A renewed model of pancreatic cancer evolution based on genomic rearrangement patterns

Faiyaz Notta, Michelle Chan-Seng-Yue, Mathieu Lemire, Yilong Li, Gavin W. Wilson, Ashton A. Connor, Robert E. Denroche, Sheng Ben Liang, Andrew M.K. Brown, Jaeseung C. Kim, Tao Wang, Jared T. Simpson, Timothy Beck, Ayelet Borgida, Nicholas Buchner, Dianne Chadwick, Sara Hafezi-Bakhtiari, John E. Dick, Lawrence Heisler, Michael A. HollingsworthEmin Ibrahimov, Gun Ho Jang, Jeremy Johns, Lars G.T. Jorgensen, Calvin Law, Olga Ludkovski, Ilinca Lungu, Karen Ng, Danielle Pasternack, Gloria M. Petersen, Liran I. Shlush, Lee Timms, Ming Sound Tsao, Julie M. Wilson, Christina K. Yung, George Zogopoulos, John M.S. Bartlett, Ludmil B. Alexandrov, Francisco X. Real, Sean P. Cleary, Michael H. Roehrl, John D. McPherson, Lincoln D. Stein, Thomas J. Hudson, Peter J. Campbell, Steven Gallinger

Research output: Contribution to journalArticlepeer-review

382 Scopus citations


Pancreatic cancer, a highly aggressive tumour type with uniformly poor prognosis, exemplifies the classically held view of stepwise cancer development. The current model of tumorigenesis, based on analyses of precursor lesions, termed pancreatic intraepithelial neoplasm (PanINs) lesions, makes two predictions: first, that pancreatic cancer develops through a particular sequence of genetic alterations (KRAS, followed by CDKN2A, then TP53 and SMAD4); and second, that the evolutionary trajectory of pancreatic cancer progression is gradual because each alteration is acquired independently. A shortcoming of this model is that clonally expanded precursor lesions do not always belong to the tumour lineage, indicating that the evolutionary trajectory of the tumour lineage and precursor lesions can be divergent. This prevailing model of tumorigenesis has contributed to the clinical notion that pancreatic cancer evolves slowly and presents at a late stage. However, the propensity for this disease to rapidly metastasize and the inability to improve patient outcomes, despite efforts aimed at early detection, suggest that pancreatic cancer progression is not gradual. Here, using newly developed informatics tools, we tracked changes in DNA copy number and their associated rearrangements in tumour-enriched genomes and found that pancreatic cancer tumorigenesis is neither gradual nor follows the accepted mutation order. Two-thirds of tumours harbour complex rearrangement patterns associated with mitotic errors, consistent with punctuated equilibrium as the principal evolutionary trajectory. In a subset of cases, the consequence of such errors is the simultaneous, rather than sequential, knockout of canonical preneoplastic genetic drivers that are likely to set-off invasive cancer growth. These findings challenge the current progression model of pancreatic cancer and provide insights into the mutational processes that give rise to these aggressive tumours.

Original languageEnglish (US)
Pages (from-to)378-382
Number of pages5
Issue number7625
StatePublished - 2016

ASJC Scopus subject areas

  • General


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