Diagnostic and Prognostic Value of Isolated and Combined MCM3 and Glypican-3 Expression in Hepatocellular Carcinoma: A Novel Immunosubtyping Prognostic Model

Despite diagnostic and therapeutic advances, hepatocellular carcinoma (HCC) remains a leading cause of morbidity/mortality worldwide. This retrospective study investigates the isolated and combined mini-chromosome maintenance complex component 3 (MCM3) and glypican-3 (GPC3) immunohistochemical (IHC) expression in HCC. A novel HCC immunosubtyping model based on combined MCM3/GPC3 expression is introduced and tested in comparison with prognostic variables and survival outcomes. Seventy-six HCC patients who underwent hepatectomy were enrolled. After the collection of clinicopathological, laboratory, and 3-year-survival data, IHC was applied to HCC tissue microarray-prepared sections using anti-MCM3 and GPC3. IHC scoring divided HCCs as: MCM3-high and MCM3-low expression, GPC3-positive and GPC3-negative expression, and combined scoring model immunosubtypes: MCM3-high/GPC3-positive; MCM3-low/GPC3-positive; MCM3-high/GPC3-negative, and MCM3-low/GPC3-negative. Statistical and Kaplan-Meier survival analyses were performed using SPSS version 23. MCM3 was expressed in 84.2% of HCCs. MCM3-high HCCs (60.5%) were significantly associated with lack of tumor capsulation, portal vein thrombosis, high grades, advanced stages, and Child-Pugh Scores B and C (all P≤0.05), and had a tendency for multiplicity, metastasis, solid growth pattern, shorter overall survival (OS) and disease-free survival (DFS). GPC3-positve HCCs (56.6%) were significantly associated with multiplicity and higher alfa-fetoprotein (all P≤0.05) with a tendency for shorter OS and DFS. Among all isolated and combined-expression immunosubtypes, MCM3-high/GPC3-positive HCCs had the worst prognosis and the shortest OS and DFS whereas MCM3-low/GPC3-negative immunosubtype showed the best prognosis and had the longest OS and DFS. MCM3 is defined as diagnostic, prognostic marker, and potential therapeutic target in HCC. The novel MCM3/GPC3 immunosubtyping model provides prognostic indications and stratification criteria for patients with HCC.