Telomerase reverse transcriptase (TERT) promoter mutation correlated with intratumoral heterogeneity in hepatocellular carcinoma

Wit Thun Kwa, Kathryn Effendi, Ken Yamazaki, Naoto Kubota, Mami Hatano, Akihisa Ueno, Yohei Masugi, Michiie Sakamoto

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Telomerase reverse transcriptase (TERT) promoter mutations are frequently observed in hepatocellular carcinoma (HCC); however, the impact of TERT promoter mutations (TPMs) on clinical features and morphological patterns in HCC remains unresolved. Using DNA extracted from 97 HCCs, correlations between TPM status and both the clinical features of HCC and the immunohistochemically-based subgroups were evaluated. Morphological tumor patterns were semi-quantitatively analyzed using hematoxylin and eosin-stained slides of the whole tumor cross-sectional area. The percentages of tumor area occupied by early, well, moderate and poor histological patterns were calculated as a homogeneity index. TPMs were observed in 53 of 97 (55%) HCCs and were significantly associated with older age (P = 0.018) and HCV-related background (P = 0.048). The biliary/stem cell marker-positive subgroup was less likely to have TPMs (29%) compared to the Wnt/β-catenin signaling marker-positive subgroup (60%). In contrast to TPM-negative HCCs, TPM-positive HCCs clearly exhibited intratumoral morphological heterogeneity (0.800 ± 0.117 vs 0.927 ± 0.096, P < 0.0001), characterized by two or more heterogeneous histological patterns (P < 0.0001) and had more well or early differentiated histological patterns (P = 0.024). Our findings showed that intratumoral heterogeneity was strongly related to TPM-positive HCCs, which established novel roles of TPMs, and may improve our understanding particularly about HCC development and diagnosis.

Original languageEnglish
Pages (from-to)624-632
Number of pages9
JournalPathology international
Issue number9
Publication statusPublished - 2020 Sept 1


  • DNA sequencing
  • HCC histological pattern
  • TERT promoter mutation
  • hepatocellular carcinoma
  • homogeneity index
  • immunohistochemistry-based HCC subgroup
  • intratumoral heterogeneity

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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