Significance

Significance describes how the variant is related to a specific, clinically-relevant property as described in the Evidence Statement. Significance terms vary depending on the Evidence Type (e.g. “Resistance” for Predictive Evidence, “Better Outcome” for Prognostic Evidence, etc.).

Understanding Significance

The available options for Significance depend on the Evidence Type selected for the Evidence statement. If a Predictive Evidence Type is selected, Significance can include: Sensitivity/Response, Resistance, Adverse Response, Reduced Sensitivity, or N/A. Each of these refers to the association between the Molecular Profile and clinical or preclinical response of the therapeutic(s). If a Diagnostic Evidence Type is selected, the Significance can be either Positive or Negative. A Positive Diagnostic Evidence Item implies that the Molecular Profile is associated with diagnosis of disease or disease subtype whereas a Negative Diagnostic Evidence Item implies lack of association. If a Prognostic Evidence Type is selected, the Significance options include: Better Outcome, Poor Outcome, or N/A. The N/A option can be used to imply that the variant does not have an impact on patient prognosis. A Functional Evidence Type should be associated with one of the following Significance values: Gain of Function, Loss of Function, Unaltered Function, Neomorphic, Dominant Negative, or Unknown. These options allow curators to indicate how the variant impacts the biological function described in the Evidence Statement. Predisposing and Oncogenic Evidence use the Significance values Predisposition/Oncogenicity and Protectiveness. However, final classification of the Significance for these Evidence Types should be established at the assertion level using the appropriate guidelines.

Significance for Predictive Evidence

Significance	Symbol	Definition
Sensitivity/Response		Associated with a clinical or preclinical response to treatment
Reduced Sensitivity		Response to treatment is lower than seen in other treatment contexts
Resistance		Associated with clinical or preclinical resistance to treatment
Adverse Response		Associated with an adverse response to drug treatment
N/A		Variant does not inform clinical interepretation

Significance for Diagnostic Evidence

Significance	Symbol	Definition
Positive		Associated with diagnosis of disease or subtype
Negative		Associated with lack of disease or subtype

Significance for Prognostic Evidence

Significance	Symbol	Definition
Better Outcome		Demonstrates better than expected clinical outcome
Poor Outcome		Demonstrates worse than expected clinical outcome
N/A		Variant does not inform clinical action

Significance for Predisposing Evidence

Significance	Symbol	Definition
Predisposition		Evidence may contribute to an interpretation of pathogenic/benign at the assertion level
Protectiveness		Presence of a germline molecular profile reduces the chance of cancer

Significance for Oncogenic Evidence

Significance	Symbol	Definition
Oncogenicity		Evidence may contributes to an interpretation of oncogenic/benign at the assertion level
Protectiveness		Presence of a somatic molecular profile reduces the chance of cancer

Significance for Functional Evidence

Significance	Symbol	Definition
Gain of Function		A sequence variant whereby enhanced function is conferred on the gene product
Loss of Function		A sequence variant whereby the gene product has diminished or abolished function
Unaltered Function		A sequence variant whereby the function of the gene product is unchanged
Neomorphic		Sequence variant creates a novel function
Dominant Negative		Sequence variant abolishes wild type allele function
Unknown		A functional variant that cannot be precisely defined by gain-of-function, loss-of-function, or unaltered function