M.
03f0a66b-f6cf-4407-999e-f2962ee41325
Papadatos-Pastos, Dionysis
f98a3a6f-78a7-491d-a1fa-ac0992573d12
Forster, Martin D.
2eab05a0-ff9e-4c79-bee9-dc18d6764891
Lee, Siow-Ming
b4c749c7-0431-46b3-82b1-501febc802c8
Ahmad, Tanya
e73ccebb-195d-4fdb-a31e-4ae8cd0f8273
Quezada, Sergio A.
0f0f9dab-6569-472e-8bb3-39b63c989008
Peggs, Karl S.
a5c55130-46df-4945-9e55-ee15b2fd2f20
Van Loo, Peter
8628fd72-0000-4110-a0d4-4f78eecfb800
Dive, Caroline
4121ad7d-d9fe-4430-8b36-4d85ada49eab
Hackhaw, Allan
d5461180-6991-4946-869b-054b760f3f4a
Birkbak, Nicolai J.
153da85d-8c1b-4036-b3b7-3190a4605d17
Zaccaria, Simone
4bfbf7b1-f2e8-4de0-bc9a-1e32b26461f5
Jamal-Hanjani, Mariam
33681d2a-c01a-4837-b39d-ed6266abdbf9
McGranahan, Nicholas
d4afb8a2-53ed-4f5e-8d77-be1fac6ff6a0
Swanton, Charles
ec4243a5-762e-4c4f-b05b-33759a19dce4
20 April 2023
Al Bakir, Maise
76cd014e-a8ae-4443-94c1-dc98f77a18c8
Huebner, Ariana
c2caa06f-4793-4193-a40f-b8a58acea114
Martínez-Ruiz, Carlos
db81e497-74ac-4eaf-ab1e-91f7dcbe3af8
Grigoriadis, Kristiana
8c34d367-6863-473e-a590-116f293be2c0
Watkins, Thomas B.K.
3592c581-be84-4092-9502-36a6cb122e19
Pich, Oriol
4d618449-9c24-41bd-aa40-ba551082d809
Moore, David A.
86236945-d938-4374-8937-96005c3a54f4
Veeriah, Selvaraju
0175b5f1-51bd-4a02-9798-58a8bc06b6e5
Ward, Sophia
e406534e-4ffb-4523-b8bf-45f14d85b12d
Laycock, Joanne
c44714ae-7749-481a-8bc3-b023ac680c58
Johnson, Diana
5144874c-5607-4f68-814a-eabe50a75bd4
Rowan, Andrew
59b38826-fabf-46cc-b360-57a2194ad824
Razaq, Maryam
0929a166-0281-42c1-8fd0-e083ff479c86
Akther, Mita
780a4b1e-2dc7-4660-893f-4003a3f09e81
Naceur-Lombardelli, Cristina
5f85216e-da4f-4644-bfbf-671fbb7236d6
Prymas, Paulina
005f6b72-1ea1-462f-aae6-88ea931a3177
Toncheva, Antonia
d330463d-7e0f-43c1-aa84-70feb5b79d47
Hessey, Sonya
7c9cc3dd-9b8e-487e-bd5e-2fe7f027abc0
Dietzen, Michelle
69a3eb07-60a3-46ae-a20f-93b50b986038
Colliver, Emma
4b8b6e4f-12e2-4418-932b-8ef7aab8c3eb
Frankell, Alexander M.
198fb30c-2780-48c1-b347-d94c2a0e9cf0
Bunkum, Abigail
784f0926-cba8-42ee-a9df-d71fbefb6203
Lim, Emilia L.
8b55c1c6-c262-4bdb-9a6b-0cefd19bd4fd
Karasaki, Takahiro
686fa77a-207f-4afb-bf0b-4dd9ce0ec4ad
Abbosh, Christopher
fa7d12fb-1e6e-4924-ad08-4be6b422278e
Hiley, Crispin T.
c5347550-443f-437e-a7fc-f25476cfac79
Hill, Mark S.
4d17d8a7-ee92-4ae9-980f-d16978efe2d5
Cook, Daniel E.
389581e1-19ed-4c26-9efe-c144ae382b9a
Wilson, Gareth A.
6af36a85-7d05-4989-9ab3-d8adac4d5eb8
Salgado, Roberto
5b1f8832-35cf-4f08-9dd3-a646be7fffc2
Nye, Emma
81d13b33-7d53-45e1-b667-7d1d1539411b
Stone, Richard Kevin
b9f6b801-653b-457f-bd7f-afe42061e002
Fennell, Dean A.
e85713c5-cf7d-4d9c-b0de-f4302baa08ab
Price, Gillian
95361664-f787-4962-b54b-d0842b3fc139
Kerr, Keith M.
c451a140-7a92-449e-97aa-01562a0ca54f
Naidu, Babu
7a60c369-1785-43e9-a6a9-fabea5b3fa3d
Middleton, Gary
31c645ca-3e55-491c-866e-370b6bbd91e5
Summers, Yvonne
408b42eb-9eac-47f4-b445-a5b8ac5331f4
Lindsay, Colin R.
c1761d1e-acf7-4b44-9ad1-88ae096d9c7a
Blackhall, Fiona H.
f6ace7d7-8bf4-4726-849a-5a71ee7d0985
Cave, Judith
60c67e39-121a-49ca-8594-93e8e456464f
Blyth, Kevin G.
a7f8a26d-ca77-4a31-b572-cf7e9384aa6e
Nair, Arjun
a9b6cef1-ccdb-48b2-8c93-659854d90bd5
Ahmed, Asia
da8d8513-8866-43b6-8fc0-6b4150889d5f
Taylor, Magali N.
991b4cca-fbbd-43aa-8d00-89318d194b26
Procter, Alexander James
0237663e-aada-4c59-ac15-721d43fef188
Falzon, Mary
2e408e33-0db5-4025-a229-fe862c0e3d96
Lawrence, David
aed91589-99ec-4fcc-82cb-9cea925d42c6
Navani, Neal
905198d0-88ec-472d-8505-83d30c68ca14
Thakrar, Ricky M.
774af2fa-efc2-40c9-b0d3-4d370251d82f
Janes, Sam M.
03f0a66b-f6cf-4407-999e-f2962ee41325
Papadatos-Pastos, Dionysis
f98a3a6f-78a7-491d-a1fa-ac0992573d12
Forster, Martin D.
2eab05a0-ff9e-4c79-bee9-dc18d6764891
Lee, Siow-Ming
b4c749c7-0431-46b3-82b1-501febc802c8
Ahmad, Tanya
e73ccebb-195d-4fdb-a31e-4ae8cd0f8273
Quezada, Sergio A.
0f0f9dab-6569-472e-8bb3-39b63c989008
Peggs, Karl S.
a5c55130-46df-4945-9e55-ee15b2fd2f20
Van Loo, Peter
8628fd72-0000-4110-a0d4-4f78eecfb800
Dive, Caroline
4121ad7d-d9fe-4430-8b36-4d85ada49eab
Hackhaw, Allan
d5461180-6991-4946-869b-054b760f3f4a
Birkbak, Nicolai J.
153da85d-8c1b-4036-b3b7-3190a4605d17
Zaccaria, Simone
4bfbf7b1-f2e8-4de0-bc9a-1e32b26461f5
Jamal-Hanjani, Mariam
33681d2a-c01a-4837-b39d-ed6266abdbf9
McGranahan, Nicholas
d4afb8a2-53ed-4f5e-8d77-be1fac6ff6a0
Swanton, Charles
ec4243a5-762e-4c4f-b05b-33759a19dce4