Evolutionary Paths and the ‘Bad Apple’ Effect in Hepatocellular Carcinoma

An atlas of hepatocellular carcinoma revealed seven genetic evolutionary paths influencing patient clinical trajectories. Most notably, the ‘bad apple’ effect showed that the aggressive cell fraction within tumors predicted prognosis better than overall heterogeneity levels, reshaping how clinicians predict survival. This study highlights the importance of tumor evolution in prognosis post-surgery and suggests personalized therapies based on tumor profiles, emphasizing the need for multi-region sampling and integrating multi-omics biomarkers in therapeutic decision-making.