a The median prevalence of mutational signatures present identified in the three disease stages (Barrett Oesophagus, n = 161; primary tumours, n = 777; metastases, n = 59). The magnitude of the circles is proportional to the median number of mutations contributed by a specific signature to samples within a disease cohort. The causative factor underlying each signature is detailed to the right of the plot when known. DDR = DNA damage repair deficiency; ROS = reactive oxygen species; BER = base excision repair; MMR = mismatch repair deficiency. b Mutational signature contributions compared across the three disease conditions in non-matched, independently measured samples (Barrett Oesophagus, n = 114, green; primary tumours, n = 706, yellow; metastases, n = 55, purple). Only signatures that show a significant change in at least one disease stage are shown (signatures 8 and 18 were stable across disease stages). The centerline of boxes depicts the median values; the bottom and top box edges correspond to the first and third quartiles. The upper and lower whiskers extend from the hinges to the largest and smallest values, respectively, no further than 1.5* the inter-quartile range. Two-sided Wilcoxon signed-rank test p-values are displayed (not adjusted for multiple comparisons). Exact p-values are provided in the Source Data file. c Changes in mutational signature prevalence between matched Barrett Oesophagus (green) and primary tumour samples (yellow, n = 47). Black triangles pointing upwards denote an increase in signature contribution in primary tumours; triangles pointing downwards denote a decrease. The centerline of boxes depicts the median values; the bottom and top box edges correspond to the first and third quartiles. The upper and lower whiskers extend from the hinges to the largest and smallest values, respectively, no further than 1.5* the inter-quartile range. Two-sided Wilcoxon signed-rank test p-values are displayed (not adjusted for multiple comparisons). Only signatures with a significant change are shown. Source data are provided as a Source Data file.