Molecular stratification of endometrioid ovarian carcinoma predicts clinical outcome

• Published in: Nature communications Vol. 11; no. 1; p. 4995
• Main Authors: Hollis, Robert L., Thomson, John P., Stanley, Barbara, Churchman, Michael, Meynert, Alison M., Rye, Tzyvia, Bartos, Clare, Iida, Yasushi, Croy, Ian, Mackean, Melanie, Nussey, Fiona, Okamoto, Aikou, Semple, Colin A., Gourley, Charlie, Herrington, C. Simon
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05.10.2020; Nature Publishing Group; Nature Portfolio
• Subjects: 1-Phosphatidylinositol 3-kinase; 13; 13/51; 14; 14/63; 45; 45/23; 631/67; 631/67/1517; 631/67/1517/1709; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor - genetics; Biomarkers, Tumor - metabolism; Carcinoma, Endometrioid - genetics; Carcinoma, Endometrioid - metabolism; Carcinoma, Endometrioid - mortality; Carcinoma, Endometrioid - pathology; Complexity; Diagnosis; DNA Copy Number Variations; Female; Heterogeneity; Humanities and Social Sciences; Humans; MAP kinase; Microsatellite Instability; Middle Aged; Mismatch repair; multidisciplinary; Mutation; Ovarian cancer; Ovarian carcinoma; Ovarian Neoplasms - genetics; Ovarian Neoplasms - metabolism; Ovarian Neoplasms - mortality; Ovarian Neoplasms - pathology; Ovaries; p53 Protein; Prognosis; PTEN protein; Science; Science (multidisciplinary); Signal Transduction; Taxonomy; Whole Exome Sequencing; Wnt protein
• ISSN: 2041-1723; 2041-1723
• DOI: 10.1038/s41467-020-18819-5

Endometrioid ovarian carcinoma (EnOC) demonstrates substantial clinical and molecular heterogeneity. Here, we report whole exome sequencing of 112 EnOC cases following rigorous pathological assessment. We detect a high frequency of mutation in CTNNB1 (43%), PIK3CA (43%), ARID1A (36%), PTEN (29%),  KRAS  (26%), TP53 (26%) and SOX8 (19%), a recurrently-mutated gene previously unreported in EnOC. POLE and mismatch repair protein-encoding genes were mutated at lower frequency (6%, 18%) with significant co-occurrence. A molecular taxonomy is constructed, identifying clinically distinct EnOC subtypes: cases with TP53 mutation demonstrate greater genomic complexity, are commonly FIGO stage III/IV at diagnosis (48%), are frequently incompletely debulked (44%) and demonstrate inferior survival; conversely, cases with CTNNB1 mutation, which is mutually exclusive with TP53 mutation, demonstrate low genomic complexity and excellent clinical outcome, and are predominantly stage I/II at diagnosis (89%) and completely resected (87%). Moreover, we identify the WNT, MAPK/RAS and PI3K pathways as good candidate targets for molecular therapeutics in EnOC. The molecular classification of endometroid ovarian carcinomas (EnOC) has not been established, preventing the development of stratified therapeutic approaches. Here the authors characterise the molecular landscape of EnOC by whole exome sequencing, identifying clinically distinct disease subtypes.