Prognostic significance of mutant-allele tumor heterogeneity in uterine corpus endometrial carcinoma

Yufang Hou; Tiegang Li; Wenqiang Gan; Silin Lv; Zifan Zeng; Zheng Yan; Weiqi Wang; Min Yang

doi:10.21037/atm.2020.02.136

Prognostic significance of mutant-allele tumor heterogeneity in uterine corpus endometrial carcinoma

Ann Transl Med. 2020 Mar;8(6):339. doi: 10.21037/atm.2020.02.136.

Authors

Yufang Hou¹, Tiegang Li¹, Wenqiang Gan¹, Silin Lv¹, Zifan Zeng¹, Zheng Yan¹, Weiqi Wang¹, Min Yang¹

Affiliation

¹ State Key Laboratory of Bioactive Substances and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.

Abstract

Background: Uterine corpus endometrial carcinoma (UCEC) is a clinically heterogeneous disease, and this heterogeneity is associated with tumor development, clinical characteristics, and prognostic outcomes. Mutant-allele tumor heterogeneity (MATH) is a novel, non-biased, quantitative measure to assess intra-tumor heterogeneity based on next-generation sequencing data. We aimed to explore the use of MATH as a measure for tumor heterogeneity and its prognostic role in UCEC patients.

Methods: We calculated MATH scores from the available data of 560 UCEC patients from The Cancer Genome Atlas (TCGA) and investigated their correlations with clinical characteristics, genetic alterations, and overall survival. Predictive accuracy was quantified using the area under the receiver operating characteristic curve (AUC) and the index of concordance (C-index).

Results: In total, 242 MATH scores were obtained from the UCEC cohort. MATH scores were significantly related to age, race, cancer type, clinical stage, histological grade, molecular type, targeted molecular therapy, and hormonal therapy. Furthermore, the genomic pattern on the basis of MATH scores showed that mutation rates of TP53 (tumor protein p53) and ARID1A (AT-rich interaction domain 1A) were independently associated with MATH scores. Correlation analysis revealed a significantly positive association of MATH scores with the fraction of somatic copy number alteration (SCNA). Importantly, a high MATH score was significantly associated with shorter overall survival [hazard ratio (HR), 2.342; 95% confidence interval (CI), 1.110-4.942]. Multivariate Cox regression combined with stratified analysis revealed that the MATH score is an independent prognostic factor in UCEC patients under 60 years old, and predictive quantification showed the MATH score had an AUC of 0.756 and a C-index of 0.845.

Conclusions: Our results suggest that MATH, a practical and useful way to measure intra-tumor heterogeneity, may serve as a significant biomarker for the prognosis of patients with UCEC, enabling more accurate prediction of clinical outcomes.

Keywords: mutant-allele tumor heterogeneity (MATH); prognosis; somatic mutation; uterine corpus endometrial carcinoma (UCEC).