Q (haiku): What cancer types in MSK-IMPACT have mutations in TP53?

▶ read_guide
{
 "uri": "cbioportal://mutation-frequency-guide"
}

▶ list_studies
{
 "search": "MSK-IMPACT"
}

◀ result
# Mutation Frequency Analysis Guide

## IMPORTANT: Reporting Mutation Frequencies
- **ALWAYS report frequencies as percentages**, not raw counts: `frequency = (altered_samples / total_profiled_samples) × 100`
- For quick frequency lookups, **prefer the TCGA Pan-Cancer Atlas study first**, then offer to expand to other studies
- When reporting across multiple studies, show **ranges** (e.g., "TP53 is mutated in 30–60% of samples") rather than a single average
- **NEVER** sum mutation events across studies to compute an aggregate frequency — this can exceed 100% due to double-counting
- Warn users that samples may overlap across cohorts (e.g., MSK studies may share patients)
- **Choose and state the counting unit**: use patient-level frequencies for prevalence/rate questions unless the user explicitly asks for samples; use sample-level frequencies when the user asks about samples.
- **For "across cancer types" questions**, jump to the [Cross-Cancer-Type Mutation Frequency](#cross-cancer-type-mutation-frequency) section below — there is one correct recipe and several common wrong ones.

## Counting Unit: Samples vs Patients

Before answering any mutation count or frequency question, decide whether the unit is samples or patients and state that choice in the answer.

| User wording | Counting unit |
|--------------|---------------|
| "prevalence", "rate", "fraction of patients", "patients with", "how common is" | Patient-level: `COUNT(DISTINCT patient_unique_id)` |
| "samples", "specimens", "biopsies", sample-level cohort composition | Sample-level: `COUNT(DISTINCT sample_unique_id)` |
| Ambiguous | Ask, or default to patient-level for prevalence/rate language and say so |

### Cross-study sample-count caveat

When an answer touches more than one study and reports a sample count, prepend a one-line caveat:

> Sample IDs are unique within cBioPortal study prefixes, not guaranteed biological-sample identifiers across studies; overlapping cohorts can count the same patient/sample more than once.

Prefer one of these safer approaches:

- Use a shipped `cancer_study_query_preferences` cohort such as `pan_cancer_tcga` or `all_studies_non_redundant`.
- Restrict to one named study.
- Aggregate by `patient_unique_id` when the biological question is patient prevalence.

## STOP rule: a frequency above 100% means your query is wrong

If your query returns a frequency over 100%, **do not try to debug or explain the data inconsistency to the user**. The cause is always one of these query bugs:

- Summing mutation events instead of `COUNT(DISTINCT sample_unique_id)` for the numerator
- Using a study-wide sample count as the denominator instead of the gene-specific profiled count
- Cross-study aggregation where the same biological sample appears under multiple `sample_unique_id` values (e.g., MSK-IMPACT and MSK-CHORD share patients)
- **Joining the profiled CTE through `gene_panel` / `gene_panel_list` without a WES branch.** `gene_panel_id = 'WES'` is *not* a row in … (35166 more chars)

◀ result
{"result":[{"cancer_study_identifier":"msk_impact_50k_2026","name":"MSK-IMPACT 50K Clinical Sequencing Cohort (MSK, Cancer Cell 2026)","type_of_cancer_id":"mixed","sample_count":54331,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=msk_impact_50k_2026"},{"cancer_study_identifier":"msk_ch_2023","name":"Cancer Therapy and Clonal Hematopoiesis (MSK, Blood Adv 2023)","type_of_cancer_id":"mixed","sample_count":42714,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=msk_ch_2023"},{"cancer_study_identifier":"msk_chord_2024","name":"MSK-CHORD (MSK, Nature 2024)","type_of_cancer_id":"mixed","sample_count":25040,"has_guide":true,"url":"https://www.cbioportal.org/study/summary?id=msk_chord_2024"},{"cancer_study_identifier":"msk_ch_2020","name":"Cancer Therapy and Clonal Hematopoiesis (MSK, Nat Genet 2020)","type_of_cancer_id":"mixed","sample_count":24146,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=msk_ch_2020"},{"cancer_study_identifier":"msk_impact_2017","name":"MSK-IMPACT Clinical Sequencing Cohort (MSK, Nat Med 2017)","type_of_cancer_id":"mixed","sample_count":10945,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=msk_impact_2017"},{"cancer_study_identifier":"crc_msk_2026","name":"Colorectal Adenocarcinoma (MSK, 2026)","type_of_cancer_id":"read","sample_count":7237,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=crc_msk_2026"},{"cancer_study_identifier":"breast_msk_2026","name":"CCNE1 Amplifications in Breast Cancer (MSK, 2026)","type_of_cancer_id":"breast","sample_count":6318,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=breast_msk_2026"},{"cancer_study_identifier":"pancan_mimsi_msk_2024","name":"Mixed Tumors - MiMSI Cohort (MSK, Nat Commun 2024)","type_of_cancer_id":"mixed","sample_count":5033,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=pancan_mimsi_msk_2024"},{"cancer_study_identifier":"breast_msk_2025","name":"Breast Cancer (MSK, Nat Genet 2025)","type_of_cancer_id":"brca","sample_count":3879,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=breast_msk_2025"},{"cancer_study_identifier":"mycf_msk_2026","name":"MYC Family Amplifications in MSK-IMPACT Solid Tumors (MSK, 2026)","type_of_cancer_id":"mixed","sample_count":3442,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=mycf_msk_2026"},{"cancer_study_identifier":"heme_msk_impact_2022","name":"MSK-IMPACT Heme Tumors (MSK, 2022)","type_of_cancer_id":"mixed","sample_count":2383,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=heme_msk_impact_2022"},{"cancer_study_identifier":"pdac_msk_2024","name":"Pancreatic Adenocarcinoma (MSK, Nat Med 2024)","type_of_cancer_id":"pancreas","sample_count":2336,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=pdac_msk_2024"},{"cancer_study_identifier":"prostate_msk_2024","name":"Prostate Cancer (MSK, Clin Cancer Res 2024)","type_of_cancer_id" … (1829 more chars)

▶ clickhouse_run_select_query
{
 "query": "
SELECT *
FROM gene_mutation_frequency_in_study(
    study = 'msk_impact_50k_2026',
    gene  = 'TP53'
)
ORDER BY frequency_pct DESC;
",
 "max_rows": 50
}

◀ result
{"rows":[{"cancer_type":"Small Cell Lung Cancer","altered_samples":421,"profiled_samples":466,"frequency_pct":90.3},{"cancer_type":"Ovarian Cancer","altered_samples":1639,"profiled_samples":2140,"frequency_pct":76.6},{"cancer_type":"Colorectal Cancer","altered_samples":3884,"profiled_samples":5277,"frequency_pct":73.6},{"cancer_type":"Esophagogastric Cancer","altered_samples":1310,"profiled_samples":1834,"frequency_pct":71.4},{"cancer_type":"Pancreatic Cancer","altered_samples":1965,"profiled_samples":2851,"frequency_pct":68.9},{"cancer_type":"Vaginal Cancer","altered_samples":32,"profiled_samples":57,"frequency_pct":56.1},{"cancer_type":"Small Bowel Cancer","altered_samples":89,"profiled_samples":161,"frequency_pct":55.3},{"cancer_type":"Ampullary Cancer","altered_samples":73,"profiled_samples":134,"frequency_pct":54.5},{"cancer_type":"Non-Small Cell Lung Cancer","altered_samples":4242,"profiled_samples":7867,"frequency_pct":53.9},{"cancer_type":"Skin Cancer, Non-Melanoma","altered_samples":231,"profiled_samples":455,"frequency_pct":50.8},{"cancer_type":"Cancer of Unknown Primary","altered_samples":802,"profiled_samples":1581,"frequency_pct":50.7},{"cancer_type":"Head and Neck Cancer","altered_samples":328,"profiled_samples":657,"frequency_pct":49.9},{"cancer_type":"Bladder Cancer","altered_samples":1242,"profiled_samples":2526,"frequency_pct":49.2},{"cancer_type":"Endometrial Cancer","altered_samples":1125,"profiled_samples":2445,"frequency_pct":46},{"cancer_type":"Uterine Sarcoma","altered_samples":145,"profiled_samples":344,"frequency_pct":42.2},{"cancer_type":"Breast Cancer","altered_samples":2835,"profiled_samples":6807,"frequency_pct":41.6},{"cancer_type":"Glioma","altered_samples":849,"profiled_samples":2322,"frequency_pct":36.6},{"cancer_type":"Appendiceal Cancer","altered_samples":94,"profiled_samples":274,"frequency_pct":34.3},{"cancer_type":"Hepatobiliary Cancer","altered_samples":473,"profiled_samples":1431,"frequency_pct":33.1},{"cancer_type":"Prostate Cancer","altered_samples":947,"profiled_samples":3324,"frequency_pct":28.5},{"cancer_type":"Adrenocortical Carcinoma","altered_samples":24,"profiled_samples":88,"frequency_pct":27.3},{"cancer_type":"Salivary Gland Cancer","altered_samples":109,"profiled_samples":411,"frequency_pct":26.5},{"cancer_type":"Gastrointestinal Neuroendocrine Tumor","altered_samples":49,"profiled_samples":210,"frequency_pct":23.3},{"cancer_type":"Soft Tissue Sarcoma","altered_samples":496,"profiled_samples":2307,"frequency_pct":21.5},{"cancer_type":"Wilms Tumor","altered_samples":14,"profiled_samples":68,"frequency_pct":20.6},{"cancer_type":"Bone Cancer","altered_samples":119,"profiled_samples":590,"frequency_pct":20.2},{"cancer_type":"Melanoma","altered_samples":363,"profiled_samples":1831,"frequency_pct":19.8},{"cancer_type":"Thyroid Cancer","altered_samples":133,"profiled_samples":867,"frequency_pct":15.3},{"cancer_type":"Thymic Tumor","altered_samples":12,"profiled_samples":80,"frequency_pct":15},{"cancer … (1363 more chars)

▶ resolve_and_route
{
 "studyIds": [
  "msk_impact_50k_2026"
 ]
}

◀ result
{"success":true,"message":"Found 1 study. Use the metadata to call the appropriate navigation tool(s).","data":{"totalCount":1,"studiesWithMetadata":[{"studyId":"msk_impact_50k_2026","name":"MSK-IMPACT 50K Clinical Sequencing Cohort (MSK, Cancer Cell 2026)","sampleCount":54331,"studyViewUrl":"https://www.cbioportal.org/study?id=msk_impact_50k_2026","metadata":{"clinicalAttributeIds":["AGE_AT_DX","ANCESTRY_LABEL","CANCER_TYPE","CANCER_TYPE_DETAILED","DISEASE_STATUS","FACETS_PLOIDY","FACETS_PURITY","FACETS_QC","FACETS_SUITE_VERSION","FACETS_WGD","FRACTION_GENOME_ALTERED","GENE_PANEL","HLA-A1","HLA-A2","HLA-B1","HLA-B2","HLA-C1","HLA-C2","HLA_A1_LOH","HLA_A2_LOH","HLA_B1_LOH","HLA_B2_LOH","HLA_C1_LOH","HLA_C2_LOH","HLA_GENOTYPE_AVAILABLE","METASTATIC_SITE","MSI_SCORE","MSI_TYPE","MUTATION_COUNT","N_OTHER_CANCER_TYPES","ONCOTREE_CODE","OS_MONTHS","OS_STATUS","PRIMARY_SITE","PURITY_ESTIMATE_FROM_MUTATIONS","SAMPLE_COUNT","SAMPLE_COVERAGE","SAMPLE_TYPE","SEX","SOMATIC_STATUS","TMB_SCORE","TUMOR_PURITY"],"molecularProfileIds":["msk_impact_50k_2026_gistic","msk_impact_50k_2026_mutations","msk_impact_50k_2026_structural_variants"],"genericAssayProfiles":["msk_impact_50k_2026_armlevel_cna","msk_impact_50k_2026_loh_hla","msk_impact_50k_2026_mutational_signatures_contribution_v2"],"availableComparisonTabs":["overlap","clinical","survival","alterations","mutations","generic_assay_armlevel_cna","generic_assay_loh_hla","generic_assay_mutational_signature"]}}]}}

▶ navigate_to_study_view
{
 "studyIds": [
  "msk_impact_50k_2026"
 ],
 "filterJson": {
  "geneFilters": [
   {
    "molecularProfileIds": [
     "msk_impact_50k_2026_mutations"
    ],
    "geneQueries": [
     [
      {
       "hugoGeneSymbol": "TP53"
      }
     ]
    ]
   }
  ]
 }
}

◀ result
{"success":true,"message":"Navigating to https://www.cbioportal.org/study/summary?id=msk_impact_50k_2026#filterJson=%7B%22geneFilters%22%3A%5B%7B%22geneQueries%22%3A%5B%5B%7B%22hugoGeneSymbol%22%3A%22TP53%22%7D%5D%5D%2C%22molecularProfileIds%22%3A%5B%22msk_impact_50k_2026_mutations%22%5D%7D%5D%7D","url":"https://www.cbioportal.org/study/summary?id=msk_impact_50k_2026#filterJson=%7B%22geneFilters%22%3A%5B%7B%22geneQueries%22%3A%5B%5B%7B%22hugoGeneSymbol%22%3A%22TP53%22%7D%5D%5D%2C%22molecularProfileIds%22%3A%5B%22msk_impact_50k_2026_mutations%22%5D%7D%5D%7D","data":{"studyIds":["msk_impact_50k_2026"],"studies":[{"studyId":"msk_impact_50k_2026","name":"MSK-IMPACT 50K Clinical Sequencing Cohort (MSK, Cancer Cell 2026)","sampleCount":54331}],"tab":"summary","hasFilters":true,"hasPlotsConfig":false,"pageDescription":"Overview of all study data displayed as interactive charts summarizing available clinical and genomic data. Click within a chart to filter. Additional charts may be available in the Charts menu."}}

═ answer (success)
## TP53 Mutations in MSK-IMPACT (50K Cohort)

TP53 is mutated in **42 cancer types** across the 54,331-sample MSK-IMPACT cohort. Here's the breakdown, ranked by mutation frequency:

### **High-Frequency TP53 Mutations (>50%)**
- **Small Cell Lung Cancer**: 421/466 (90.3%)
- **Ovarian Cancer**: 1,639/2,140 (76.6%)
- **Colorectal Cancer**: 3,884/5,277 (73.6%)
- **Esophagogastric Cancer**: 1,310/1,834 (71.4%)
- **Pancreatic Cancer**: 1,965/2,851 (68.9%)

### **Moderate Frequency (35–50%)**
- Vaginal Cancer: 56.1%
- Small Bowel Cancer: 55.3%
- Ampullary Cancer: 54.5%
- Non-Small Cell Lung Cancer: 4,242/7,867 (53.9%)
- Skin Cancer (Non-Melanoma): 50.8%
- Cancer of Unknown Primary: 50.7%
- Head and Neck Cancer: 49.9%
- Bladder Cancer: 49.2%
- Endometrial Cancer: 46.0%
- Uterine Sarcoma: 42.2%
- Breast Cancer: 2,835/6,807 (41.6%)

### **Lower Frequency (<35%)**
- Glioma: 36.6% | Prostate Cancer: 28.5% | Melanoma: 19.8% | Thyroid Cancer: 15.3% | Renal Cell Carcinoma: 10.0% | CNS Cancer: 1.8%

**[View TP53-mutated samples in MSK-IMPACT](https://www.cbioportal.org/study/summary?id=msk_impact_50k_2026#filterJson=%7B%22geneFilters%22%3A%5B%7B%22geneQueries%22%3A%5B%5B%7B%22hugoGeneSymbol%22%3A%22TP53%22%7D%5D%5D%2C%22molecularProfileIds%22%3A%5B%22msk_impact_50k_2026_mutations%22%5D%7D%5D%7D)** — this link opens the filtered cohort dashboard where you can explore the cancer-type breakdown interactively and drill into individual samples.