High expression of TRAF4 in hepatocelullar carcinoma as an independent negative survival and recurrence predictor

Objective: To identify potential tumor markers for the development and recurrence of hepatocelullar carcinoma(HCC), this research studied the relationship between the expression of the tumor necrosis factor receptor-associated factor 4(TRAF4) and tumor angiogenesis together with its survival time of HCC patients. Methods: The expressions of TRAF4,vascular endothelial growth factor and CD34 were performed upon 90 patients with curative liver resection between August 2006 and November 2009 by immunohistochemical method in locally advanced HCC and adjacent non-tumoral liver. The expression of TRAF4 was determined by the Spearman rank correlation. Their prognostic factors on disease free survival(DFS) and overall survival(OS) were guaranteed by Kaplan-Meier and Cox regression analyses. The detection of the levels of vascular endothelial growth factor and CD34 was fulfilled in 90 cases of HCC. Results: TRAF4 expression was both significantly higher in HCC than in surrounding non-tumor tissues(57.8% vs. 22.2 %; P0.001) and significantly correlated with tumor size and tumor staging. High TRAF4 was correlated with reduced DFS rate(P=0.001) and overall OS rate(P0.001) and were displayed in Kaplan-Meier survival analysis. Conclusions: TRAF4 is involved with multifarious clinicopathologic features.TRAF4 expression, as an independent adverse prognostic factor, DFS and OS in HCC, is associated with increased tumor angiogenesis. The combined detection of TRAF4 in locally advanced HCC is a trustworthy predictive factor for the tumor development and recurrence.     

肝细胞癌组织中Fas抗原和bcl-2蛋白的表达

目的 了解Ｆａｓ抗原及ｂｃｌ－２蛋白在肝癌中的意义。方法 用流式细胞技术对２６例肝细胞癌（ＨＣＣ）癌组织及相应硬变肝组织,以及１４例正常肝组织中Ｆａｓ抗原和ｂｃｌ－２蛋白的表达进行分析。结果 上述３种组织中均测到Ｆａｓ抗原和ｂｃｌ－２蛋白。ＨＣＣ组织中Ｆａｓ明显高于硬变肝组织中的表达（Ｐ〈０．０５）,而与正常肝组织Ｆａｓ表达差异无统计学意义（Ｐ〉０．０５）。ｂｃｌ－２在肝癌组织中明显低于正常组肝组     

Tumor cyclooxygenase-2 levels correlate with tumor invasiveness in human hepatocellular carcinoma

ABM: Recent studies suggested that cyclooxygenase-2 (COX-2) enhances tumor angiogenesis via upregulation of vascular endothelial growth factor (VEGF). Although COX-2 expression has been demonstrated in hepatocellular carcinoma (HCC), the significance of COX-2 in progression of HCC remains unclear. This study evaluated the clinico-pathological correlation of COX-2 level and its relationship with VEGF level in HCC. METHODS: Fresh tumor tissues were obtained from 100 patients who underwent resection of HCC. COX-2 protein expression was examined by immunohistochemistry, and quantitatively by an enzyme immunometric assay (EIA) of tumor cytosolic COX-2 levels. Tumor cytosolic VEGF levels were measured by an ELISA. RESULTS: Immunostaining showed expression of COX-2 in tumor cells. Tumor cytosolic COX-2 levels correlated with VEGF levels (r = 0.469,P<0.001). Correlation with clinicopathological features showed significantly higher tumor cytosolic COX-2 levels in the presence of multiple tumors (P = 0.027), venous invasion (P = 0.030), microsatellite lesions (P=0.037) and advanced tumor stage (P = 0.008). Higher tumor cytosolic COX-2 levels were associated with worse patient survival. CONCLUSION: This study shows that elevated tumor COX-2 levels correlate with elevated VEGF levels and invasiveness in HCC, suggesting that COX-2 plays a significant role in the progression of HCC.     

Elevation of endoglin (CD105) concentrations in serum of patients with liver cirrhosis and carcinoma

OBJECTIVE: Liver cirrhosis is considered as a premalignant state, as about 80% of hepatocellular carcinoma (HCC) is associated with liver cirrhosis. Although alpha-fetoprotein (AFP) has a high negative predictive value, its sensitivity for detecting HCC is poor. The aim of this study was to evaluate circulating endoglin (CD105) in the serum of patients with liver cirrhosis and at high risk for HCC. METHODS: CD105 and AFP serum concentrations were measured in 70 healthy and 94 nonliver-diseased controls and 130 patients with chronic liver diseases and HCC, respectively. RESULTS: Fifty-seven liver cirrhotic patients, 45 patients with liver cirrhosis plus HCC, 19 liver fibrosis patients and nine patients with HCC only were studied. Serum CD105 is significantly elevated in liver cirrhotic patients compared with healthy (P<0.0001) and nonliver-diseased controls (P<0.0001). Patients with liver cirrhosis and HCC show the highest CD105 concentrations being significantly elevated in comparison to liver cirrhosis (P=0.0006) and HCC only (P=0.0134). A stronger positive correlation exists between CD105 and AFP in the patient group suffering from liver cirrhosis and HCC (r=0.479, P=0.0015) than the obtained correlation between both markers in the group of patients diagnosed with liver cirrhosis alone (r=0.358, P=0.0073). The logistic regression model identified CD105 as an independent marker (P=0.0077, odds ratio 1.3). CONCLUSION: CD105 has the potential to be a novel complementary biomarker that has some important bearing on the risk assessment for development of HCC in cirrhotic patients.     

Oncogenic Wnt3a expression as an estimable prognostic marker for hepatocellular carcinoma

AIM: To investigate member 3a of Wingless-type MMTV integration site family(Wnt3a) expression in cancerous and surrounding tissues and the relationship between clinicopathologic features of hepatocellular carcinoma(HCC) and Wnt3 a expression.METHODS: Wnt3 a expression and cellular distribution and clinicopathologic characteristics in cancerous tissue and matched surrounding tissues were analyzed in 80 HCC patients from January 2006 to August 2008 by tissue microarrays and immunohistochemistry. The overall and disease-free survival rates were estimated using the Kaplan-Meier method and compared with the log-rank test. The prognostic analysis was carried out with univariate and multivariate Cox regressions models.RESULTS : The incidence of oncogenic Wnt3a expression in the cancerous group was up to 96.25%(77 of 80), which was significantly higher(χ2 = 48.818, P 0.001) than that in the surrounding group(46.25%, 37 of 80). Brown Wnt3 a staining gradually increased with clinical staging that showed very strong staining in advanced HCC. The clinicopathologic features of high Wnt3 a expression in HCC were related to poorlydifferentiated grade(χ2 = 20.211, P 0.001), liver cirrhosis(χ2 = 8.467, P 0.004), hepatitis B virus(HBV) infection(χ2 = 12.957, P 0.001), higher tumor-nodemetastasis stage(χ2 = 22.960, P 0.001), and 5-year survival rate(χ2 = 15.469, P 0.001).CONCLUSION: Oncogenic Wnt3 a expression associated with HBV infection and cirrhotic liver might be an independent prognostic factor for HCC.     

Expression pattern of angiogenic factors and prognosis after hepatic resection in hepatocellular carcinoma: importance of angiopoietin-2 and hypoxia-induced factor-1 alpha.

BACKGROUND: Hepatocellular carcinoma (HCC) is a hypervascular tumor and angiogenesis plays an important role in its progression. Angiogenesis is regulated by a balance between pro and antiangiogenic molecules. The aim of this study was to investigate the expressions of angiogenic factors and elucidate their roles in angiogenesis in HCC. METHODS: We investigated immunohistochemical expression of vascular endothelial growth factor (VEGF), angiopoietins (Ang-1 and Ang-2), hypoxia-induced factor-1alpha (HIF-1alpha) and thrombospondin-1 (TSP-1) in 60 specimens of surgically resected HCC. We investigated the relationship between their expressions and clinicopathological factors or prognosis. RESULTS: Ang-2 staining had a significant correlation with the grade of differentiation of HCC cells (P=0.0082). VEGF and Ang-2 expression correlated positively with microvessel density (MVD) (P=0.0061 and 0.0374, respectively). MVD of well-differentiated HCC were significantly lower than those of moderately and poorly differentiated HCC. The disease-free survival time of patients with high Ang-2 and/or HIF-1alpha expression was significantly shorter than that of the low expression group (P=0.0278 and 0.0374, respectively). CONCLUSION: Our study showed that the expression of VEGF and Ang-2 correlated with MVD. Strong Ang-2 expression and/or high nuclear expression of HIF-1alpha is a significant predictive factor for recurrence after curative resection in HCC patients.     

CD34与CD117在人肝癌组织中的表达及其临床意义

目的 研究肝细胞肝癌组织中CD34与CD117的表达情况,探讨其与临床病理的关系及其对肝细胞肝癌(HCC)患者预后的评价.方法 应用免疫组织化学PV-9000二步法检测55例HCC组织标本中CD34和CD117的表达,并与临床病理学指标和术后无瘤生存期进行比较分析,对照组为肝硬化组织10例,正常肝组织6例.采用SPSS16.0统计分析软件对CD34和CD117表达结果及与临床病理参数的关系进行Fisher精确检验,Pearson χ2检验,Kaplan-Meier生存分析,Log-Rank检验,Cox回归模型分析等检验.结果 CD34在HCC组、肝硬化组和正常肝组织组表达阳性率分别为65.4%、20.0%和16.7%,HCC组织中的阳性率大于肝硬化组织(P=0.012)及正常肝组织组(P=0.031),差异有统计学意义.但正常肝组织组与肝硬化组比较,差异无统计学意义.CD34表达在HCC组中与脉管瘤栓、中瘤分化程度有密切相关性,χ2值分别为4.000和11.008,P值分别为0.046和0.001.CD117在HCC组、肝硬化组和正常肝组织组表达阳性率分别为47.3%、10%和0,HCC组阳性率大于肝硬化组(P=0.037)及正常肝组织(P=0.033),差异无统计学意义.但正常肝组织与肝硬化组比较,差异无统计学意义.CD117表达在HCC组中与肿瘤分化程度、肿瘤分期有相关性,χ2值分别为5.115和15.459,P值分别为0.024和0.000.HCC组CD34阳性组及CD34阴性组的中位无瘤生存时间分别为17个月和19个月,CD34阳性组较CD34阴性组无瘤生存时间缩短,χ2=4.105,P=0.043,差异有统计学意义.CD117阳性组及CD117阴性组的中位无瘤生存时间分别为12个月和19个月,CD117阳性组的无瘤生存时间较CD117阴性组也明显缩短,χ2=28.023,P=0.000,差异有统计学意义.COX多因素分析显示CD117表达、血清甲胎蛋白水平及肿瘤大小是HCC患者术后2年无瘤生存时间的独立预后因素.结论 CD34与CD117可能在HCC发生、发展过程中具有重要作用,有望成为判断预后的指标.     

Absence of Clinical Prognostic Value of Vascular Endothelial Growth Factor and Microvessel Density in Multiple Myeloma

Vascular endothelial growth factor (VEGF) is considered a potent stimulator of angiogenesis. In multiple myeloma (MM), it has been reported that bone marrow angiogenesis parallels tumor progression and correlates with a poor prognosis. To investigate the role of angiogenesis in MM, we investigated VEGF expression and microvessel density (MVD) in the bone marrow of 75 MM patients by immunohistochemical methods. VEGF expression was observed in 87.3% (62 of 71) of patients. MVD was 69.42 +/- 9.67 (mean +/- SE) compared with the normal control values of 26.81 +/- 2.85. MVD values were 73.98 +/- 11.27 and 36.04 +/- 6.99 in the VEGF-positive and VEGF-negative groups, respectively. The MVD of patients in the VEGF-positive group was significantly higher than in the VEGF-negative group (P = .045). However, there were no significant differences in various clinical parameters, such as age, sex, hemoglobin, platelet count, serum levels of albumin, calcium, creatinine, and beta2-microglobulin, and bone marrow plasma cell percentage, between the VEGF-positive and VEGF-negative groups. Multivariate analysis revealed that age, hemoglobin, platelet count, serum levels of albumin and creatinine, and bone marrow plasma cell percentage were correlated with overall survival, whereas VEGF expression or MVD was not. In conclusion, our results suggest that VEGF is highly expressed and that MVD is increased in MM, indicating that angiogenesis may play a role in MM. Although MVD in the bone marrow of the VEGF-positive group is significantly higher compared with the VEGF-negative group (P = .045), VEGF is not correlated with overall survival. Further studies that include other angiogenic factors are needed to determine the functional role of angiogenesis in MM.     

人肝癌组织血管内皮生长因子及微血管密度分析的临床价值

目的 探讨血管内皮生长因子(VEGF)在肝癌(HCC)微血管形成、生长和转移方面的作用。 方法 以免疫组织化学法分析36例HCC组织中VEGF表达状态和细胞内分布,采用微血管染色方法测定微血管密度(MVD),并定量检测癌及癌周组织中总RNA和VEGF水平。 结果 所有HCC组织中VEGF阳性率为63.9％,无包膜组为78.3％,伴有远处转移组为90.9％;VEGF表达与MVD密切相关(t=4.49,,P<0.01);HCC组织VEGF水平或MVD值,在肿瘤直径大小组及肿瘤分化程度高低组间差异无显著性;HCC组织总RNA水平低于癌旁及远癌组织,而VEGF水平明显高于癌旁和远癌组织(q=6.10,P<0.01)。 结论VEGF过度表达和MVD异常是反映HCC侵润生长及转移的有效指标。     

Clinicopathological features of hepatocellular carcinoma evaluated by vascular endothelial growth factor expression

AIM: To evaluate the significance of the expression of vascular endothelial growth factor (VEGF), its correlation with clinicopathological variables were studied in the tissue of hepatocellular carcinoma (HCC) and surrounding liver. METHODS: In 56 samples (tumor and non-tumor liver tissue) collected from 28 patients, VEGF expression was examined by immunohistochemistry and western blot analysis. RESULTS: The value of VEGF expression by western blotting was correlated with immunohistochemical staining grade. In tumor tissue, the value of VEGF expression correlated with tumor size (P = 0.034), á-fetoprotein (P = 0.036) and protein induced by vitamin K absence-II by simple regression, and histological grade (P = 0.0132) by the unpaired t-test. The level of VEGF expression in non-tumor liver was found to correlate with the value of serum albumin (P = 0.008), cholinesterase (P = 0.012) and prothrombin activity (P = 0.046). The frequency of simple nodular type in gross appearance decreased in cases with high tumor/non-tumor (T/N) ratio (P = 0.022), and the degree of portal vein invasion progressed with an increase in the T/N ratio (P = 0.008). The T/N ratio was significantly higher in early recurrence cases (P = 0.0081). CONCLUSION: This study on the expression of VEGF might be useful to estimate the liver condition and the clinicopathological features of HCC.     

人蛋白酶体β亚基4型在肝细胞癌中的表达及与预后的关系

目的 探讨人蛋白酶体β亚基4型(PSMB4)在肝细胞癌(以下简称肝癌)组织及正常肝组织中的表达及其在临床预后中的意义。方法 收集2017年1月-10月在南通大学附属医院行手术治疗的8例肝癌组织及癌旁组织标本,应用Western Blot法检测肝癌组织及相应癌旁组织中PSMB4蛋白的表达情况。另收集2009年1月-2012年10月南通大学附属医院留存的105例肝癌组织和25例正常肝组织的石蜡包埋标本,应用免疫组化法进一步检测PSMB4的表达情况。根据PSMB4免疫组化结果差异将105例肝癌患者分为PSMB4高表达组(n=57)和PSMB4低表达组(n=48)。计量资料2组间比较采用独立样本t检验;计数资料2组间比较采用χ2检验。Cox风险回归模型分析2组患者临床病理特征及预后的关系,Kaplan-Meier生存曲线分析不同PSMB4水平患者的生存情况。结果 2组间HBV感染、肿瘤最大直径、肿瘤分化程度、TNM分期比较差异均有统计学意义(χ^2值分别为22.482、8.219、14.964、6.587,P值均<0.05)。105例肝癌患者中57例(54.29%)为PSMB4 高表达,48例(45.71%)为PSMB4低表达;而25例正常肝组织中8例(32%)为PSMB4高表达,17例(68%)为PSMB4低表达或不表达,2组表达情况比较差异有统计学意义(χ^2=4.011, P<0.05)。PSMB4染色主要分布于细胞浆和细胞核内,染色呈棕色及棕黄色颗粒样。8例新鲜肝癌及癌旁组织样本中有7例肝癌组织的PSMB4蛋白表达水平明显高于癌旁组织(P值均<0.05)。单因素分析显示患者的5年生存状态与肿瘤大小(P=0.01)、转移情况(P<0.001)、分化程度(P=0.01)、TNM分期(P=0.003)以及PSMB4表达水平(P<0.001)有关;多因素结果显示肿瘤转移[风险比(HR)=11.375,95%可信区间(95%CI):4.911~26.348)]和PSMB4高表达(HR=6.834,95%CI: 2.939~15.889)是肝癌患者的独立危险因素(P值均<0.001)。PSMB4高表达组患者5年生存率明显低于PSMB4低表达组(27.6% vs 79.2%, χ^2=22.96,P<0.05)。结论 PSMB4在肝癌组织中的表达增高,并且其高表达是肝癌患者预后的独立危险因素,PSMB4有可能作为肝癌预后的潜在标志及治疗的潜在靶点。     

Effect of preoperative transcatheter arterial chemoembolization on angiogenesis of hepatocellular carcinoma cells

AIM： To evaluate the effects of four types of preoperative transcatheter arterial chemoembolization （TACE） on angiogenesis of hepatocellular carcinoma （HCC） ceils. METHODS： A total of 136 patients with HCC underwent liver resection. One to five courses of TACE prior to liver resection were performed in 79 patients （TACE group）, in which one to four courses of chemotherapy alone were performed in 11 patients （group A）; one to five courses of chemotherapy combined with iodized oil were performed in 33 patients （group B）; one to three courses of chemotherapy combined with iodized oil and gelatin sponge were performed in 23 patients （group C）, one to three courses of chemotherapy combined with iodized oil, ethanol and gelatin sponge were performed in 12 patients （group D）. The other 57 patients only received liver resection （non-TACE group）. The microvessels were marked by CD31. The expression of CD31 and vascular endothelial growth factor （VEGF） protein were detected by immunohistochemical methods. RESULTS： The mean microvessel density （MVD） in HCC cells was significantly higher in groups A, B, C and D than in the nonACE group （P 〈 0.05）. The expression of VEGF protein in HCC cells were significantly higher in groups A, B, C and D than in the non-TACE group （P 〈 0.05）. MVD and the expression of VEGF protein were positively correlated. Mean MVD and the expression of VEGF protein were closely related to the number of courses of TACE and the interval of TACE. CONCLUSION： Four different types of preoperative TACE regimens enhanced angiogenesis in HCC cells by up-regulating the expression of VEGF protein. It is necessary to repress angiogenesis of liver cancer after TACE.     

Clinical value of apoptosis and angiogenesis factors in estimating the prognosis of hepatocellular carcinoma

Purpose Whereas some studies have indicated that the prognosis of hepatocellular carcinoma (HCC) was correlated to some apoptosis and angiogenesis factors: p53, survivin, matrix metalloproteinases (MMPs, including MMP-2 and MMP-9) and vascular endothelial growth factor (VEGF), other studies have failed to confirm this. The aim of the present study is to investigate the expression of p53, survivin, MMPs and VEGF in HCC and the relationship between these factors and the prognosis of HCC patients.Methods The expression of p53, survivin, MMP-2, MMP-9 and VEGF was measured by immunohistochemical assays in the liver resection specimens of 90 patients with HCC.Results The positive rate of p53, survivin, MMP-2, MMP-9 and VEGF was 33.3, 51.1, 60.0, 37.8 and 76.7%, respectively. The expression of MMP-2, MMP-9 and VEGF was correlated to the recurrence of HCC patients, respectively (P < 0.01). No correlation was found between the expression of apoptosis factors (p53 and survivin) and the recurrence of HCC patients, respectively (P > 0.05). The positive correlations were found between MMP-2 and VEGF (r = 0.32, P < 0.01), MMP-9 and VEGF (r = 0.24, P < 0.05). Significant differences of disease-free survival rates occurred among subgroups according to the expression of MMP-2, MMP-9 and VEGF (P < 0.01). Multivariate analysis revealed that macroscopically disseminated nodules, tumor micrometastasis, high serum alpha-fetoprotein level, positive expression of MMP-9 and VEGF were independent recurrence risk factors.Conclusions Our investigation revealed that p53 and survivin could not estimate the prognosis of HCC patients. Angiogenesis factors (MMPs and VEGF) positively correlated to the prognosis of HCC patients. The expression of MMPs and VEGF in HCC tissues could be regarded as a valuable indicator in estimating the prognosis of HCC patients.     

Clinicopathological and prognostic implications of endoglin （CD105） expression in hepatocellular carcinoma and its adjacent non-tumorous liver

AIM: The expression pattern of endoglin (CD105) in hepatocellular carcinoma (HCC) has not been reported so far. We hypothesized that CD105 could differentially highlight a subset of microvessels in HCC, and intratumoral microvessel density (IMVD) by CD105 immunostaining (IMVD-CD105) could provide better prognostic information than IMVD by CD34 immunostaining (IMVD-CD34). METHODS: Paraffin blocks of tumor and adjacent non-tumorous liver tissues from 86 patients who underwent curative resection of HCC were used for this study. Serial sections were stained for CD105 and CD34, respectively, to highlight the microvessels. IMVD was counted according to a standard protocol. RESULTS: In the HCC tissues, CD105 was either negatively or positively stained only in a subset of microvessels. In contrast, CD34 showed positive and more extensive microvessel staining in all cases examined. However, in the adjacent non-tumorous liver sections, CD105 showed a diffuse pattern of microvessel staining in 20 of 86 cases, while CD34 showed negative or only focal staining of the sinusoids around portal area. Correlation with clinicopathological data demonstrated that lower scores of IMVD-CD105 were found in larger sized tumors [mean 41.4/0.74 mm2 (>5 cm tumor) vs 65.9/0.74 mm2 (≤5 cm tumor), P= 0.043] and more aggressive tumors, as indicated by venous infiltration [36.8/0.74 mm2 (present) vs 64.2/0.74 mm2 (absent), P = 0.020], microsatellite nodules [35.1/0.74 mm2 (present) vs 65.9/0.74 mm2 (absent), P= 0.012], and advanced TNM tumor stage [38.8/0.74 mm2 (stage 3 or 4) vs 68.3/0.74 mm2 (stage 1 or 2), P= 0.014]. No prognostic significance was observed when median values were used as cut-off points using either IMVD-CD105 or IMVD-CD34. However, the presence of the diffuse pattern of CD105 expression in the adjacent non-tumorous liver tissues predicted a poorer disease-free survival (median 8.6 vs 21.5 mo, P= 0.026). CONCLUSION: Our data demonstrate that a lower IMVD-CD105 is associated with larger and more aggressive tumors. In this study, IMVD-CD105 did not provide significant prognostic information. However, active angiogenesis as highlighted by diffuse CD105 staining of the microvessels in the adjacent non-tumorous liver tissues is predictive of early recurrence.