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The genomic landscape of primary high-grade serous ovarian cancer (HGSC) is characterized by ubiquitous TP53 mutations, frequent disruption to the homologous recombination (HR) DNA repair pathway, CCNE1 amplification associated with primary treatment resistance, and extensive copy number aberrations. We recently described a cohort of 49 HGSC patients where we performed genomic and phenotypic profiling of multi-site tumors collected at primary cytoreductive surgery and at relapse, identifying 3 distinct evolutionary patterns and inter-tumor heterogeneity. The aim of this study was to further characterize the heterogeneity of genomic alterations in HGSC. Twenty-one patients undergoing upfront maximal effort cytoreductive surgery for advanced HGSC underwent mapping of their tumor locations and biopsies were collected from disseminated tumors. Tumor samples were also collected from ten …