Evolutionary tree balance predicts disease-free survival in the TRACERx non-small cell lung cancer cohort

Methods for quantifying and classifying modes of tumour evolution promise to enable more personalised prognostic forecasting and treatment optimisation. We recently developed an approach to quantifying evolutionary tree shape that makes full use of the information in tumour clone trees including clone sizes, genetic distances, and phylogenetic relationships. Here, by applying this approach to data from the TRACERx non-small cell lung cancer cohort, we show that clone tree balance predicts disease-free survival after controlling for cancer stage. The association is robust to the omission of rare clones and to the absence of clone sizes or genetic distances. Tree balance outperforms previously proposed evolutionary indices, suggesting that the evenness of evolutionary branching may be more important than the extent of intratumour heterogeneity for determining clinical outcomes.