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<p>Current methods for distinguishing neutral from selection-driven tumour evolution rely on assumptions frequently violated in clinical samples. We argue that tumour evolution is not a binary state, but a dynamic continuum shaped by genetic and non-genetic heterogeneity, spatial constraints, microenvironmental pressures and therapeutic bottlenecks. Refining evolutionary inference through integrative, longitudinal and spatially resolved analyses will be essential to align these models with therapeutic decision-making in precision oncology.</p>

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Moving beyond the neutral-Darwinian dichotomy to inform precision oncology

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月10日

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  • Amit Sud,
  • Richard S. Houlston

摘要

Current methods for distinguishing neutral from selection-driven tumour evolution rely on assumptions frequently violated in clinical samples. We argue that tumour evolution is not a binary state, but a dynamic continuum shaped by genetic and non-genetic heterogeneity, spatial constraints, microenvironmental pressures and therapeutic bottlenecks. Refining evolutionary inference through integrative, longitudinal and spatially resolved analyses will be essential to align these models with therapeutic decision-making in precision oncology.