Differences in Pathway Activity across Grades and Stages in Human Hepatocellular Carcinoma

While only the sixth most common cancer globally, liver cancer is the third most deadly. Despite the importance of accurate diagnosis and effective treatment, standard diagnostic tests for most solid organ neoplasms are not required for the most common type of liver cancer, Hepatocellular Carcinoma (HCC). In addition, major discrepancies in the practices currently in place limits the ability to develop more precise oncological treatment and prognosis. This study aimed to identify biomarkers, with potential to more accurately diagnose how far cancer has advanced within a patient and determine prognosis. It is the hope that pathways provided by this study form the basis for future research into more standardized practices and potential treatment based on specific affected biological processes. The PathOlogist tool was utilized to calculate activity metrics for 1,324 biological pathways in 374 The Cancer Genome Atlas (TCGA) hepatocellular carcinoma donors. Further statistical analysis was done on two datasets, formed to identify grade or stage at time of diagnosis for the activity levels calculated by PathOlogist. The datasets were evaluated individually. Based on the variance and normality of each pathway’s activity levels in the respective data sets analysis of variance, Tukey-Kramer, Kruskal-Wallis, and Mann-Whitney-Wilcox tests were performed, when appropriate, to determine any statistically significant differences in pathway activity levels. Pathways were identified in both stage and grade data analyses that show significant differences in activity levels across designation. While some overlap is seen, there was a significant number of pathways unique to either stage or grade. These pathways are known to affect the cell cycle, cellular transport, disease, immune system, and metabolism regulation. The biological pathways named by this research depict prospective biomarkers for progression of hepatocellular carcinoma per subdivision within both stage and grade. These findings may be instrumental to new methods of early and more accurate diagnosis. The distinct differences in identified pathways in grade and stage illustrate the need for these new methods to not only look at stage but also grade when determining prognosis. Furthermore, the pathways identified herein have potential to aid in the development of targeted treatment based on the affected biological processes.