ABSTRACT Ovarian high-grade serous carcinoma (HGSC) is typically diagnosed at an advanced stage, with multiple genetically heterogeneous clones existing in the tumors long before therapeutic intervention. Herein we characterized HGSC evolutionary states using whole-genome sequencing data from 214 samples of 55 HGSC patients in the prospective, longitudinal, multiregion DECIDER study. Comparison of the tissues revealed that site-of-origin samples have 70% more unique clones than the metastatic tumors or ascites. By integrating clonal composition and topology of HGSC tumors we discovered three evolutionary states that represent a continuum from genomically highly variable to stable tumors with significant association to treatment response. The states and their evolutionary trajectories were characterized by unique, targetable pathways, which were validated with RNA-seq data. Our study reveals that genomic heterogeneity is unaffected by the current standard-of-care and pinpoints effective treatment targets for each group. All genomics data are available via an interactive visualization platform for rapid exploration.

Evolutionary states and trajectories characterized by distinct pathways stratify ovarian high-grade serous carcinoma patients