PIGU overexpression adds value to TNM staging in the prognostic stratification of patients with hepatocellular carcinoma

Summary Phosphatidylinositol glycan anchor biosynthesis class U (PIGU), which is a critical subunit of the glycosylphosphatidylinositol transamidase (GPI-T) complex, has been reported to be an oncogene in bladder cancer. However, the expression and prognostic significance of PIGU in hepatocellular carcinoma (HCC) remain unclear. In this study, we conducted bioinformatics, quantitative real-time polymerase chain reaction, and immunohistochemistry analysis to investigate the expression profile of GPI-T subunits in HCC tissues, finding that PIGU was the most significantly overexpressed GPI-T subunit in HCC tissues at both the RNA and protein levels. Using Kaplan-Meier analysis and Cox proportional hazards regression models, we then comprehensively explored the prognostic impact of overexpressed PIGU in HCC patients in 2 independent HCC cohorts, and the results showed that overexpressed PIGU was an independent predictor for poor survival in HCC patients. Furthermore, based on the constructed nomogram, we proposed a risk score combining PIGU expression with the standard TNM staging system and provided a more powerful tool for the prognostic stratification of HCC patients. We also investigated the potential functional role of PIGU in HCC by performing bioinformatic analysis, indicating that PIGU might be involved in cell cycle–related biological processes in HCC. In conclusion, our findings suggest that PIGU overexpression provides independent and complementary prognostic information in HCC patients and that incorporation of this information with the traditional TNM staging system can improve prognostic stratification.