Recurrent chromosomal gains and heterogeneous driver mutations characterise papillary renal cancer evolutionMore about Open Access at the Crick
Authors listMichal Kovac Carolina Navas Stuart Horswell Max Salm Chiara Bardella Andrew Rowan Mark Stares Francesc Castro-Giner Rosalie Fisher Elza C de Bruin Monika Kovacova Maggie Gorman Seiko Makino Jennet Williams Emma Jaeger Angela Jones Kimberley Howarth James Larkin Lisa Pickering Martin Gore David L Nicol Steven Hazell Gordon Stamp Tim O'Brien Ben Challacombe Nik Matthews Benjamin Phillimore Sharmin Begum Adam Rabinowitz Ignacio Varela Ashish Chandra Catherine Horsfield Alexander Polson Maxine Tran Rupesh Bhatt Luigi Terracciano Serenella Eppenberger-Castori Andrew Protheroe Eamonn Maher Mona El Bahrawy Stewart Fleming Peter Ratcliffe Karl Heinimann Charles Swanton Ian Tomlinson
Papillary renal cell carcinoma (pRCC) is an important subtype of kidney cancer with a problematic pathological classification and highly variable clinical behaviour. Here we sequence the genomes or exomes of 31 pRCCs, and in four tumours, multi-region sequencing is undertaken. We identify BAP1, SETD2, ARID2 and Nrf2 pathway genes (KEAP1, NHE2L2 and CUL3) as probable drivers, together with at least eight other possible drivers. However, only ~10% of tumours harbour detectable pathogenic changes in any one driver gene, and where present, the mutations are often predicted to be present within cancer sub-clones. We specifically detect parallel evolution of multiple SETD2 mutations within different sub-regions of the same tumour. By contrast, large copy number gains of chromosomes 7, 12, 16 and 17 are usually early, monoclonal changes in pRCC evolution. The predominance of large copy number variants as the major drivers for pRCC highlights an unusual mode of tumorigenesis that may challenge precision medicine approaches.