Background: Hepatocellular carcinoma (HCC) is among the top-five cancer killers worldwide. Here, we describe our analysis of 20 gene signatures with reported prognostic value in a cohort of patients with early stage HCC treated with surgical resection. Methods: We performed gene-expression profiling of 164 formalin-fixed, paraffin-embedded HCC from three hepatology centers participating the HCC Genomic Consortium. We utilized Illumina’s whole-genome DASL assay measuring ~24,000 annotated human genes. We evaluated genomic concordance and prognostic performance of 20 already reported prognostic gene signatures. Additionally, since only the largest nodule was profiled, we also excluded patients with multiple tumors to avoid biases related to intra-individual genomic tumor heterogeneity. Results: Among the 20 signatures evaluated, 15 were able to confidently allocate patients (FDR<0.05) within their predicted poor-outcome subclass. Pairwise comparisons showed a significant overlap between almost all poor-outcome signatures derived from the tumor (P<0.001), except for the metastatic HCC signature. Interestingly, poor-outcome signatures from the tumor were not significantly associated with those obtained from non-tumor adjacent tissue in the same patient. The prognosis analysis for earliest stages (BCLC 0 or A) with single nodules revealed that the G3 signature reported by Boyault et al. Conclusions: We present a composite genomic model for prediction of tumor recurrence in early HCC. It will allow risk stratification, personalized surveillance, and eventually customized interventions in patients with early HCC candidates for resection. Samples with "used for prognostic prediction: yes" were included in the study.
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