Carbon dating cancer: defining the chronology of metastatic progression in colorectal cancer

Lote, H. et al. (2017) Carbon dating cancer: defining the chronology of metastatic progression in colorectal cancer. Annals of Oncology, 28(6), pp. 1243-1249. (doi: 10.1093/annonc/mdx074) (PMID:28327965) (PMCID:PMC5452067)

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Background: Patients often ask oncologists how long a cancer has been present before causing symptoms or spreading to other organs. The evolutionary trajectory of cancers can be defined using phylogenetic approaches but lack of chronological references makes dating the exact onset of tumours very challenging. Patients and methods: Here, we describe the case of a colorectal cancer (CRC) patient presenting with synchronous lung metastasis and metachronous thyroid, chest wall and urinary tract metastases over the course of 5 years. The chest wall metastasis was caused by needle tract seeding, implying a known time of onset. Using whole genome sequencing data from primary and metastatic sites we inferred the complete chronology of the cancer by exploiting the time of needle tract seeding as an in vivo ‘stopwatch’. This approach allowed us to follow the progression of the disease back in time, dating each ancestral node of the phylogenetic tree in the past history of the tumour. We used a Bayesian phylogenomic approach, which accounts for possible dynamic changes in mutational rate, to reconstruct the phylogenetic tree and effectively ‘carbon date’ the malignant progression. Results: The primary colon cancer emerged between 5 and 8 years before the clinical diagnosis. The primary tumour metastasized to the lung and the thyroid within a year from its onset. The thyroid lesion presented as a tumour-to-tumour deposit within a benign Hurthle adenoma. Despite rapid metastatic progression from the primary tumour, the patient showed an indolent disease course. Primary cancer and metastases were microsatellite stable and displayed low chromosomal instability. Neo-antigen analysis suggested minimal immunogenicity. Conclusion: Our data provide the first in vivo experimental evidence documenting the timing of metastatic progression in CRC and suggest that genomic instability might be more important than the metastatic potential of the primary cancer in dictating CRC fate.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Braconi, Dr Chiara and Kalkman, Dr Eric and Valeri, Dr Nicola
Authors: Lote, H., Spiteri, I., Ermini, L., Vatsiou, A., Roy, A., McDonald, A., Maka, N., Balsitis, M., Bose, N., Simbolo, M., Mafficini, A., Lampis, A., Hahne, J. C., Trevisani, F., Eltahir, Z., Mentrasti, G., Findlay, C., Kalkman, E.A.J., Punta, M., Werner, B., Lise, S., Aktipis, A., Maley, C., Greaves, M., Braconi, C., White, J., Fassan, M., Scarpa, A., Sottoriva, A., and Valeri, N.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
Journal Name:Annals of Oncology
Publisher:Oxford University Press
ISSN (Online):1569-8041
Published Online:23 February 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Annals of Oncology 28(6): 1243-1249
Publisher Policy:Reproduced under a Creative Commons License

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