To elucidate the mechanisms underlying the divergent clinicopathologic spectrum of
EWSR1/FUS
-
CREB
translocation-associated tumors, we performed a comprehensive genomic analysis of fusion transcript variants, recurrent genetic alterations (mutations, copy number alterations), gene expression, and methylation profiles across a large cohort of tumor types. The distribution of the
EWSR1
/
FUS
fusion partners –
ATF1
,
CREB1
, and
CREM
– and exon involvement was significantly different across different tumor types. Our targeted sequencing showed that secondary genetic events are associated with tumor type rather than fusion type. Of the 39 cases that underwent targeted NGS testing, 18 (46%) had secondary OncoKB mutations or copy number alterations (29 secondary genetic events in total), of which 15 (52%) were recurrent. Secondary recurrent, but mutually exclusive,
TERT
promoter and
CDKN2A
mutations were identified only in clear cell sarcoma (CCS) and associated with worse overall survival.
CDKN2A/B
homozygous deletions were recurrent in angiomatoid fibrous histiocytoma (AFH) and restricted to metastatic cases. mRNA upregulation of
MITF
,
CDH19
,
PARVB
, and
PFKP
was found in CCS, compared to AFH, and correlated with a hypomethylated profile. In contrast,
S100A4
and
XAF1
were differentially upregulated and hypomethylated in AFH but not CCS. A sarcoma methylation classifier was able to accurately match 100% of CCS cases to the correct methylation class; however, it was suboptimal when applied to other histologies. In conclusion, our comprehensive genomic profiling of
EWSR1/FUS
-
CREB
translocation-associated tumors uncovered mostly histotype, rather than fusion-type associated correlations in transcript variants, prognostically significant secondary genetic alterations, and gene expression and methylation patterns.