Q (sonnet-5.5): In the TCGA Breast Cancer study, do TP53 mutations and high MYC expression co-occur or are they mutually exclusive?

▶ read_guide
{
 "uri": "cbioportal://statistical-tests-guide"
}

▶ read_guide
{
 "uri": "cbioportal://gene-expression-guide"
}

▶ list_studies
{
 "search": "TCGA breast"
}

◀ result
Statistical Test Selection Guide
================================

Purpose
-------
This guide ensures the correct statistical test is selected before performing any group comparison, matching cBioPortal's own Group Comparison defaults.

HARD RULES — NEVER FABRICATE A STATISTIC
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ClickHouse cannot run statistical tests. The agent therefore must NEVER produce a derived statistic that is not a literal column value from a SQL result. Specifically:

1. **Never invent a p-value.** Not "p < 0.001", not "p ≈ 0.05", not any p-value. If the user asks "what is the p-value?", the answer is *"I can't compute that — here is the 2x2 contingency table (or group statistics). Run it in cBioPortal's Group Comparison tab, in R with `fisher.test(...)` / `wilcox.test(...)`, or in Python with `scipy.stats.fisher_exact(...)` / `mannwhitneyu(...)`."*
2. **Never claim mutual exclusivity (or co-occurrence) from a contingency table alone.** A 2x2 table is not a test. The shape "altered/not altered × group A/group B" needs Fisher's exact + a defined direction (odds ratio < 1 with significant p). Without that test, the agent presents the table and stops. Descriptive phrasing is also a claim: "largely/mostly mutually exclusive", "rarely co-occur", "tend to co-occur" are forbidden without the test — point to cBioPortal's Mutual Exclusivity tab instead.
3. **Never report a "median" that came from `AVG(...)` or any non-median aggregate.** "Median" and "mean" are different statistics; for skewed clinical distributions (especially survival) they differ substantially. Use ClickHouse's `quantile(0.5)(...)` for actual median, and label arithmetic averages as "mean", never "median".
4. **Never report a hazard ratio, odds ratio, risk ratio, or relative risk** that wasn't computed by an external tool. These require regression / model fitting that ClickHouse does not do.
5. **Never report median overall survival from `AVG(OS_MONTHS)` or even `quantile(0.5)(OS_MONTHS)`.** Median OS requires Kaplan-Meier estimation, which handles censoring (`OS_STATUS = 0:LIVING` means the event hasn't happened yet). Naive medians/means over `OS_MONTHS` ignore censoring and are systematically wrong. The correct handoff: return the raw `(OS_MONTHS, OS_STATUS)` pairs (or descriptive counts: N events, N censored, follow-up range) and tell the user to run KM in R (`survival::survfit`) or Python (`lifelines.KaplanMeierFitter`), or use cBioPortal's Survival comparison.

If asked to do any of (1)–(5), respond with the appropriate handoff template from the "Approved Response Templates" section below — do not produce the number.

Ambiguous-Term Clarification (before any analysis)
--------------------------------------------------
If the user's question uses an ambiguous term, ask before computing anything. Examples:

- **"aggressive"** → could mean shorter overall survival, higher metastasis rate, higher grade/stage, higher TMB, or specific molecular features. Ask which definit … (9984 more chars)

◀ result
# Gene Expression Analysis Guide

This guide covers continuous-value genomic data: gene **expression**, **copy number** values, **methylation**, and related profile types. Mutation/CNA/SV *frequency* analysis lives in `cbioportal://mutation-frequency-guide`.

## Where this data lives

Continuous per-sample-per-gene values are stored in `genetic_alteration_derived`:

| Column | Description |
|---|---|
| `sample_unique_id` | `<study>_<sample_stable_id>` |
| `cancer_study_identifier` | study scope |
| `hugo_gene_symbol` | gene |
| `profile_type` | which assay/normalization (see below) |
| `alteration_value` | the actual value — stored as Nullable(String); cast with `toFloat64OrNull` |

`alteration_value` is a string because the same column hosts many different value scales. The `''` and `'NA'` sentinels mean "missing"; always filter them out and use `toFloat64OrNull(alteration_value) IS NOT NULL` for downstream math.

## Discovering profile types for a study

Different studies expose different profile types depending on what assays were run and how the data was normalized. Always check what a specific study supports before picking one:

```sql
SELECT DISTINCT profile_type
FROM genetic_alteration_derived
WHERE cancer_study_identifier = 'brca_metabric'
ORDER BY profile_type;
```

Common values across the public portal:

| Family | Profile types |
|---|---|
| mRNA expression | `rna_seq_v2_mrna`, `rna_seq_v2_mrna_median_Zscores`, `rna_seq_v2_mrna_median_all_sample_Zscores` (TCGA PanCancer Atlas), `mrna`, `mrna_median_Zscores`, `mrna_seq_v2_rsem`, `mrna_seq_v2_rsem_Zscores`, `mrna_seq_cpm`, `mrna_seq_fpkm`, `mrna_U133`, `mrna_outliers` |
| Copy number (continuous) | `cna`, `linear_CNA`, `log2CNA`, `cna_consensus`, `cna_rae`, `gistic` |
| Methylation | `methylation_hm27`, `methylation_hm450`, `methylation_epic`, `methylation_promoters_rrbs` |
| miRNA | `mirna`, `mirna_median_Zscores` |
| Protein | `protein_quantification`, `protein_level`, `RPPA` |

**Z-score vs raw choice.** When the user asks "is X correlated with Y", either works for Spearman (rank-based) — Pearson would care. Default to the non-Z-score variant if both exist, and call out which one in the response.

## Canonical recipe — Spearman correlation between two genes

```sql
SELECT *
FROM gene_pair_coexpression(
    study        = 'brca_metabric',
    gene_a       = 'TP53',
    gene_b       = 'MYC',
    profile_type = 'mrna'
);
```

Returns one row: `(gene_a, gene_b, profile_type, spearman_correlation, num_samples)`.

- `spearman_correlation` in [−1, 1]; `NULL` when fewer than 3 valid paired samples.
- Mirrors cbioportal-backend's `ClickhouseCoExpressionMapper.getCoExpressions`, simplified to a pair lookup (the backend computes one ref gene vs ALL other genes for the coexpression page; here the agent asks about a specific pair).

### Verified examples

| Study | gene_a | gene_b | profile_type | spearman | n |
|---|---|---|---|---|---|
| `brca_metabric` | TP53 | MYC | `mrna` | 0.118 | 1980 |
|  … (4931 more chars)

◀ result
{"result":[{"cancer_study_identifier":"brca_tcga","name":"Breast Invasive Carcinoma (TCGA, Firehose Legacy)","type_of_cancer_id":"brca","sample_count":1108,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=brca_tcga"},{"cancer_study_identifier":"brca_tcga_gdc","name":"Invasive Breast Carcinoma (TCGA GDC, 2025)","type_of_cancer_id":"brca","sample_count":1102,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=brca_tcga_gdc"},{"cancer_study_identifier":"brca_tcga_pan_can_atlas_2018","name":"Breast Invasive Carcinoma (TCGA, PanCancer Atlas)","type_of_cancer_id":"brca","sample_count":1084,"has_guide":true,"url":"https://www.cbioportal.org/study/summary?id=brca_tcga_pan_can_atlas_2018"},{"cancer_study_identifier":"brca_tcga_pub","name":"Breast Invasive Carcinoma (TCGA, Nature 2012)","type_of_cancer_id":"brca","sample_count":825,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=brca_tcga_pub"},{"cancer_study_identifier":"brca_tcga_pub2015","name":"Breast Invasive Carcinoma (TCGA, Cell 2015)","type_of_cancer_id":"brca","sample_count":818,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=brca_tcga_pub2015"},{"cancer_study_identifier":"mixed_msk_tcga_2021","name":"RAD51B Associated Mixed Cancers (MSK, NPJ Breast Cancer 2021)","type_of_cancer_id":"mixed","sample_count":17,"has_guide":false,"url":"https://www.cbioportal.org/study/summary?id=mixed_msk_tcga_2021"}]}

═ answer (success)
More than one TCGA breast cancer study is available, so I need to know which one you want before I run the analysis:

- Breast Invasive Carcinoma (TCGA, PanCancer Atlas), `brca_tcga_pan_can_atlas_2018`, 1,084 samples
- Breast Invasive Carcinoma (TCGA, Firehose Legacy), `brca_tcga`, 1,108 samples
- Invasive Breast Carcinoma (TCGA GDC, 2025), `brca_tcga_gdc`, 1,102 samples
- Breast Invasive Carcinoma (TCGA, Nature 2012), `brca_tcga_pub`, 825 samples
- Breast Invasive Carcinoma (TCGA, Cell 2015), `brca_tcga_pub2015`, 818 samples

Should I use one of these, or all of them? The PanCancer Atlas study is the usual default.

I also need you to define "high MYC expression". The usual choices are:

- **Z-score threshold:** for example, mRNA z-score > 1.5 or > 2, which is what cBioPortal's OncoPrint uses.
- **Cohort percentile:** for example, the top quartile of MYC expression.

If you don't have a preference, I'll use z-score > 2.

I can only give you the counts for TP53 mutation against high MYC expression, as a 2×2 table. I can't calculate a significance test or call the pattern "co-occurring" or "mutually exclusive". cBioPortal's Mutual Exclusivity tab runs the required Fisher's exact test, and I'll link you to it with the counts.