Cell 173, 595–610.e11 (2018)

Cell 173, 611–623.e17 (2018)

Cell 173, 581–594.e12 (2018)

Three publications from the TRACERx consortium trace the evolution of clear cell renal carcinoma (ccRCC), providing insights that can guide therapy in this cancer.

In a whole-genome analysis of 95 biopsies from 33 patients with ccRCC, Swanton, Campbell and colleagues gain insights into the landmark early genetic mechanisms in ccRCC development.

With regards to the further evolution of these tumors, Swanton, Larkin and colleagues analyzed genetic data from 1,206 primary tumor regions from 101 patients with ccRCC. They find ccRCC evolution and outcome is determined by progressive, identifiable mutations.

Similarly, Swanton and colleagues find in an analysis of 575 primary and 335 metastatic biopsies across 100 patients with metastatic ccRCC that metastasis is largely driven by chromosomal aberrations. These create genetic drivers for either rapid progression to metastasis or attenuated progression, which in turn influences patient mortality. In the future, genetic evolutionary analysis may aid in standard-of-care decisions.