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Genomic Landscape and Tumor Mutational Burden Determination of Circulating Tumor DNA in Over 5,000 Chinese Patients with Lung Cancer

肺癌 循环肿瘤DNA 医学 癌症 DNA 癌症研究 生物 病理 遗传学
作者
Jie Shi,Zhiyu Wang,Junping Zhang,Yaping Xu,Xiao Xiao,Xiangming Quan,Ying Bai,Xia Yang,Zongjuan Ming,Xiaojin Guo,Huijing Feng,Xiaoling Yang,Xiaofei Zhuang,Fei Han,Kai Wang,Yonglei Shi,Yu Lei,Jun Bai,Shuanying Yang
出处
期刊:Clinical Cancer Research [American Association for Cancer Research]
卷期号:27 (22): 6184-6196 被引量:13
标识
DOI:10.1158/1078-0432.ccr-21-1537
摘要

Abstract Purpose: Having emerged as a noninvasive and clinically applicable approach for molecular determination of lung cancer, a genomic overview of circulating tumor DNA (ctDNA) of large-scale cohort may be helpful in novel biomarker development and therapeutic innovation. Experimental Design: Primary cohort encompasses 5,671 blood samples from 4,892 patients with lung cancer. Pair-wise tissue samples from 579 patients and additional 358 sample pairs were collected to evaluate the correlation between blood and tissue tumor mutational burden (TMB). Parallel sequencing with plasma/tissue and white blood cells was performed using a 1,021-gene panel. Results: Histologic subtyping was the most relevant to ctDNA detectability independent of other demographic characteristics, with small cell lung cancer showing the highest detectability, ctDNA abundance, and blood TMB (bTMB). Mutational landscape demonstrated significant differences, and integrated clonality analysis highlighted distinct driver-pattern and functional pathway interaction among various subtypes. The clonality and concurrent genes of EGFR mutations could predict the therapeutic efficacy of tyrosine kinase inhibitors (TKI), and RB1 mutations in non–small cell lung cancer characterized a subset with high bTMB, elevated ctDNA level, and potential small cell transformation. Most importantly, we developed an adjusted algorithm for bTMB in samples with extremely low ctDNA level and validated its correlation with tissue TMB in an independent cohort. Conclusions: ctDNA could serve as a promising alternative in genomic profiling for lung cancer. The novel identification of ctDNA clonality and adjusted bTMB might improve therapeutic and prognostic evaluation. This dataset was also a valuable resource for the development of new therapeutic targets and new genomically guided clinical trials.
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