Sex-biased gene expression and pathway activation in hepatitis-associated HCC.

Hepatocellular Carcinoma (HCC) is one of the main types of liver cancer accounting for 75% of cases and is the second deadliest cancer worldwide. Chronic Hepatitis B (HBV) and Hepatitis C (HCV) remain one of the most important global risk factors and account for 80% of all HCC cases. HCC also exhibits sex-differences with significantly higher incidence and worse prognosis in males. The mechanistic basis of these sex-differences is poorly understood. To identify genes and pathways that are sex-differentially expressed in viral-mediated HCC, we performed differential expression analysis on tumor vs. tumor adjacent samples that were stratified based on sex, viral etiology, and both. The differentially expressed genes were then used in a pathway enrichment analysis to identify potential pathways of interest. We found differentially expressed genes in both sexes and both etiologies. 65 genes were unique to females and 184 genes unique to males. 381 genes are unique to HBV and 195 genes are unique to HCV. We also found pathways that were significantly enriched by the differentially expressed genes. Ten pathways unique to the female tumor tumor-adjacent comparison and a majority of those pathways were a part of the cell cycle. Four enriched pathways unique to male tumor tumor-adjacent and three of them were a part of the immune system. There were no pathways unique to either etiology, but seven pathways shared by both etiologies. Two were a part of the cell cycle and one involved lipid metabolism. These differentially expressed genes and significant pathways are potential targets for individualized therapeutics and diagnostics for HCC.