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Samreen S, Khan E, Ahmad IZ. Molecular docking and molecular dynamics simulation analysis of bioactive compounds of Cichorium intybus L. seed against hepatocellular carcinoma. J Biomol Struct Dyn 2023:1-12. [PMID: 37621217 DOI: 10.1080/07391102.2023.2250465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/12/2023] [Indexed: 08/26/2023]
Abstract
In this article, bioactive compounds present in Cichorium intybus L. seeds were collected from literature review and analyzed for probable remedy for hepatocellular carcinoma. Cichorium intybus L. is a traditional plant used all over the world mainly in hepatic disorders and renal diseases. This therapeutic plant has many bioactive compounds like chicoric acid, chlorogenic acid, sesquiterpne lactones, stigmasterols etc are found in seeds. Here, the target protein p53 (PDB ID: 2OCJ) which is involved in many cancerous pathways, is chosen. The preADMET study filtered out some compounds which were then subjected to molecular docking studies by Autodock tool 4.2. Afterwards, two best compounds (Esculetin and Isochlorogenic acid) were screened out on the basis of binding energy as compared to the standard compound (Doxorubicin). All these complexes were then analyzed for stability by molecular dynamics using online GROMACS tool. In the comparative simulation study, the compound Esculetin shows a stable interaction with the p53 over the 100 ns trajectory. Hepatocellular carcinoma accounts for high mortality of cancer related death worldwide. These findings suggest that these compound can be used to treat the hepatocellular carcinoma.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Sadiyah Samreen
- Natural Products Laboratory, Department of Bioengineering, Integral University, Lucknow, India
| | - Elhan Khan
- Natural Products Laboratory, Department of Bioengineering, Integral University, Lucknow, India
| | - Iffat Zareen Ahmad
- Natural Products Laboratory, Department of Bioengineering, Integral University, Lucknow, India
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Chang Y, Liu B, Niu H, Wang Z, Xia S, Li H. Value of anti-p53 antibody as a biomarker for hepatocellular carcinoma: Evidence from a meta-analysis. Medicine (Baltimore) 2020; 99:e21887. [PMID: 32846849 PMCID: PMC7447394 DOI: 10.1097/md.0000000000021887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The incidence of hepatocellular carcinoma (HCC) ranks sixth in the world, but its mortality is the third highest due to the lack of early diagnostic markers. Nowadays, the increase of autoantibody levels has been found in many cancers, and many studies have begun to pay attention to the detection of anti-p53 antibodies in HCC. The purpose of this study is to quantitatively and comprehensively analyze the potential diagnostic value of anti-p53 autoantibodies in HCC METHODS:: English articles up to November 2019 were collected. The overall sensitivity and specificity were calculated. Besides, the positive likelihood ratio, negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic curves of the overall diagnostic accuracy of anti-p53 antibody were calculated by STATA software. Finally, according to the heterogeneity of the results, the subgroup analysis, and the publication bias were performed. RESULTS A total of 16 eligible studies were incorporated into this meta-analysis, including 1323 patients with HCC and 1896 control. The pooled sensitivity was 0.28(0.17-0.41) and specificity was 0.98 (0.95-0.99). The pooled DOR was 10.44 (6.31-17.29) and the pooled NLR was 0.74 (0.63-0.86). The area under ROC curve of symmetrical ROC was 0.840. CONCLUSIONS The anti-p53 antibody has a high specificity for HCC, but the low sensitivity is not perfect and would limit the clinical application. The anti-p53 antibody would help rule out HCC but not help rule in HCC for early diagnosis. Whether combined as a diagnostic panel with other biomarkers or laboratory tests may prove useful requires further study.
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Affiliation(s)
- Yue Chang
- Department of Hepatopancreatobiliary and Splenic Medicine, Characteristic Medical Center of People's Armed Police Force
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment
| | - Baiqing Liu
- Department of Hepatopancreatobiliary and Splenic Medicine, Characteristic Medical Center of People's Armed Police Force
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment
| | - Haiyan Niu
- Department of Hepatopancreatobiliary and Splenic Medicine, Characteristic Medical Center of People's Armed Police Force
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment
| | - Zhenguo Wang
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment
| | - Shihai Xia
- Department of Hepatopancreatobiliary and Splenic Medicine, Characteristic Medical Center of People's Armed Police Force
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment
| | - Hai Li
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment
- Division of Gastroenterology and Hepatology, Tianjin Xiqing Hospital, Tianjin, China
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Burkhart RA, Ronnekleiv-Kelly SM, Pawlik TM. Personalized therapy in hepatocellular carcinoma: Molecular markers of prognosis and therapeutic response. Surg Oncol 2017; 26:138-145. [PMID: 28577719 DOI: 10.1016/j.suronc.2017.01.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/31/2016] [Accepted: 01/04/2017] [Indexed: 12/30/2022]
Abstract
Hepatocellular carcinoma (HCC) represents a growing worldwide health crisis with rising incidence, limited effective therapies and persistently poor prognosis. Five-year survival remains less than 20% despite decades of research. One byproduct of research efforts is the identification of numerous biomarkers of disease. From prognosis to therapeutic response, biomarker identification parallels a deeper molecular understanding of the disease that to date has generated limited gain in clinical outcomes. As one example, the classical prognostic biomarkers of tumor Ki-67 protein expression and TP53 gene mutation have been repeatedly demonstrated to correlate with poor prognosis. There have been several studies throughout the past two decades identifying other gene-based biomarkers of prognosis. Critically, translation into the clinic has been slow and focus has shifted to a search for markers of therapeutic response in hopes of generating novel approaches to the disease. With this focus, many of the correlates are based on retrospective review of sorafenib effectiveness. Sorafenib, an oral targeted multi-kinase inhibitor, is currently the standard of care systemic agent for non-resectable disease. The Wnt-pathway, particularly when activated, is the most commonly cited molecular marker of sorafenib responsiveness. Additional work has identified a profile of genes involved in drug absorption, processing, and elimination that also appears to increase responsiveness. Overall, despite promising clinical data the use of biomarkers in the clinic for HCC is limited. In this piece, progress and opportunities for future work "beyond the genome" are highlighted, including metabolomic, epigenetic, and non-coding RNA studies. Additionally, barriers to the implementation of personalized therapeutic selection in HCC are reviewed.
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Affiliation(s)
- Richard A Burkhart
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
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Abe S, Kawai K, Ishihara S, Nozawa H, Hata K, Kiyomatsu T, Tanaka T, Nishikawa T, Ootani K, Yasuda K, Murono K, Watanabe T. Prognostic Value of Pre- and Postoperative Anti-p53 Antibody Levels in Colorectal Cancer Patients: A Retrospective Study. Oncology 2016; 92:31-38. [PMID: 27794579 DOI: 10.1159/000449527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the utility of the post-/preoperative anti-p53 antibody (p53 Ab) ratio as a prognostic factor for colorectal cancer (CRC) recurrence. METHODS A total of 737 nonmetastatic CRC patients who had undergone R0 resection were retrospectively analyzed. p53 Ab levels were measured within 1 month prior to and at least every 3 months after surgery. Post-/preoperative p53 Ab ratios were calculated, and the optimal ratio cutoff values for predicting recurrence were determined using the Kaplan-Meier method and the log-rank test. RESULTS Preoperative p53 Ab elevation was observed in 194 patients (pre-p53 high). Preoperative p53 Ab levels correlated with TNM stage. Re-elevation of p53 Ab levels occurred on recurrence in the pre-p53 high group, but not in the pre-p53 low group (n = 543). In the pre-p53 high group, patients who experienced tumor recurrence exhibited a slow postoperative reduction of p53 Ab levels, and a post-/preoperative p53 Ab ratio >0.4 at postoperative 3 months predicted relapse-free survival. In other words, a p53 Ab level remaining higher than 40% of the preoperative level was an independent and strong risk factor for recurrence in multivariate analyses. CONCLUSION In CRC patients with preoperative p53 Ab elevation, the rate of p53 Ab reduction in the early postsurgical period is a promising prognostic factor for recurrence.
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Affiliation(s)
- Shinya Abe
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Yamaguchi T, Takii Y, Maruyama S. Usefulness of serum p53 antibody measurement in colorectal cancer: an examination of 1384 primary colorectal cancer patients. Surg Today 2013; 44:1529-35. [DOI: 10.1007/s00595-013-0703-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
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Clinical significance of autoantibodies to p53 protein in patients with autoimmune liver diseases. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:125-9. [PMID: 22408762 DOI: 10.1155/2012/890698] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Autoantibodies to p53 (anti-p53) are rarely present in the sera of patients with autoimmune diseases or the sera of patients with malignancies. OBJECTIVE To examine the prevalence of anti-p53 in patients with autoimmune liver disease including autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), AIH⁄PBC overlap syndrome (AIH⁄PBC OS) and primary sclerosing cholangitis (PSC), and to determine the clinical significance of anti-p53 in autoimmune liver diseases. METHODS Forty patients with AIH, 41 patients with PBC, eight patients with AIH⁄PBC OS and five patients with PSC were enrolled. Anti-p53 and antibodies to double-stranded DNA (anti-ds-DNA) were analyzed using commercially available ELISA kits. Demographic, laboratory and histological data were compared between the AIH groups seropositive and seronegative for anti-p53. RESULTS Six of 40 (15.0%) patients with AIH and four of eight (50.0%) patients with AIH⁄PBC OS were positive for anti-p53. One of 41 (2.4%) patients with PBC was also positive for anti-p53, but all five patients with PSC were negative, indicating a significantly higher prevalence of anti-p53 in patients with AIH or AIH⁄PBC OS compared with patients with PBC. None of the AIH patients positive for anti-p53 progressed to hepatic failure or relapsed after immunosuppressive treatment. Titres of anti-ds-DNA in patients with AIH and AIH⁄PBC OS significantly correlated with titres of anti-p53 (r=0.511; P=0.0213). CONCLUSION The emergence of anti-p53 is likely to be useful for discriminating AIH or AIH⁄PBC OS from PBC and helpful for predicting favourable prognoses in patients with AIH. DNA damage may trigger the production of anti-p53 in patients with AIH or AIH⁄PBC OS.
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Molecular and serum markers in hepatocellular carcinoma: Predictive tools for prognosis and recurrence. Crit Rev Oncol Hematol 2012; 82:116-40. [DOI: 10.1016/j.critrevonc.2011.05.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 04/08/2011] [Accepted: 05/18/2011] [Indexed: 12/12/2022] Open
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Liu J, Ma Q, Zhang M, Wang X, Zhang D, Li W, Wang F, Wu E. Alterations of TP53 are associated with a poor outcome for patients with hepatocellular carcinoma: evidence from a systematic review and meta-analysis. Eur J Cancer 2012; 48:2328-38. [PMID: 22459764 DOI: 10.1016/j.ejca.2012.03.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 02/29/2012] [Accepted: 03/02/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognostic significance of p53 aberration in hepatocellular carcinoma (HCC) remains inconclusive. This systematic review and meta-analysis aimed to provide comprehensive evidence on the association of p53 alterations with recurrence-free survival (RFS) and overall survival (OS) in HCC patients. METHODS Systematic literature searches were conducted until July 2010. Meta-analysis was performed to estimate prognostic effects of p53 alterations on patient outcomes in HCC. Sensitivity and subgroup analyses were also conducted in the meta-analysis. RESULTS Thirty-seven studies (7 tumour p53 mutation, 23 tumour p53 expression and 7 serum anti-p53 antibodies) were included in the systematic review and meta-analysis. The average percentages of p53 mutation, p53 expression upregulation and anti-p53 antibody level elevation in HCC patients were 31.5%, 35.0% and 23.8%, respectively. Tumour p53 alterations were associated significantly with poor patient outcomes in HCC: the summary hazard ratio (HR) of mutant p53 versus wild type p53 phenotype was 2.58 [95% confidence interval (CI): 1.96-3.41] for OS and 3.19 [95% CI: 2.21-4.60] for RFS, respectively; and the summary HR of upregulated p53 expression versus low/undetectable p53 expression was 1.68 [95% CI: 1.49-1.90] for OS and 1.89 [95% CI: 1.34-2.66] for RFS, respectively. However, elevated serum anti-p53 antibody was only associated with poor OS in HCC group with a high proportion of (≥ 50%) of hepatitis C virus (HCV) infection [HR: 1.92; 95% CI: 1.30-2.85]. Moreover, sensitivity analyses showed that the results of meta-analyses were not altered. CONCLUSION HCC patients with p53 mutation and upregulated expression in tumour tissue have a shorter OS and RFS than patients with wild type p53 and low/undetectable p53 expression. However, the prognostic value of serum anti-p53 antibody is required to be further examined.
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Affiliation(s)
- Jiangbo Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an, China
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Abstract
BACKGROUND Although there are many studies of the predictors of death in hepatocellular carcinoma (HCC), most combine patients with and without cirrhosis and many combine those with compensated and decompensated cirrhosis. OBJECTIVE To perform a systematic review of the literature evaluating the predictors of death in patients with cirrhosis and HCC and to evaluate whether the predictors differ between patients with compensated and decompensated cirrhosis. INCLUSION CRITERIA (i) publication in English, (ii) adult patients, (c) >80% of the patients had cirrhosis, (iv) follow-up >6 months and (v) multivariable analysis. Quality was based on the accepted quality criteria for prognostic studies. RESULTS Of the 1106 references obtained, 947 were excluded because they did not meet the inclusion criteria. A total of 23 968 patients were included in 72 studies (median, 177/study); 77% male, median age 64, 55% Child-Pugh class A. The most robust predictors of death were portal vein thrombosis, tumour size, alpha-foetoprotein and Child-Pugh class. Sensitivity analysis using only 15 'good' studies and 22 studies in which all patients had cirrhosis yielded the same variables. In the studies including mostly compensated or decompensated patients, the predictors were both liver and tumour related. However, these studies were few and the results were not robust. CONCLUSIONS This systematic review of 72 studies shows that the most robust predictors of death in patients with cirrhosis and HCC are tumour related and liver related. Future prognostic studies should include these predictors and should be performed in specific patient populations to determine whether specific prognostic indicators are more relevant at different stages of cirrhosis.
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Affiliation(s)
- Puneeta Tandon
- Digestive Diseases Section, Yale University School of MedicineNew Haven, CT, USA,VA Connecticut Healthcare SystemWest Haven, CT, USA,Division of Gastroenterology, University of AlbertaEdmonton, AB, Canada
| | - Guadalupe Garcia-Tsao
- Digestive Diseases Section, Yale University School of MedicineNew Haven, CT, USA,VA Connecticut Healthcare SystemWest Haven, CT, USA
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Hui KM. Human hepatocellular carcinoma: expression profiles-based molecular interpretations and clinical applications. Cancer Lett 2008; 286:96-102. [PMID: 19095350 DOI: 10.1016/j.canlet.2008.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 11/04/2008] [Indexed: 12/31/2022]
Abstract
Primary liver cancer is the fifth most common cancer worldwide and hepatocellular carcinoma (HCC) accounts for over 85% of all primary liver cancers. The clinical management of advanced and metastatic HCC is challenging on many counts. Besides largely occurs within a background of underlying chronic liver disease and cirrhosis, HCC is a phenotypically and genetically heterogeneous polyclonal disease and resistant to most conventional chemotherapy. Early manifestation of HCC is characteristically slow growing with few symptoms, and HCC is therefore often diagnosed at an advanced stage when potentially curative surgical or local ablative therapy is not feasible. In this review, I have summarized my presentation at the recent HCC workshop at IARC, Lyon, on our knowledge generated from comprehensive molecular studies of primary liver cancer tissues and attempt to translate these results to gain molecular insights, especially on identification of biomarkers that could confer pathological and functional changes associated with the pathogenesis and progression of HCC, hoping to provide important molecular basis for the development of novel diagnosis and treatments to alter clinical outcomes of this disease.
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Affiliation(s)
- Kam M Hui
- Bek Chai Heah Laboratory of Cancer Genomics, Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research National Cancer Centre, 11 Hospital Drive, Singapore 169610, Singapore.
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Atta MM, El-Masry SA, Abdel-Hameed M, Baiomy HA, Ramadan NE. Value of serum anti-p53 antibodies as a prognostic factor in Egyptian patients with hepatocellular carcinoma. Clin Biochem 2008; 41:1131-9. [DOI: 10.1016/j.clinbiochem.2008.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Revised: 05/15/2008] [Accepted: 06/04/2008] [Indexed: 12/26/2022]
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Liu BH, Goh CHK, Ooi LLPJ, Hui KM. Identification of unique and common low abundance tumour-specific transcripts by suppression subtractive hybridization and oligonucleotide probe array analysis. Oncogene 2008; 27:4128-36. [PMID: 18332864 DOI: 10.1038/onc.2008.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Most human cancers are characterized by genetic aberrations accompanied by altered expression and function of numerous genes. Applying genome-wide, microarray gene expression analysis to identify deregulated genes in different tumour types can provide potential gene candidates as diagnostic and prognostic tools and promising targets for drug development. However, the detection of deregulated genes with low levels of expression remains a major challenge. In this study, we have designed a strategy, termed modified suppression subtractive hybridization (mSSH), to identify genes encoding rare transcripts. The strategy entails incorporating the T(7)-promoter sequence at the 5' end of the noncoding cDNA strand during first strand cDNA synthesis to generate unidirectional antisense RNA from the resultant cDNA following conventional SSH. These transcripts are subsequently analysed by Affymetrix oligonucleotide gene arrays. Here, we have used five hepatocellular carcinoma (HCC), five breast carcinoma and four nasopharyngeal carcinoma (NPC) biopsies separately as testers and their corresponding normal biopsies as drivers to enrich for low abundance tumour type-specific transcripts. The total detectable number of probe sets following mSSH was reduced almost 10-fold in comparison to those detected for the same resected tumour tissues without undergoing subtraction, thus yielding a subtraction efficacy of over 90%. Using this experimental approach, we have identified 48 HCC-specific, 45 breast carcinoma-specific, and 83 NPC-specific genes. In addition, 115 genes were upregulated in all the three cancer types. When compared to gene-profiling data obtained without mSSH, the majority of these identified transcripts were of low abundance in the original cancer tissues. mSSH can therefore serve as a comprehensive molecular strategy for pursuing functional genomic studies of human cancers.
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Affiliation(s)
- B H Liu
- Bek Chai Heah Laboratory of Cancer Genomics, Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore, Singapore
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Saffroy R, Pham P, Reffas M, Takka M, Lemoine A, Debuire B. New perspectives and strategy research biomarkers for hepatocellular carcinoma. Clin Chem Lab Med 2008; 45:1169-79. [PMID: 17635075 DOI: 10.1515/cclm.2007.262] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. Cirrhosis caused by hepatitis B virus, hepatitis C virus or chronic alcohol intake is associated with major risk. Systematic screening for HCC of asymptomatic patients with cirrhosis is needed for earlier detection of small tumors requiring treatment (liver transplantation, surgical resection, percutaneous techniques). The recommended screening strategy among cirrhotic patients is based on regular liver ultrasonography associated with serum alpha-fetoprotein (AFP) assay. As the performance of AFP is not satisfactory, additional tumoral markers are proposed (des-gamma-carboxyprothrombin, glycosylated AFP-L3 fraction). Currently, diagnosis of HCC in cirrhotic patients includes non-invasive tests (imaging after contrast administration, AFP assay); diagnostic biopsy is performed when imaging is limited. After treatment, tumor recurrence is assessed by regular follow-up (AFP assay and imaging). Despite the lack of accurate markers, recent developments in genomic and proteomic approaches will allow the discovery of new biomarkers for primary tumors, as well as for recurrence. This review summarizes the current state of biomarkers for screening, diagnosis and follow-up of HCC, and highlights new perspectives in the field.
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Affiliation(s)
- Raphaël Saffroy
- Service de Biochimie, Biologie Moléculaire et Toxicologie, Hôpital Universitaire Paul Brousse, Université Paris-Sud, UMR-S602, Villejuif, INSERM, Villejuif, France.
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Saif MW, Zalonis A, Syrigos K. The clinical significance of autoantibodies in gastrointestinal malignancies: an overview. Expert Opin Biol Ther 2007; 7:493-507. [PMID: 17373901 DOI: 10.1517/14712598.7.4.493] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Autoimmunity can be associated with cancer and one of the forms of its expression is the development of antibodies to autologous cellular antigens. The types of cellular proteins which induce autoantibody responses in gastrointestinal malignancies are quite varied and include cellular proteins encoded by mutated normal genes (p53), cellular proteins that are overexpressed and/or aberrantly expressed in malignant tissues (carcinoembryonic antigen), inhibitors of apoptosis (survivin and livin), major components of mucus (mucins), surface receptors of apoptosis (Fas) and nuclear-restricted proteins (double-stranded DNA, single-stranded DNA and Sm family proteins). In the past few years, due to the great clinical interest and the advancement in detection techniques, the above list has grown significantly and a large number of cancer-related antigens, which trigger a specific humoral immune response to the host, have also been identified. The authors review the autoantibodies associated with gastrointestinal malignancies and their clinical implications.
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Affiliation(s)
- Muhammad Wasif Saif
- Yale University School of Medicine, Division of Medical Oncology, 333 Cedar Street, FMP 116, New Haven, CT 06520-8032, USA.
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Nanashima A, Sumida Y, Abo T, Shindou H, Fukuoka H, Takeshita H, Hidaka S, Tanaka K, Sawai T, Yasutake T, Nagayasu T, Omagari K, Mine M. Modified Japan Integrated Staging is currently the best available staging system for hepatocellular carcinoma patients who have undergone hepatectomy. J Gastroenterol 2006; 41:250-6. [PMID: 16699859 DOI: 10.1007/s00535-005-1751-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 10/28/2005] [Indexed: 02/06/2023]
Abstract
BACKGROUND We previously reported the effectiveness of the modified Cancer of the Liver Italian Program (CLIP) score in hepatocellular carcinoma (HCC) staging. To determine the best predictive staging system for HCC patients, we conducted a comparative analysis of prognosis using multivariate analysis in 230 Japanese HCC patients following hepatic resection. METHODS We compared overall survival as predicted by different staging systems: the tumor node metastasis (TNM) system by the Liver Cancer Study Group of Japan, the Japan Integrated Staging (JIS) score (Japanese TNM and Child-Pugh classification), the modified JIS score using liver damage grade, the CLIP score, and our modified CLIP score using protein induced by vitamin K absence or the antagonist II (PIVKA-II). RESULTS By a univariate analysis the PIVKA-II level (cut-off level, 400 mAU/ml) was significantly associated with patient survival (P = 0.031); however, alpha-fetoprotein level was not related to survival. Liver damage grade was significantly associated with patient survival (P = 0.039), although Child-Pugh classification was not related to survival. Univariate analysis showed that prediction of survival, according to disease stage, was better with the modified JIS score than with the TNM system, CLIP, modified CLIP, or JIS score. Multivariate analysis showed the modified JIS score showed the best ability to predict overall survival according to disease stage (Hazard ratio, 1.77; P = 0.002), and its Akaike information criteria statistic was the lowest (634.3). CONCLUSIONS The modified JIS score, a staging system that combines tumor factors and hepatic function, is a better predictor of prognosis than other systems in HCC patients who have undergone hepatic resection.
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Affiliation(s)
- Atsushi Nanashima
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Gumus E, Erdamar S, Demirel G, Horasanli K, Kendirci M, Miroglu C. Association of positive serum anti-p53 antibodies with poor prognosis in bladder cancer patients. Int J Urol 2005; 11:1070-7. [PMID: 15663677 DOI: 10.1111/j.1442-2042.2004.00948.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS To assess the association of serum anti-p53 antibodies and overexpression of tumor p53 protein with survival and prognostic factors in patients with urinary bladder tumors. METHODS Seventy-six patients with transitional cell carcinoma of the urinary bladder were assessed prospectively (Ta, 18; T(1), 30; > or =T(2), 28). Serum anti-p53 antibodies were detected by enzyme-linked immunosorbent assay. Tumor p53 gene overexpression was assessed by immunohistochemical staining. The mean follow-up time was 34 months. RESULTS Serum anti-p53 antibodies were positive in 25 patients (33%). Overexpression of tumor p53 protein was positive in 41 patients (54%). There was an association between the presence of serum anti-p53 antibodies and tumor p53 gene overexpression (P = 0.001). The total survival of the patients with positive serum anti-p53 antibodies was shorter than the patients with positive tumor p53 gene overexpression (P < 0.001, P = 0.344, respectively). In the multivariate survival analysis, both tumor stage and serum-p53 antibodies were found to be independent survival predictors (P = 0.004, P = 0.006, respectively). CONCLUSION Serum anti-p53 antibody positive tumors had a worse prognosis than those with negative serum levels, regardless of the p53 status of the tumor.
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Affiliation(s)
- Eyup Gumus
- 2nd Urology Clinic, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
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Shao JY, Gao HY, Li YH, Zhang Y, Lu YY, Zeng YX. Quantitative detection of common deletion of mitochondrial DNA in hepatocellular carcinoma and hepatocellular nodular hyperplasia. World J Gastroenterol 2004; 10:1560-4. [PMID: 15162525 PMCID: PMC4572754 DOI: 10.3748/wjg.v10.i11.1560] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To study the deletion of mitochondiral DNA in hepatocellular carcinoma and hepatocellular nodular hyperplasia and its significance in the development of cancer.
METHODS: Deleted mtDNA (CD-mtDNA) and wild type mtDNA (WT-mtDNA) were quantitatively analyzed by using real-time PCR in 27 hepatocellular carcinomas (HCC) and corresponding noncancerous liver tissues and 27 hepatocellular nodular hyperplasiae (HNH).
RESULTS: A novel CD (4981 bp) was detected in 85% (23/27) and 83% (22/27) of HCC and HNH tumor tissues, respectively, which were significantly higher than that in paired noncancerous liver tissues (57%, 15/27) (P < 0.05). The CD/WT-mtDNA ratio in HCC tumors was 0.00092 (median, interquartile range, 0.0001202 - 0.00105), which was significantly higher than that in paired noncancerous liver tissues (median, 0.000, quartile range, 0 - 0) (P = 0.002, Mann-Whitney Test), and was 25 of times of that in HNH tissues (median, 0.0000374, quartile range, 0 - 0.0004225) (P = 0.002, Mann-Whitney test).
CONCLUSION: CD-mtDNA mutation plays an important role in the development and progression of HCC.
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Affiliation(s)
- Jian-Yong Shao
- Department of Pathology, Cancer Center, Sun Yat-Sen University, Guangzhou 510060, Guangdong Province, China.
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18
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Shimada H, Ochiai T, Nomura F. Titration of serum p53 antibodies in 1,085 patients with various types of malignant tumors: a multiinstitutional analysis by the Japan p53 Antibody Research Group. Cancer 2003; 97:682-9. [PMID: 12548611 DOI: 10.1002/cncr.11092] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND There have been very few large-scale, multiinstitutional studies of surveillance of serum p53 antibodies (S-p53 Abs) in patients with various malignant tumors. METHODS A highly specific, quantitative enzyme-linked immunosorbent assay (ELISA) kit was developed and used to evaluate the efficiency of detecting p53 Abs. A cut-off value was established by analyzing sera from 205 healthy volunteers as reference individuals. Sera from 1085 patients with various types of primary malignant tumors were studied for the presence of S-p53 Abs before treatment. Sera from 34 patients were selected randomly for a competition assay to ensure that antibodies were specific to p53 protein. Carcinoembryonic antigen (CEA) was assessed to compare its positive rate with the positive rate of S-p53 Abs. RESULTS The median value of S-p53 Abs in healthy control individuals was 0.33 U/mL (range, 0.0-4.39 U/mL). Based on reference values that were calculated using parametric determination of the lower 0.95 fraction of the reference distribution in healthy control individuals, the cut-off value was determined as 1.3 U/mL. Two hundred twenty-one of 1085 patients (20.4%) were positive for S-p53 Abs. The highest relevance of S-53 Abs was associated with head and neck carcinoma (32%), followed by esophageal carcinoma (30%), colorectal carcinoma (24%), and carcinoma of the uterus (23%). The positive rate for S-p53 Abs was higher compared with the positive rate for CEA in patients with squamous cell carcinoma. CONCLUSIONS Surveillance of S-p53 Abs is useful in detecting various types of malignant tumors, particular in patients with squamous cell carcinoma.
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Affiliation(s)
- Hideaki Shimada
- Department of Academic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
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19
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Qin LX, Tang ZY, Ma ZC, Wu ZQ, Zhou XD, Ye QH, Ji Y, Huang LW, Jia HL, Sun HC, Wang L. p53 immunohistochemical scoring: an independent prognostic marker for patients after hepatocellular carcinoma resection. World J Gastroenterol 2002; 8:459-63. [PMID: 12046070 PMCID: PMC4656421 DOI: 10.3748/wjg.v8.i3.459] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To confirm if p53 mutation could be a routine predictive marker for the prognosis of hepatocellular carcinoma (HCC) patients.
METHODS: Two hundreds and forty-four formalin-fixed paraffin-embedded tumor samples of the patients with HCC receiving liver resection were detected for nuclear accumulation of p53. The percent of p53 immunoreactive tumor cells was scored as 0 to 3 + in p53 positive region (< 10% -, 10%-30% +, 31%-50% ++, > 50% +++). Proliferating cell nuclear antigen (PCNA) and some clinicopathological characteristics, including patients’ sex, preoperative serum AFP level, tumor size, capsule, vascular invasion (both visual and microscopic), and Edmondson grade were also evaluated.
RESULTS: In univariate COX harzard regression model analysis, tumor size, capsule status, vascular invasion, and p53 expression were independent factors that were closely related to the overall survival (OS) rates of HCC patients. The survival rates of patients with 3+ for p53 expression were much lower than those with 2+ or + for p53 expression. Only vascular invasion (P < 0.05) and capsule (P < 0.01) were closely related to the disease-free survival (DFS) of HCC patients. In multivariate analysis, p53 overexpression (RI 0.5456, P < 0.01) was the most significant factor associated with the OS rates of patients after HCC resection, while tumor size (RI 0.5209, P < 0.01), vascular invasion (RI 0.5271, P < 0.01) and capsule (RI 0.8691, P < 0.01) were also related to the OS. However, only tumor capsular status was an independent predictive factor (P < 0.05) for the DFS. No significant prognostic value was found in PCNA-LI, Edmondson’s grade, patients’ sex and preoperative serum AFP level.
CONCLUSION: Accumulation of p53 expression, as well as tumor size, capsule and vascular invasion, could be valuable markers for predicting the prognosis of HCC patients after resection. The quantitative immunohistochemical scoring for p53 nuclear accumulation might be more valuable for predicting prognosis of patients after HCC resection than the common qualitative analysis.
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Affiliation(s)
- Lun-Xiu Qin
- Liver Cancer Institute & Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, China
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20
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Qin LX, Tang ZY. The prognostic molecular markers in hepatocellular carcinoma. World J Gastroenterol 2002; 8:385-92. [PMID: 12046056 PMCID: PMC4656407 DOI: 10.3748/wjg.v8.i3.385] [Citation(s) in RCA: 230] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2002] [Revised: 04/23/2002] [Accepted: 05/08/2002] [Indexed: 02/06/2023] Open
Abstract
The prognosis of hepatocellular carcinoma (HCC) still remains dismal, although many advances in its clinical study have been made. It is important for tumor control to identify the factors that predispose patients to death. With new discoveries in cancer biology, the pathological and biological prognostic factors of HCC have been studied quite extensively. Analyzing molecular markers (biomarkers) with prognostic significance is a complementary method. A large number of molecular factors have been shown to associate with the invasiveness of HCC, and have potential prognostic significance. One important aspect is the analysis of molecular markers for the cellular malignancy phenotype. These include alterations in DNA ploidy, cellular proliferation markers (PCNA, Ki-67, Mcm2, MIB1, MIA, and CSE1L/CAS protein), nuclear morphology, the p53 gene and its related molecule MD M2, other cell cycle regulators (cyclin A, cyclin D, cyclin E, cdc2, p27, p73), oncogenes and their receptors (such as ras, c-myc, c-fms, HGF, c-met, and erb-B receptor family members), apoptosis related factors (Fas and FasL), as well as telomerase activity. Another important aspect is the analysis of molecular markers involved in the process of cancer invasion and metastasis. Adhesion molecules (E-cadherin, catenins, serum intercellular adhesion molecule-1, CD44 variants), proteinases involved in the degradation of extracellular matrix (MMP-2, MMP-9, uPA, uPAR, PAI), as well as other molecules have been regarded as biomarkers for the malignant phenotype of HCC, and are related to prognosis and therapeutic outcomes. Tumor angiogenesis is critical to both the growth and metastasis of cancers including HCC, and has drawn much attention in recent years. Many angiogenesis-related markers, such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), platelet-derived endothelial cell growth factor (PD-ECGF), thrombospondin (TSP), angiogenin, pleiotrophin, and endostatin (ES) levels, as well as intratumor microvessel density (MVD) have been evaluated and found to be of prognostic significance. Body fluid (particularly blood and urinary) testing for biomarkers is easily accessible and useful in clinical patients. The prognostic significance of circulating DNA in plasma or serum, and its genetic alterations in HCC are other important trends. More attention should be paid to these two areas in future. As the progress of the human genome project advances, so does a clearer understanding of tumor biology, and more and more new prognostic markers with high sensitivity and specificity will be found and used in clinical assays. However, the combination of some items, i.e., the pathological features and some biomarkers mentioned above, seems to be more practical for now.
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Affiliation(s)
- Lun-Xiu Qin
- Liver Cancer Institute and Zhongshan Hospital, Fudan university, 136 Yi Xue Yuan Road, Shanghai 200032, China
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21
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Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. The Cancer of the Liver Italian Program (CLIP) Investigators. Hepatology 2000; 31:840-5. [PMID: 10733537 DOI: 10.1053/he.2000.5628] [Citation(s) in RCA: 363] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prognosis of patients with cirrhosis and hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. The CLIP score includes Child-Pugh stage, tumor morphology and extension, serum alfa-fetoprotein (AFP) levels, and portal vein thrombosis. We externally validated the CLIP score and compared its discriminatory ability and predictive power with that of the Okuda staging system in 196 patients with cirrhosis and HCC prospectively enrolled in a randomized trial. No significant associations were found between the CLIP score and the age, sex, and pattern of viral infection. There was a strong correlation between the CLIP score and the Okuda stage. As of June 1999, 150 patients (76.5%) had died. Median survival time was 11 months, overall, and it was 36, 22, 9, 7, and 3 months for CLIP categories 0, 1, 2, 3, and 4 to 6, respectively. In multivariate analysis, the CLIP score had additional explanatory power above that of the Okuda stage. This was true for both patients treated with locoregional therapy or not. A quantitative estimation of 2-year survival predictive power showed that the CLIP score explained 37% of survival variability, compared with 21% explained by Okuda stage. In conclusion, the CLIP score, compared with the Okuda staging system, gives more accurate prognostic information, is statistically more efficient, and has a greater survival predictive power. It could be useful in treatment planning by improving baseline prognostic evaluation of patients with HCC, and could be used in prospective therapeutic trials as a stratification variable, reducing the variability of results owing to patient selection.
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22
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Hamada K, Koyama T, Shimizu K, Ikawa S, Kawate S, Yokota J, Ohwada S, Morishita Y. Absence of p51 mutation in human hepatocellular carcinoma. Cancer Lett 2000; 148:161-4. [PMID: 10695992 DOI: 10.1016/s0304-3835(99)00330-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The p51 gene encodes a protein with significant homology to p53. To investigate the involvement of the p51 gene in human hepatocarcinogenesis, mutation analysis of the p51 gene was performed in 54 cases of hepatocellular carcinoma (HCC). No mutations causing amino acid substitutions or frameshifts were found by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) analysis of the entire coding region. The result indicated that mutation of the p51 gene does not play a major role in the development of HCC in Japanese patients. Further studies on p51 expression and its functions, including the interaction with p53, are necessary to elucidate the role of the p51 gene in human hepatocarcinogenesis.
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Affiliation(s)
- K Hamada
- Second Department of Surgery, Gunma University School of Medicine, Japan
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23
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Shiota G, Ishida M, Noguchi N, Oyama K, Takano Y, Okubo M, Katayama S, Tomie Y, Harada K, Hori K, Ashida K, Kishimoto Y, Hosoda A, Suou T, Kanbe T, Tanaka K, Nosaka K, Tanida O, Kojo H, Miura K, Ito H, Kaibara N, Kawasaki H. Circulating p53 antibody in patients with colorectal cancer: relation to clinicopathologic features and survival. Dig Dis Sci 2000. [PMID: 10695624 DOI: 10.1023/a: 1005473729976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The presence of serum anti-p53 antibody has been reported to be associated with survival of patients with breast cancer, ovarian cancer, and hepatocellular carcinoma. To clarify prognostic significance of p53 antibody in colorectal cancer, serum p53 antibody was measured in patients with colorectal cancer. The 89 patients included 71 with colorectal cancer and 18 with colon polyp. An enzyme-linked immunosorbent assay was used to detect p53 antibodies in serum. Clinicopathological parameters such as age, sex, degree of differentiation of cancer, location of tumor, liver metastasis, stage classification, Dukes classification, CEA, CA19-9, and immunostaining of p53 and anti-p53 antibody were evaluated as prognostic factors of colorectal cancer. p53 antibody was positive in 18 of 71 (25%) with colorectal cancer, whereas it was positive in only 1 of 18 (6%) with colon polyp. The patients with p53 antibody had higher CEA and CA19-9 levels, higher positive rates of p53 protein expression in cancer cells, and higher liver metastasis rates. The p53 antibody positivity at stage classification I-IIIb/ Dukes classification A-C was significantly lower than that at stage classification IV/Dukes classification D. Overall survival in colorectal cancer patients with p53 antibody was significantly shorter than in those without p53 antibody. A Cox regression analysis showed that liver metastasis, stage classification, Dukes classification, CA19-9, and p53 antibody were significant prognostic factors in colorectal cancer. Serum anti-p53 antibody could serve as one of the prognostic factors in patients with colorectal cancer.
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Affiliation(s)
- G Shiota
- Second Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan
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24
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Saffroy R, Lelong JC, Azoulay D, Salvucci M, Reynes M, Bismuth H, Debuire B, Lemoine A. Clinical significance of circulating anti-p53 antibodies in European patients with hepatocellular carcinoma. Br J Cancer 1999; 79:604-10. [PMID: 10027337 PMCID: PMC2362420 DOI: 10.1038/sj.bjc.6690095] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
p53 alterations are considered to be predictive of poor prognosis in hepatocellular carcinoma (HCC) and may induce a humoral response. Anti-p53 serum antibodies were assessed by enzyme-linked immunosorbent assay (ELISA) using purified recombinant human p53 on 130 European HCC patients before treatment and during the clinical course of the disease. p53 immunohistochemistry was performed on tumours from the 52 patients who underwent surgery, and DNA sequencing analysis was initiated when circulating anti-p53 antibodies were detected. Nine (7%) HCC patients had anti-p53 serum antibodies before treatment. During a mean period of 30 months of follow-up, all the negative patients remained negative, even when recurrence was observed. Of the nine positive patients, eight were still positive 12-30 months after surgery. The presence of anti-p53 serum antibodies was correlated neither with mutation of the p53 gene nor the serum alpha-fetoprotein levels and clinicopathological characteristics of the tumours. However, a greater incidence of vascular invasion and accumulation of p53 protein were observed in the tumours of these patients (P<0.03 and P<0.01 respectively) as well as a better survival rate without recurrence (P = 0.05). In conclusion, as was recently shown in pancreatic cancer, anti-p53 serum antibodies may constitute a marker of relative 'good prognosis' in a subgroup of patients exhibiting one or several markers traditionally thought to be of bad prognosis.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Neoplasm/analysis
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- DNA Mutational Analysis
- DNA, Neoplasm/analysis
- DNA, Neoplasm/genetics
- Enzyme-Linked Immunosorbent Assay
- Europe
- Female
- Humans
- Liver Neoplasms/immunology
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- Prognosis
- Prospective Studies
- Survival Analysis
- Tumor Suppressor Protein p53/analysis
- Tumor Suppressor Protein p53/immunology
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Affiliation(s)
- R Saffroy
- Service de Biochimie, Villejuif, France
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25
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Edis C, Kähler C, Klotz W, Herold M, Feichtinger H, Königsreiner A, Margreiter R, Jaschke W, Vogel W. A comparison between alpha-fetoprotein and p53 antibodies in the diagnosis of hepatocellular carcinoma. Transplant Proc 1998; 30:780-1. [PMID: 9595095 DOI: 10.1016/s0041-1345(98)00045-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- C Edis
- University of Innsbruck, Department of Gastroenterology, Austria
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