Criticality in tumor evolution and clinical outcome

Significance How mutation and selection co-determine the course of cancer evolution remains an open, fundamental question. We construct a mutation-selection phase diagram, using tumor mutation load (ML) and selection strength (dN/dS) as key variables, and assess their association with clinical outcome. The results reveal a biphasic evolutionary regime whereby beyond a critical ML, tumor fitness decreases with the number of mutations, although the proteome evolves near neutrality—that is, without strong selection. Deviations from neutrality at extreme ML show how positive selection (at low ML) and purifying selection (at high ML) may act to maintain tumor fitness. These results corroborate the existence of a critical state in cancer evolution predicted by theory and have fundamental and likely clinical implications.