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Supplementary Figures 1 - 9. Supp. Figure 1. Comparison of mutation rates between never-smokers and smokers. Supp. Figure 2. Druggable gene candidates. Supp. Figure 3. Prevalence of somatic mutations and the CNVs of the genes in the RB pathway. Supp. Figure 4. Association between RB pathway alterations and poor prognosis in early-stage LA patients who were not treated with adjuvant chemotherapy. Supp. Figure 5. Disease-free survival curve of randomly resampled early-stage LA patients included in the discovery cohort. Supp. Figure 6. Global landscape of significantly mutated genes and significantly altered CNV regions. Supp. Figure 7. Comparison of read depths for EGFR, KRAS, and BRAF. Supp. Figure 8. Mapped read depths of exome-captured regions of KEAP1 and STK11. Supp. Figure 9. Mutation rates between smokers and never-smokers.

Supplementary Tables 1 - 15. Supp. Table 1. Sequenced reads per tumor and normal sample. Supp. Table 2. Comparison of significantly mutated genes detected using various MuTect thresholds. Supp. Table 3. Comparison of the number and rate of substitutions between never-smokers and smokers. Supp. Table 4. Comparison of various methods used to compute the background mutation rate. Supp. Table 5. Significantly mutated genes detected in our discovery cohort. Supp. Table 6. Comparison of significantly mutated genes and previously reported cancer driver genes. Supp. Table 7. Thirteen significantly altered CNV regions detected in our discovery cohort. Supp. Table 8. Druggable target candidates in the 22 significantly mutated genes and the 60 genes in the significantly altered CNV regions detected in the discovery cohort. Supp. Table 9. Pathways significantly enriched in the 22 significantly mutated genes and the 60 genes included in the significantly altered CNV regions that were detected in the discovery cohort. Supp. Table 10. Cox multivariable regression analysis for RB pathway alterations. Supp. Table 11. Cox univariable regression analysis of RB pathway alterations. Supp. Table 12. Comparison of mutations detected using whole-exome sequencing and Sequenom in selected genes. Supp. Table 13. Prevalence of known driver candidates when using two different MuTect parameters. Supp. Table 14. Number of patients included in the overall, tumor, node, and metastasis stage categories. Supp. Table 15. List of potential cancer driver genes with somatic substitutions or small indels determined in previous studies.

Supplementary Methods, Supplementary Figure Legends, and Supplementary Table Legends.

Purpose: To better understand the complete genomic architecture of lung adenocarcinoma.Experimental Design: We used array experiments to determine copy number variations and sequenced the complete exomes of the 247 lung adenocarcinoma tumor samples along with matched normal cells obtained from the same patients. Fully annotated clinical data were also available, providing an unprecedented opportunity to assess the impact of genomic alterations on clinical outcomes.Results: We discovered that genomic alternations in the RB pathway are associated with significantly shorter disease-free survival in early-stage lung adenocarcinoma patients. This association was also observed in our independent validation cohort. The current treatment guidelines for early-stage lung adenocarcinoma patients recommend follow-up without adjuvant therapy after complete resection, except for high-risk patients. However, our findings raise the interesting possibility that additional clinical interventions might provide medical benefits to early-stage lung adenocarcinoma patients with genomic alterations in the RB pathway. When examining the association between genomic mutation and histologic subtype, we uncovered the characteristic genomic signatures of various histologic subtypes. Notably, the solid and the micropapillary subtypes demonstrated great diversity in the mutated genes, while the mucinous subtype exhibited the most unique landscape. This suggests that a more tailored therapeutic approach should be used to treat patients with lung adenocarcinoma.Conclusions: Our analysis of the genomic and clinical data for 247 lung adenocarcinomas should help provide a more comprehensive genomic portrait of lung adenocarcinoma, define molecular signatures of lung adenocarcinoma subtypes, and lead to the discovery of useful prognostic markers that could be used in personalized treatments for early-stage lung adenocarcinoma patients. Clin Cancer Res; 21(11); 2613–23. ©2014 AACR.See related commentary by Collisson, p. 2418

Purpose: To better understand the complete genomic architecture of lung adenocarcinoma. Experimental Design: We used array experiments to determine copy number variations and sequenced the complete exomes of the 247 lung adenocarcinoma tumor samples along with matched normal cells obtained from the same patients. Fully annotated clinical data were also available, providing an unprecedented opportunity to assess the impact of genomic alterations on clinical outcomes. Results: We discovered that genomic alternations in the RB pathway are associated with significantly shorter disease-free survival in early-stage lung adenocarcinoma patients. This association was also observed in our independent validation cohort. The current treatment guidelines for early-stage lung adenocarcinoma patients recommend follow-up without adjuvant therapy after complete resection, except for high-risk patients. However, our findings raise the interesting possibility that additional clinical interventions might provide medical benefits to early-stage lung adenocarcinoma patients with genomic alterations in the RB pathway. When examining the association between genomic mutation and histologic subtype, we uncovered the characteristic genomic signatures of various histologic subtypes. Notably, the solid and the micropapillary subtypes demonstrated great diversity in the mutated genes, while the mucinous subtype exhibited the most unique landscape. This suggests that a more tailored therapeutic approach should be used to treat patients with lung adenocarcinoma. Conclusions: Our analysis of the genomic and clinical data for 247 lung adenocarcinomas should help provide a more comprehensive genomic portrait of lung adenocarcinoma, define molecular signatures of lung adenocarcinoma subtypes, and lead to the discovery of useful prognostic markers that could be used in personalized treatments for early-stage lung adenocarcinoma patients. Clin Cancer Res; 21(11); 2613–23. ©2014 AACR. See related commentary by Collisson, p. 2418

Hepatic resection is the most curative treatment option for early-stage hepatocellular carcinoma, but is associated with a high recurrence rate, which exceeds 50% at 5 years after surgery. Understanding the genetic basis of hepatocellular carcinoma at surgically curable stages may enable the identification of new molecular biomarkers that accurately identify patients in need of additional early therapeutic interventions. Whole exome sequencing and copy number analysis was performed on 231 hepatocellular carcinomas (72% with hepatitis B viral infection) that were classified as early-stage hepatocellular carcinomas, candidates for surgical resection. Recurrent mutations were validated by Sanger sequencing. Unsupervised genomic analyses identified an association between specific genetic aberrations and postoperative clinical outcomes. Recurrent somatic mutations were identified in nine genes, including TP53, CTNNB1, AXIN1, RPS6KA3, and RB1. Recurrent homozygous deletions in FAM123A, RB1, and CDKN2A, and high-copy amplifications in MYC, RSPO2, CCND1, and FGF19 were detected. Pathway analyses of these genes revealed aberrations in the p53, Wnt, PIK3/Ras, cell cycle, and chromatin remodeling pathways. RB1 mutations were significantly associated with cancer-specific and recurrence-free survival after resection (multivariate P = 0.038 and P = 0.012, respectively). FGF19 amplifications, known to activate Wnt signaling, were mutually exclusive with CTNNB1 and AXIN1 mutations, and significantly associated with cirrhosis (P = 0.017). Conclusion: RB1 mutations can be used as a prognostic molecular biomarker for resectable hepatocellular carcinoma. Further study is required to investigate the potential role of FGF19 amplification in driving hepatocarcinogenesis in patients with liver cirrhosis and to investigate the potential of anti-FGF19 treatment in these patients. (Hepatology 2014;60:1971–1981)