Uterine Tumor Resembling Ovarian Sex Cord Tumor (UTROSCT) A Morphologic and Molecular Study of 26 Cases Confirms Recurrent NCOA1-3 Rearrangement
AMERICAN JOURNAL OF SURGICAL PATHOLOGY
Authors: Goebel, Emily A.; Hernandez Bonilla, Silvia; Dong, Fei; Dickson, Brendan C.; Hoang, Lien N.; Hardisson, David; Lacambra, Maribel D.; Lu, Fang-I; Fletcher, Christopher D. M.; Crum, Christopher P.; Antonescu, Cristina R.; Nucci, Marisa R.; Kolin, David L.
Abstract
Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare mesenchymal neoplasm, of uncertain biological potential, that was recently reported to exhibit recurrent gene fusions involving NCOA2-3. The purpose of this study was to, using a larger sample size, better characterize the histopathologic and molecular diversity of UTROSCT. Twenty-six cases of UTROSCT from 5 institutions were selected for further study. Fluorescence in situ hybridization for NCOA1, NCOA2, NCOA3, ESR1 and GREB1, and targeted RNA sequencing was performed on 17 and 8 UTROSCTs, respectively. Eight cases underwent massively parallel sequencing to detect single nucleotide variants (SNV), copy number variations, and structural variants using a targeted hybrid-capture based assay. NCOA1-3 rearrangement was identified in 81.8% (18/22) of cases. The most common fusion was ESR1-NCOA3, occurring in 40.9% (9/22). GREB1-NCOA1 (n=4), ESR1-NCOA2 (n=3), and GREB1-NCOA2 (n=1) rearrangements were also identified. No recurrent SNVs were identified and no tumor had SNVs in FOXL2, DICER1, STK11, or AKT1, which can be seen in ovarian sex cord-stromal tumors. Copy number variations were infrequent. Clinical follow-up was available for 11 cases with a mean follow-up interval of 94.4 (range, 1 to 319) months. Only one case had a recurrence 66 months after the initial diagnosis and this was the single case with a GREB1-NCOA2 fusion. This study reports the morphologic spectrum of UTROSCT and confirms the recently reported recurrent NCOA2-3 gene fusions, in addition to identifying novel rearrangements involving NCOA1 in these tumors.
The Genomic Landscape of SMARCA4 Alterations and Associations with Outcomes in Patients with Lung Cancer
CLINICAL CANCER RESEARCH
Authors: Schoenfeld, Adamj.; Bandlamudi, Chai; Lavery, Jessica A.; Montecalvo, Joseph; Namakydoust, Azadeh; Rizvi, Hira; Egger, Jacklynn; Concepcion, Carla P.; Paul, Sonal; Arcila, Maria E.; Daneshbod, Yahya; Chang, Jason; Sauter, Jennifer L.; Beras, Amanda; Ladanyi, Marc; Jacks, Tyler; Rudin, Charles M.; Taylor, Barry S.; Donoghue, Mark T. A.; Heller, Glenn; Hellmann, Matthew D.; Rekhtman, Natasha; Riely, Gregory J.
Abstract
Purpose: SMARCA4 mutations are among the most common recurrent alterations in non-small cell lung cancer (NSCLC), but the relationship to other genomic abnormalities and clinical impact has not been established. Experimental Design: To characterize SMARCA4 alterations in NSCLC, we analyzed the genomic, protein expression, and clinical outcome data of patients with SMARCA4 alterations treated at Memorial Sloan Kettering. Results: In 4,813 tumors from patients with NSCLC, we identified 8% (n = 407) of patients with SMARCA4-mutant lung cancer. We describe two categories of SMARCA4 mutations: class 1 mutations (truncating mutations, fusions, and homozygous deletion) and class 2 mutations (missense mutations). Protein expression loss was associated with class 1 mutation (81% vs. 0%, P < 0.001). Both classes of mutation co-occurred more frequently with KRAS, STK11, and KEAP1 mutations compared with SMARCA4 wild-type tumors (P < 0.001). In patients with metastatic NSCLC, SMARCA4 alterations were associated with shorter overall survival, with class 1 alterations associated with shortest survival times (P < 0.001). Conversely, we found that treatment with immune checkpoint inhibitors (ICI) was associated with improved outcomes in patients with SMARCA4-mutant tumors (P = 0.01), with class 1 mutations having the best response to ICIs (P = 0.027). Conclusions: SMARCA4 alterations can be divided into two clinically relevant genomic classes associated with differential protein expression as well as distinct prognostic and treatment implications. Both classes co-occur with KEAP1, STK11, and KRAS mutations, but individually represent independent predictors of poor prognosis. Despite association with poor outcomes, SMARCA4-mutant lung cancers may be more sensitive to immunotherapy.