Colorectal adenoma and cancer divergence. Evidence of multilineage progression

Am J Pathol. 1999 Jun;154(6):1815-24. doi: 10.1016/S0002-9440(10)65437-5.


Colorectal cancer progression involves changes in phenotype and genotype. Although usually illustrated as a linear process, more complex underlying pathways have not been excluded. The object of this paper is to apply modern quantitative principles of molecular evolution to multistep tumor progression. To reconstruct progression lineages, the genotypes of two adjacent adenoma-cancer pairs were determined by serial dilution and polymerase chain reaction at 28-30 microsatellite (MS) loci and then traced back to their most recent common ancestor. The tumors were mismatch repair deficient, and therefore relatively large numbers of MS mutations should accumulate during progression. As expected, the MS genotypes were similar (correlation coefficients >0.9) between different parts of the same adenoma or cancer, but very different (correlation coefficients <0. 2) between unrelated metachronous adenoma-cancer pairs. Unexpectedly, the genotypes of the adjacent adenoma-cancer pairs were also very different (correlation coefficients of 0.30 and 0.36), consistent with early adenoma-cancer divergence rather than direct linear progression. More than 60% of the divisions occurred after this early adenoma-cancer divergence. Therefore, the tumor phylogenies were not consistent with sequential stepwise selection along a single most "fit" and frequent lineage from adenoma to cancer. Instead, one effective early progression strategy creates and maintains multiple evolving candidate lineages, which are subsequently selected for terminal clonal expansion.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adenoma / genetics*
  • Adult
  • Cell Division / genetics
  • Cell Lineage / genetics
  • Cell Transformation, Neoplastic / genetics*
  • Clone Cells
  • Colorectal Neoplasms / genetics*
  • Disease Progression
  • Genotype
  • Humans
  • Male
  • Microsatellite Repeats
  • Neoplasms, Multiple Primary / genetics*
  • Neoplasms, Second Primary / genetics*
  • Polymerase Chain Reaction
  • Time