Association of TERT promoter mutations with early recurrence in hepatocellular carcinoma: a subgroup analysis in a Vietnamese cohort

BACKGROUND: Telomerase reverse transcriptase (TERT) promoter mutation is among the most frequent genetic alterations in hepatocellular carcinoma (HCC), closely associated with tumor initiation, progression, and early recurrence; however, its prognostic role remains unclear. This study aimed to investigate the prevalence of TERT promoter mutations in HCC and evaluate their association with early recurrence, and to further explore whether its prognostic impact varies across clinically relevant subgroups. MATERIALS AND METHODS: We retrospectively analyzed 108 patients with histologically confirmed HCC who underwent curative hepatectomy. TERT promoter mutations were identified via Sanger sequencing. The risk of early recurrence, defined as tumor relapse within 24 months after surgery, was assessed using Cox proportional hazards models, including subgroup analyses. RESULTS: TERT promoter mutations were present in 45.4% of patients. While not predictive of early recurrence in the overall cohort (HR = 1.39; 95% CI: 0.76–2.56; p = 0.282), mutation status was significantly associated with reduced recurrence-free survival (RFS) in specific subgroups: patients < 60 years (HR = 3.45; 95% CI: 1.22–9.82; p = 0.020), males (HR = 2.03; 95% CI: 1.02–4.02; p = 0.043), and those with high mitotic activity (HR = 3.60; 95% CI: 1.01–12.80; p = 0.047). CONCLUSION: Although TERT promoter mutations did not predict early recurrence in the overall cohort, they were significantly associated with poorer RFS in defined clinical and pathological subgroups. These findings suggest the context-dependent prognostic value of TERT promoter mutations and may support their potential role in individualized risk stratification following curative resection in HCC.