Optimized digital polymerase chain reaction enables detection of telomerase reverse transcriptase C228T mutation for prognostic assessment in hepatocellular carcinoma

doi:10.4251/wjgo.v17.i12.113289

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World Journal of Gastrointestinal Oncology

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World J Gastrointest Oncol. Dec 15, 2025; 17(12): 113289
Published online Dec 15, 2025. doi: 10.4251/wjgo.v17.i12.113289

Table 1 Clinicopathological characteristics of hepatectomy patients stratified by survival and recurrence status, n (%)

Characteristics	Survival			Recurrence
Characteristics	Live, n = 44	Death, n = 22	P value	No, n = 24	Yes, n = 42	P value
Age			0.432			0.080
≤ 55	26 (59.1)	10 (45.5)		17 (70.8)	19 (45.2)
> 55	18 (40.9)	12 (54.5)		7 (29.2)	23 (54.8)
Gender			0.193			0.512
Male	38 (86.4)	16 (72.7)		21 (87.5)	33 (78.6)
Female	6 (13.6)	6 (27.3)		3 (12.5)	9 (21.4)
ALT			0.501			0.817
≤ 40 U/L	33 (75.0)	14 (63.6)		18 (75.0)	29 (69.0)
> 40 U/L	11 (25.0)	8 (36.4)		6 (25.0)	13 (31.0)
AST			0.117			0.560
≤ 40 U/L	37 (84.1)	14 (63.6)		20 (83.3)	31 (73.8)
> 40 U/L	7 (15.9)	8 (36.4)		4 (16.7)	11 (26.2)
LDH			0.281			0.736
≤ 214 U/L	39 (88.6)	17 (77.3)		21 (87.5)	35 (83.3)
> 214 U/L	5 (11.4)	5 (22.7)		3 (12.5)	7 (16.7)
GGT			0.025^a			0.058
≤ 55 U/L	32 (72.7)	9 (40.9)		19 (79.2)	22 (52.4)
> 55 U/L	12 (27.3)	13 (59.1)		5 (20.8)	20 (47.6)
APTT			1.000			0.511
≤ 34.6 seconds	37 (84.1)	18 (81.8)		19 (79.2)	36 (85.7)
> 34.6 seconds	7 (15.9)	4 (18.2)		5 (20.8)	6 (14.3)
AFP			0.003^a			0.817
≤ 200 ng/mL	37 (84.1)	10 (45.5)		18 (75.0)	29 (69.0)
> 200 ng/mL	7 (15.9)	12 (54.5)		6 (25.0)	13 (31.0)
Cirrhosis			0.739			0.733
No	8 (18.2)	3 (13.6)		3 (12.5)	8 (19.0)
Yes	36 (81.8)	19 (86.4)		21 (87.5)	34 (81.0)
Alcohol			0.258			0.561
No	24 (54.5)	8 (36.4)		10 (41.7)	22 (52.4)
Yes	20 (45.5)	14 (63.6)		14 (58.3)	20 (47.6)
Tumor number			0.720			0.306
Single	38 (86.4)	18 (81.8)		22 (91.7)	34 (81.0)
Multiple	6 (13.6)	4 (18.2)		2 (8.3)	8 (19.0)
Tumor diameter			1.000			1.000
≤ 2 cm	3 (6.8)	1 (4.5)		1 (4.2)	3 (7.1)
> 2 cm	41 (93.2)	21 (95.5)		23 (95.8)	39 (92.9)
MVI¹			0.052			0.722
Negative	30 (75.0)	10 (45.5)		15 (68.2)	25 (62.5)
1	7 (17.5)	8 (36.4)		4 (18.2)	11 (27.5)
2	3 (7.5)	4 (18.2)		3 (13.6)	4 (10.0)
Differe			0.132			0.322
High	9 (20.5)	1 (4.5)		5 (20.8)	5 (11.9)
Medium	28 (63.6)	14 (63.6)		16 (66.7)	26 (61.9)
Low	7 (15.9)	7 (31.8)		3 (12.5)	11 (26.2)
LCI			1.000			1.000
No	19 (43.2)	9 (40.9)		10 (41.7)	18 (42.9)
Yes	25 (56.8)	13 (59.1)		14 (58.3)	24 (57.1)
BVI			0.022^a			0.325
No	37 (84.1)	12 (54.5)		20 (83.3)	29 (69.0)
Yes	7 (15.9)	10 (45.5)		4 (16.7)	13 (31.0)
BCLC			0.551			0.388
A	13 (29.5)	4 (18.2)		7 (29.2)	10 (23.8)
B	29 (66.0)	16 (72.7)		17 (70.8)	28 (66.7)
C	2 (4.5)	2 (9.1)		0 (0.0)	4 (9.5)
Digital polymerase chain reaction TERT mutation			0.066			0.005^a
No	28 (63.6)	8 (36.4)		19 (79.2)	17 (40.5)
Yes	16 (36.4)	14 (63.6)		5 (20.8)	25 (59.5)
Sanger TERT mutation			0.786			0.038^a
No	28 (63.6)	13 (54.5)		19 (79.2)	21 (50.0)
Yes	16 (36.4)	9 (45.5)		5 (20.8)	21 (50.0)

¹Four patients had missing data.

^aP < 0.05 was significant.

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDH: Lactate dehydrogenase; GGT: Gamma-glutamyl transferase; APTT: Activated partial thromboplastin time; AFP: Alpha fetoprotein; MVI: Microvascular invasion; Differe: Tumor differentiation; LCI: Liver capsular invasion; BVI: Blood vessel invasion; BCLC: Barcelona Clinic Liver Cancer; TERT: Telomerase reverse transcriptase.

Full Size Table

Table 2 Univariate and multivariate Cox regression analyses of overall survival and disease-free survival in hepatocellular carcinoma patients after hepatectomy

Characteristics	OS, univariate analysis		OS, multivariate analysis		DFS, univariate analysis		DFS, multivariate analysis
Characteristics	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Age (> 55/≤ 55)	0.65 (0.28-1.50)	0.311			0.64 (0.35-1.18)	0.149
Gender (female/male)	1.81 (0.71-4.64)	0.214			1.43 (0.68-3.00)	0.341
ALT (≤ 40/> 40 U/L)	1.70 (0.71-4.05)	0.235			1.45 (0.76-2.80)	0.264
AST (≤ 40/> 40 U/L)	2.84 (1.17-6.90)	0.021^a	1.17 (0.42-3.24)	0.766	1.70 (0.85-3.39)	0.132
LDH (≤ 214/> 214 U/L)	1.71 (0.63-4.63)	0.295			1.22 (0.54-2.74)	0.639
GGT (≤ 55/> 55 U/L)	3.40 (1.43-8.10)	0.006^a	2.40 (0.88-6.54)	0.087	2.53 (1.37-4.68)	0.003^a	2.14 (1.13-4.05)	0.019^a
APTT (> 34.6 seconds/≤ 34.6 seconds)	0.99 (0.33-2.93)	0.984			1.45 (0.61-3.46)	0.398
AFP (> 200/≤ 200 ng/mL)	0.28 (0.12-0.66)	0.004^a	0.36 (0.13-0.98)	0.044^a	0.91 (0.49-1.68)	0.756
Cirrhosis (yes/no)	0.85 (0.25-2.86)	0.788			1.41 (0.65-3.06)	0.380
Alcohol (no/yes)	2.13 (0.89-5.11)	0.090			0.93 (0.51-1.70)	0.806
Tumor number (single/multiple)	1.46 (0.49-4.33)	0.495			1.61 (0.75-3.49)	0.224
Tumor diameter (> 2 cm/≤ 2 cm)	0.62 (0.08-4.64)	0.644			1.44 (0.44-4.68)	0.545
MVI		0.038^a				0.634
Negative	Reference				Reference
2	3.58 (1.11-11.53)	0.032^a	1.24 (0.22-6.84)	0.806	1.25 (0.43-3.59)	0.683
1	2.68 (1.05-6.82)	0.038^a	0.89 (0.20-4.04)	0.877	1.40 (0.69-2.86)	0.353
Differe		0.086				0.086
Medium	Reference				Reference
High	0.27 (0.04-2.08)	0.210			0.74(0.29-1.94)	0.544
Low	2.14 (0.85-5.37)	0.105			2.02 (1.00-4.11)	0.052
LCI (yes/no)	0.97 (0.41-2.29)	0.948			1.08 (0.59-2.01)	0.797
BVI (no/yes)	4.36 (1.82-10.43)	< 0.001^a	2.23 (0.50-9.84)	0.292	2.19 (1.13-4.23)	0.020^a	2.27 (1.15-4.50)	0.018^a
BCLC		0.230				0.096
A	Reference				Reference
B	1.66 (0.55-4.97)	0.365			2.50 (1.01-6.14)	0.047^a
C	2.64 (0.48-14.53)	0.264			1.67 (0.75-3.72)	0.206
TERT mutation (no/yes)	2.70 (1.12-6.54)	0.028^a	2.27 (0.84-6.14)	0.107	2.69 (1.45-5.02)	0.002^a	2.43 (1.28-4.63)	0.007^a

^aP < 0.05 was significant.

OS: Overall survival; DFS: Disease-free survival; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDH: Lactate dehydrogenase; GGT: Gamma-glutamyl transferase; APTT: Activated partial thromboplastin time; AFP: Alpha fetoprotein; MVI: Microvascular invasion; Differe: Tumor differentiation; LCI: Liver capsular invasion; BVI: Blood vessel invasion; BCLC: Barcelona Clinic Liver Cancer; TERT: Telomerase reverse transcriptase; HR: Hazard ratio; CI: Confidence interval.

Full Size Table

Citation: Aizimuaji Z, Hu N, Li HY, Wang XJ, Ma S, Wang YR, Zheng RQ, Li Z, Zhao H, Rong WQ, Xiao T. Optimized digital polymerase chain reaction enables detection of telomerase reverse transcriptase C228T mutation for prognostic assessment in hepatocellular carcinoma. World J Gastrointest Oncol 2025; 17(12): 113289
URL: https://www.wjgnet.com/1948-5204/full/v17/i12/113289.htm
DOI: https://dx.doi.org/10.4251/wjgo.v17.i12.113289