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Zhu D, Yang W, Zhou HF, Shi HB, Liu S, Shao ZF, Zhou WZ. Prognostic implications of CK19 positivity in patients with early recurrent hepatocellular carcinoma after hepatic resection undergoing transarterial chemoembolization. BMC Gastroenterol 2024; 24:347. [PMID: 39363264 PMCID: PMC11451204 DOI: 10.1186/s12876-024-03417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 09/11/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND This study aimed to compare the survival outcomes of transarterial chemoembolization (TACE) between patients with early recurrent hepatocellular carcinoma (rHCC) after hepatic resection, stratified by cytokeratin (CK) 19 expression. METHODS A retrospective analysis was conducted on 63 patients with early rHCC after hepatic resection who underwent TACE between January 2017 and December 2021. Patients were divided into two groups based on CK19 expression: CK19-negative (n=31) and CK19-positive (n=32). Overall survival (OS) and progression-free survival (PFS) were compared between the two groups using the Kaplan-Meier method and log-rank test. Cox regression analysis was performed to identify independent risk factors for OS and PFS. RESULTS The CK19-negative group demonstrated a significantly longer median OS compared to the CK19-positive group (635 days vs. 432 days, p=0.013). Similarly, the CK19-negative group had a longer median PFS than the CK19-positive group (291 days vs. 117 days, p=0.014). Multivariate Cox analysis identified Child-Pugh A grade, CK19-negative expression, and increased TACE sessions as protective factors for OS. No severe TACE-related adverse events were observed. CONCLUSION In patients with early rHCC after hepatic resection, those with CK19-positive expression had poorer survival outcomes following TACE compared to CK19-negative patients. These findings suggest the need for additional therapies to improve survival in CK19-positive individuals.
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Affiliation(s)
- Di Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Wei Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Hai-Feng Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Ze-Feng Shao
- Department of Interventional Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
| | - Wei-Zhong Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China.
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Safaei S, Sajed R, Shariftabrizi A, Dorafshan S, Saeednejad Zanjani L, Dehghan Manshadi M, Madjd Z, Ghods R. Tumor matrix stiffness provides fertile soil for cancer stem cells. Cancer Cell Int 2023; 23:143. [PMID: 37468874 PMCID: PMC10357884 DOI: 10.1186/s12935-023-02992-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023] Open
Abstract
Matrix stiffness is a mechanical characteristic of the extracellular matrix (ECM) that increases from the tumor core to the tumor periphery in a gradient pattern in a variety of solid tumors and can promote proliferation, invasion, metastasis, drug resistance, and recurrence. Cancer stem cells (CSCs) are a rare subpopulation of tumor cells with self-renewal, asymmetric cell division, and differentiation capabilities. CSCs are thought to be responsible for metastasis, tumor recurrence, chemotherapy resistance, and consequently poor clinical outcomes. Evidence suggests that matrix stiffness can activate receptors and mechanosensor/mechanoregulator proteins such as integrin, FAK, and YAP, modulating the characteristics of tumor cells as well as CSCs through different molecular signaling pathways. A deeper understanding of the effect of matrix stiffness on CSCs characteristics could lead to development of innovative cancer therapies. In this review, we discuss how the stiffness of the ECM is sensed by the cells and how the cells respond to this environmental change as well as the effect of matrix stiffness on CSCs characteristics and also the key malignant processes such as proliferation and EMT. Then, we specifically focus on how increased matrix stiffness affects CSCs in breast, lung, liver, pancreatic, and colorectal cancers. We also discuss how the molecules responsible for increased matrix stiffness and the signaling pathways activated by the enhanced stiffness can be manipulated as a therapeutic strategy for cancer.
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Affiliation(s)
- Sadegh Safaei
- Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran
- Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran
| | - Roya Sajed
- Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran
- Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran
| | - Ahmad Shariftabrizi
- Division of Nuclear Medicine, Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Division of Nuclear Medicine, Department of Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Shima Dorafshan
- Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran
- Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran
| | - Leili Saeednejad Zanjani
- Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran
- Department of Pathology and Genomic Medicine, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Masoumeh Dehghan Manshadi
- Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran
- Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran
| | - Zahra Madjd
- Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran.
- Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran.
| | - Roya Ghods
- Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran.
- Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Hemmat Street (Highway), Next to Milad Tower, Tehran, 14496-14530, Iran.
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Lv J, Yin H, Yu H, Shi H. The added value of 18F-FDG PET/MRI multimodal imaging in hepatocellular carcinoma for identifying cytokeratin 19 status. Abdom Radiol (NY) 2023; 48:2331-2339. [PMID: 37119293 DOI: 10.1007/s00261-023-03911-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE In hepatocellular carcinoma (HCC), cytokeratin 19(CK19) has been proven to be associated with clinical aggressiveness. Therefore, this study aimed to explore the added value of 18F-FDG PET/MRI in predicting CK19 status in HCC. METHODS Sixty-six patients who underwent whole-body or abdominal 18F-FDG PET/MRI after conventional PET/CT for HCC were retrospectively enrolled. The maximal standard uptake value (T-SUVmax) and the mean apparent diffusion coefficient (T-ADCmean) of the tumor (T), as well as those of the normal liver tissues (L) were derived, followed by calculations of the T-SUVmax/L-SUVmax (SUVmax-T/L) and the T-ADCmean/L-ADCmean (ADCmean-T/L) ratios. Combined with the postoperative pathological results, the performance in predicting the CK19 status in HCC was evaluated using receiver operating characteristic analysis (ROC). RESULTS The areas under the ROC curve (AUCs) for T-SUVmax, SUVmax-T/L, T-ADCmean, and ADCmean-T/L in predicting the CK19-positive HCC were 0.700, 0.717, 0.717, and 0.735, respectively. In the logistic regression analysis, the T-SUVmax was an independent and significant factor to predict CK19-positive HCC, with an odds ratio of 1.27. In addition, no significant differences were found in the pathological grading, microvascular invasion, liver capsular invasion, Hepatitis B virus (HBV) infection, alpha fetoprotein (AFP) level, and tumor diameter between the CK19-positive and CK19-negative groups, except the recurrent rate. CONCLUSIONS The radiomic features derived from 18F-FDG PET/MRI can be used to predict the CK19 status of HCC. T-SUVmax and T-ADCmean were significant indicators, whereas T-SUVmax was an independent predictor.
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Affiliation(s)
- Jing Lv
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Hongyan Yin
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Haojun Yu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
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Wu Q, Yu YX, Zhang T, Zhu WJ, Fan YF, Wang XM, Hu CH. Preoperative Diagnosis of Dual-Phenotype Hepatocellular Carcinoma Using Enhanced MRI Radiomics Models. J Magn Reson Imaging 2023; 57:1185-1196. [PMID: 36190656 DOI: 10.1002/jmri.28391] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dual-phenotype hepatocellular carcinoma (DPHCC) is highly aggressive and difficult to distinguish from hepatocellular carcinoma (HCC). PURPOSE To develop and validate clinical and radiomics models based on contrast-enhanced MRI for the preoperative diagnosis of DPHCC. STUDY TYPE Retrospective. POPULATION A total of 87 patients with DPHCC and 92 patients with non-DPHCC randomly divided into a training cohort (n = 125: 64 non-DPHCC; 61 DPHCC) and a validation cohort (n = 54: 28 non-DPHCC; 26 DPHCC). FIELD STRENGTH/SEQUENCE A 3.0 T; dynamic contrast-enhanced MRI with time-resolved T1-weighted imaging sequence. ASSESSMENT In the clinical model, the maximum tumor diameter and hepatitis B virus (HBV) were independent risk factors of DPHCC. In the radiomics model, a total of 1781 radiomics features were extracted from tumor volumes of interest (VOIs) in the arterial phase (AP) and portal venous phase (PP) images. For feature reduction and selection, Pearson correlation coefficient (PCC) and recursive feature elimination (RFE) were used. Clinical, AP, PP, and combined radiomics models were established using machine learning algorithms (support vector machine [SVM], logistic regression [LR], and logistic regression-least absolute shrinkage and selection operator [LR-LASSO]) and their discriminatory efficacy assessed and compared. STATISTICAL TESTS The independent sample t test, Mann-Whitney U test, Chi-square test, regression analysis, receiver operating characteristic curve (ROC) analysis, Pearson correlation analysis, the Delong test. A P value < 0.05 was considered statistically significant. RESULTS In the validation cohort, the combined radiomics model (area under the curve [AUC] = 0.908, 95% confidence interval [CI]: 0.831-0.985) showed the highest diagnostic performance. The AUCs of the PP (AUC = 0.879, 95% CI: 0.779-0.979) and combined radiomics models were significantly higher than that of clinical model (AUC = 0.685, 95% CI: 0.526-0.844). There were no significant differences in AUC between AP or PP radiomics model and combined radiomics model (P = 0.286, 0.180 and 0.543). CONCLUSION MRI radiomics models may be useful for discriminating DPHCC from non-DPHCC before surgery. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Qian Wu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi-Xing Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tao Zhang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, China
| | - Wen-Jing Zhu
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, China
| | - Yan-Fen Fan
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xi-Ming Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun-Hong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Fahmy D, Alksas A, Elnakib A, Mahmoud A, Kandil H, Khalil A, Ghazal M, van Bogaert E, Contractor S, El-Baz A. The Role of Radiomics and AI Technologies in the Segmentation, Detection, and Management of Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14246123. [PMID: 36551606 PMCID: PMC9777232 DOI: 10.3390/cancers14246123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic neoplasm. Thanks to recent advances in computed tomography (CT) and magnetic resonance imaging (MRI), there is potential to improve detection, segmentation, discrimination from HCC mimics, and monitoring of therapeutic response. Radiomics, artificial intelligence (AI), and derived tools have already been applied in other areas of diagnostic imaging with promising results. In this review, we briefly discuss the current clinical applications of radiomics and AI in the detection, segmentation, and management of HCC. Moreover, we investigate their potential to reach a more accurate diagnosis of HCC and to guide proper treatment planning.
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Affiliation(s)
- Dalia Fahmy
- Diagnostic Radiology Department, Mansoura University Hospital, Mansoura 35516, Egypt
| | - Ahmed Alksas
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ahmed Elnakib
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ali Mahmoud
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Heba Kandil
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
- Faculty of Computer Sciences and Information, Mansoura University, Mansoura 35516, Egypt
| | - Ashraf Khalil
- College of Technological Innovation, Zayed University, Abu Dhabi 4783, United Arab Emirates
| | - Mohammed Ghazal
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates
| | - Eric van Bogaert
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Sohail Contractor
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
- Correspondence:
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Menz A, Bauer R, Kluth M, Marie von Bargen C, Gorbokon N, Viehweger F, Lennartz M, Völkl C, Fraune C, Uhlig R, Hube-Magg C, De Wispelaere N, Minner S, Sauter G, Kind S, Simon R, Burandt E, Clauditz T, Lebok P, Jacobsen F, Steurer S, Wilczak W, Krech T, Marx AH, Bernreuther C. Diagnostic and prognostic impact of cytokeratin 19 expression analysis in human tumors: a tissue microarray study of 13,172 tumors. Hum Pathol 2021; 115:19-36. [PMID: 34102222 DOI: 10.1016/j.humpath.2021.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022]
Abstract
To evaluate cytokeratin 19 (CK19) expression in normal and cancerous tissues, 15,977 samples from 122 tumor types and 608 samples of 76 normal tissue types were analyzed by immunohistochemistry (IHC). In normal tissues, CK19 expression occurred in epithelial cells of most glandular organs but was strictly limited to the basal cell layer of nonkeratinizing squamous epithelium and absent in the skin. CK19 expression in ≥90% of cases was seen in 34% of the tumor entities including the adenocarcinomas of the pancreas (99.4%), colorectum (99.8%), esophagus (98.7%), and stomach (97.7%), as well as breast cancer (90.0%-100%), high-grade serous (99.1%) or endometrioid (97.8%) ovarian cancer, and urothelial carcinoma (92.6%-100%). A low CK19 positivity rate (0.1-10%) was seen in 5 of 122 tumor entities including hepatocellular carcinoma and seminoma. A comparison of tumor versus normal tissue findings demonstrated that upregulation and downregulation of CK19 can occur in cancer and that both alterations can be linked to unfavorable phenotypes. CK19 downregulation was linked to high grade (p = 0.0017) and loss of estrogen receptor- and progesterone receptor-expression (p < 0.0001 each) in invasive breast carcinoma of no special type. CK19 upregulation was linked to nodal metastases in neuroendocrine tumors and papillary thyroid carcinomas (p < 0.05 each) and to poor grade in clear cell renal cell carcinoma (p < 0.05). CK19 upregulation was particularly common in squamous cell carcinomas. We concluded that CK19 IHC might separate primary liver cell carcinoma from liver metastases, seminoma from other testicular tumors, and helps in the detection of early neoplastic transformation in squamous epithelium.
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Affiliation(s)
- Anne Menz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Rifka Bauer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Martina Kluth
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Clara Marie von Bargen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Natalia Gorbokon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Florian Viehweger
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Cosima Völkl
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ria Uhlig
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Noémi De Wispelaere
- Department and Clinic of Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Simon Kind
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Till Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Waldemar Wilczak
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Till Krech
- Institute of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Andreas H Marx
- Department of Pathology, Academic Hospital Fuerth, 90766 Fuerth Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Kmeid M, Lukose G, Hodge K, Cho D, Kim KA, Lee H. Aberrant expression of SATB2, CDX2, CDH17 and CK20 in hepatocellular carcinoma: a pathological, clinical and outcome study. Histopathology 2021; 79:768-778. [PMID: 34036629 DOI: 10.1111/his.14420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/08/2021] [Accepted: 05/23/2021] [Indexed: 12/11/2022]
Abstract
AIMS Data regarding expression of intestinal markers in hepatocellular carcinoma (HCC) are limited. We determined the clinicopathological associations of cytokeratin (CK)19, a progenitor liver epithelial cell marker as well as biliary epithelial marker, and intestinal immunohistochemical markers expression in HCC and assessed their prognostic value. METHODS AND RESULTS Tissue sections and/or tissue microarrays (TMAs) from 202 known HCCs were immunostained using CK19, CK20, CDH17, CDX2 and SATB2 antibodies. Haematoxylin and eosin (H&E)-stained slides were reviewed for tumour grading. Clinical and oncological outcomes were retrieved. Associations of staining with clinicopathological features and survival outcomes were evaluated. CK19, CK20, CDH17, CDX2 and SATB2 were positive in 12.8, 5.4, 10.3, 8.6 and 59.9%, respectively. All but SATB2 were strongly associated with higher tumour grade and AFP levels > 400 ng/ml (P < 0.05). CK19-positive HCC were more likely to express CDX2 (P = 0.001), CDH17 (P < 0.001) and/or CK20 (P = 0.012). CK20, CDX2 and CDH17 co-expression was seen in five cases (2.5%). CK19 and SATB2 positivity, tumour size ≥ 5 cm, background cirrhosis, AFP > 400 ng/ml and having no treatment were associated with decreased overall survival by log-rank test and univariable proportional hazards regression. However, in a multivariable model, CK19 and SATB2 positivity were not independent predictors of decreased survival while their association with known poor prognosticators in HCC was evident. CONCLUSIONS HCC can express markers of intestinal differentiation. This phenotypical aberrancy correlates with variable clinicopathological parameters, some of which are independent predictors of poor survival.
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Affiliation(s)
- Michel Kmeid
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | | | | | - Daniel Cho
- Schenectady Pathology Associates, Ellis Hospital, Schenectady, NY, USA
| | - Kelly-Ann Kim
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Hwajeong Lee
- Department of Pathology, Albany Medical Center, Albany, NY, USA
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8
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Zhang J, Qi YP, Ma N, Lu F, Gong WF, Chen B, Ma L, Zhong JH, Xiang BD, Li LQ. Overexpression of Epcam and CD133 Correlates with Poor Prognosis in Dual-phenotype Hepatocellular Carcinoma. J Cancer 2020; 11:3400-3406. [PMID: 32231746 PMCID: PMC7097958 DOI: 10.7150/jca.41090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/02/2020] [Indexed: 01/27/2023] Open
Abstract
Background: Dual-phenotype hepatocellular carcinoma (DPHCC) is associated with high rate of post-operative recurrence and low rate of survival, which may reflect the post-operative persistence of cancer stem cells (CSCs). Here we explored the potential correlation between DPHCC and expression of CSCs markers. Methods: In this retrospective study, we included 19 patients with DPHCC and 61 patients with non-DPHCC treated in 2015 by liver resection. Paraffin-embedded tumor tissue specimens were analyzed using immunohistochemistry as well as immunofluorescence double-staining. Rates of recurrence-free survival and overall survival were compared between the two groups using the Kaplan-Meier method, and expression of the CSC markers CD133, CD90, and EpCAM were compared using real-time quantitative PCR and western blotting. Results: Overall survival rates were significantly lower for patients with DPHCC than patients with non-DPHCC at 1 year (78.9% vs 93.4%), 2 years (52.6% vs 72.1%), and 3 years (42.1% vs 67.2%) (P = 0.019). Multivariate Cox proportional hazard modeling identified CK19 positivity (P = 0.016) and multiple nodules (P = 0.023) as independent predictors of poor recurrence-free survival. Independent predictors of poor overall survival were CK19 positivity (P = 0.032), Barcelona Clinic Liver Cancer stage C (P = 0.025) and carbohydrate antigen 19-9 (CA19-9) >37 ng/ml (P = 0.016). Expression of CD133 and EpCAM mRNA and protein were significantly higher in DPHCC tissue than non-DPHCC tissue, while CD90 expression was similar between the groups. Conclusions: These results suggest that DPHCC is associated with significantly lower overall survival than non-DPHCC, and that the poor prognosis among DPHCC patients may be related to the presence of CSCs expressing CD133 and EpCAM.
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Affiliation(s)
- Jie Zhang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Ya-Peng Qi
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Ning Ma
- Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Fei Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Weng-Feng Gong
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Bin Chen
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Liang Ma
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi, China
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Wang W, Gu D, Wei J, Ding Y, Yang L, Zhu K, Luo R, Rao SX, Tian J, Zeng M. A radiomics-based biomarker for cytokeratin 19 status of hepatocellular carcinoma with gadoxetic acid-enhanced MRI. Eur Radiol 2020; 30:3004-3014. [PMID: 32002645 DOI: 10.1007/s00330-019-06585-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/14/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We aimed to develop a radiomics-based model derived from gadoxetic acid-enhanced MR images to preoperatively identify cytokeratin (CK) 19 status of hepatocellular carcinoma (HCC). METHODS A cohort of 227 patients with single HCC was classified into a training set (n = 159) and a time-independent validated set (n = 68). A total of 647 radiomic features were extracted from multi-sequence MR images. The least absolute shrinkage and selection operator regression and decision tree methods were utilized for feature selection and radiomics signature construction. A multivariable logistic regression model incorporating clinico-radiological features and the fusion radiomics signature was built for prediction of CK19 status by evaluating area under curve (AUC). RESULTS In the whole cohort, 57 patients were CK19 positive and 170 patients were CK19 negative. By combining 11 and 6 radiomic features extracted in arterial phase and hepatobiliary phase images, respectively, a fusion radiomics signature achieved AUCs of 0.951 and 0.822 in training and validation datasets. The final combined model integrated a-fetoprotein levels, arterial rim enhancement pattern, irregular tumor margin, and the fusion radiomics signature, with a sensitivity of 0.818 and specificity of 0.974 in the training cohort and that of 0.769 and 0.818 in the validated cohort. The nomogram based on the combined model showed satisfactory prediction performance in training (C-index 0.959) and validation (C-index 0.846) dataset. CONCLUSIONS The combined model based on a fusion radiomics signature derived from arterial and hepatobiliary phase images of gadoxetic acid-enhanced MRI can be a reliable biomarker for CK19 status of HCC. KEY POINTS • Arterial rim enhancement pattern and irregular tumor margin on hepatobiliary phase on gadoxetic acid-enhanced MRI can be useful for evaluating CK19 status of HCC. • A radiomics-based model performed better than the clinico-radiological model both in training and validation datasets for predicting CK19 status of HCC. • The nomogram based on the fusion radiomics signature can be easily used for CK19 stratification of HCC.
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Affiliation(s)
- Wentao Wang
- Department of Radiology, Zhongshan Hospital, and Shanghai Medical Imaging Institute, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Dongsheng Gu
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jingwei Wei
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Ying Ding
- Department of Radiology, Zhongshan Hospital, and Shanghai Medical Imaging Institute, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Li Yang
- Department of Radiology, Zhongshan Hospital, and Shanghai Medical Imaging Institute, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Kai Zhu
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, and Shanghai Medical Imaging Institute, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100049, China. .,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, 100191, China. .,Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, 710126, Shaanxi, China.
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, and Shanghai Medical Imaging Institute, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
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Radiomics for diagnosis of dual-phenotype hepatocellular carcinoma using Gd-EOB-DTPA-enhanced MRI and patient prognosis. J Cancer Res Clin Oncol 2019; 145:2995-3003. [PMID: 31664520 PMCID: PMC6861194 DOI: 10.1007/s00432-019-03062-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/17/2019] [Indexed: 12/13/2022]
Abstract
Purpose To describe the clinical characteristics and outcomes of patients with dual-phenotype hepatocellular carcinoma (DPHCC) and investigate the use of radiomics to establish an image-based signature for preoperative differential diagnosis. Methods This study included 50 patients with a postoperative pathological diagnosis of DPHCC (observation group) and 50 patients with CK7- and CK19-negative HCC (control group) who attended our hospital between January 2015 and December 2018. All patients underwent Gd-EOB-DTPA-enhanced MRI within 1 month before surgery. Arterial phase (AP), portal venous phase (PVP), delayed phase (DP) and hepatobiliary phase (HBP) images were transferred into a radiomics platform. Volumes of interest covered the whole tumor. The dimensionality of the radiomics features were reduced using LASSO. Four classifiers, including multi-layer perceptron (MLP), support vector machines (SVM), logistic regression (LR) and K-nearest neighbor (KNN) were used to distinguish DPHCC from CK7- and CK19-negative HCC. Kaplan–Meier survival analysis was used to assess 1-year disease-free survival (DFS) and overall survival (OS) in the observation and control groups. Results The best preoperative diagnostic power for DPHCC will likely be derived from a combination of different phases and classifiers. The sensitivity, specificity and accuracy of LR in PVP (0.740, 0.780, 0.766), DP (0.893, 0.700, 0.798), HBP (0.800, 0.720, 0.756) and MLP in PVP (0.880, 0.720, 0.798) were better performance. The 1-year DFS and OS of the patients in the observation group were 69% and 78%, respectively. The 1-year DFS and OS of the patients in the control group were 83% and 85%, respectively. Kaplan–Meier survival analysis showed no statistical difference in DFS and OS between groups (P = 0.231 and 0.326), but DFS and OS were numerically lower in patients with DPHCC. Conclusion The radiomics features extracted from Gd-EOB-DTPA-enhanced MR images can be used to diagnose preoperative DPHCC. DPHCC is more likely to recur and cause death than HCC, suggesting that active postoperative management of patients with DPHCC is required.
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11
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Normal Alpha-Fetoprotein Hepatocellular Carcinoma: Are They Really Normal? J Clin Med 2019; 8:jcm8101736. [PMID: 31635078 PMCID: PMC6832124 DOI: 10.3390/jcm8101736] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/12/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction: serum alpha-fetoprotein (AFP) was routinely employed as a tumor marker for screening, diagnosis, and treatment follow-up of hepatocellular carcinoma (HCC). However, a substantial proportion of HCC patients had normal AFP level even at an advanced disease status. Few studies to date had tried to explore the nature and behavior of this normal AFP HCC (N-HCC). The purpose of this study was to investigate the clinicopathological characteristics and survival outcome of N-HCC after operation. In addition, potential tumor markers for N-HCC were also sought in an attempt to augment diagnostic ability. Methods: between 2005 and 2015, patients with hepatocellular carcinoma who were treated with hepatectomy in Chang Gung Memorial Hospital Linkou branch were divided into two groups according to their preoperative serum AFP level (<15 ng/mL: NHCC; ≥15 ng/mL: abnormal AFP HCC (A-HCC)). Patient demographic data and clinicopathological variables were collected. Kaplan–Meier and Cox regression multivariate analyses were performed to identify significant risk factors for disease-free survival (DFS) and overall survival (OS) for N-HCC. ELISA and immunohistochemical (IHC) studies were employed to determine the diagnostic accuracy of various tumor markers. Results: a total of 1616 patients (78% male) who underwent liver resection for HCC were included in this study. Of them, 761 patients (47.1%) were N-HCC. N-HCC patients were significantly older with more comorbidities and less hepatitis virus infections. Furthermore, N-HCC had fewer early recurrences (49.6% vs. 60.8%, p < 0.001) and better DFS (44.6 months vs. 23.6 months, p < 0.001) and OS (94.5 months vs. 81.7 months, p < 0.001). Both ELISA and IHC studies demonstrated that glypican-3 (GPC3) would be a promising diagnostic tumor marker for N-HCC. Conclusion: N-HCC patients were significantly older and had less hepatitis virus infections or cirrhosis. Their tumors tended to be smaller, less vascular invaded, and well-differentiated. The carcinogenesis of N-HCC may thus not be identical to that of typical HCC. GPC3 would be a promising tumor marker for diagnosing N-HCC. Further study is warranted to validate our findings.
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12
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Duan Q, Xu M, Zhang X, Jia M, Yuan R, Gan M. Clinical significance of cytokeratin in the cervical lymph nodes of patients with mandibular gingival squamous cell carcinoma. Oncol Lett 2018; 16:3135-3139. [PMID: 30127905 PMCID: PMC6096087 DOI: 10.3892/ol.2018.9005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/12/2018] [Indexed: 12/13/2022] Open
Abstract
The present study aims to analyze the expression of broad spectrum cytokeratin in the cervical lymph nodes of patients with mandibular gingival squamous cell carcinoma and explore the metastasis of mandibular gingival squamous cell carcinoma in cervical lymph nodes. This study included 42 patients with mandibular gingival squamous cell carcinoma, which was staged according to the clinical staging criteria by International Union Against Cancer 2002 (UICC) and the Level staging method of cervical lymph node by American Academy of Otolaryngology-Head and Neck Surgery 1991. Monoclonal mouse anti-human cytokeratin (AE1/AE3) antibody was used in immunohistochemical examination and hematoxylin and eosin (H&E) staining. All positive sections by H&E staining were also positive by immunohistochemistry (IHC). The positive rate of routine H&E staining and serial-section H&E staining was 8.03 and 9.57%, respectively, the positive rate of IHC was 12.82%. The positive rate of IHC was significantly different with that of routine H&E staining (χ2=7.17, P<0.01), yet not significantly different with that of serial-section H&E staining (χ2=3.10, P>0.05). Lymph node metastasis was mainly in Level I, II and III, both serial-section H&E staining and IHC showed lymph node metastasis in Level IV for advanced patients. IHC showed 19 lymph node micrometastasis in 12 patients, while neither serial-section nor routine H&E staining showed micrometastasis. Lymph node dissection of hyoid bone (mainly in Level I, II and III) could be used for early patients, and the dissection could be expanded to Level IV for advanced patients.
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Affiliation(s)
- Qingyun Duan
- Oral and Maxillofacial Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Mei Xu
- Department of Ophtalmology, Hangzhou Jianggan District People's Hospital, Hangzhou, Zhejiang 310016, P.R. China
| | - Xiong Zhang
- Oral and Maxillofacial Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Muyun Jia
- Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University Medical College, Qingdao, Shandong 266003, P.R. China
| | - Rongtao Yuan
- Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University Medical College, Qingdao, Shandong 266003, P.R. China
| | - Min Gan
- Oral and Maxillofacial Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang 310006, P.R. China
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13
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Acquisition of Cholangiocarcinoma Traits during Advanced Hepatocellular Carcinoma Development in Mice. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 188:656-671. [PMID: 29248454 DOI: 10.1016/j.ajpath.2017.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/01/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023]
Abstract
Past studies have identified hepatic tumors with mixed hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) characteristics that have a more aggressive behavior and a poorer prognosis than classic HCC. Whether this pathologic heterogeneity is due to a cell of origin of bipotent liver progenitors or the plasticity of cellular constituents comprising these tumors remains debated. In this study, we investigated the potential acquisition of CC-like traits during advanced development of HCC in mice. Primary and rare high-grade HCC developed in a genetic mouse model. A mouse model of highly efficient HCC invasion and metastasis by orthotopic transplantation of liver cancer organoids propagated from primary tumors in the genetic model was further developed. Invasive/metastatic tumors developed in both models closely recapitulated advanced human HCC and displayed a striking acquisition of CC-related pathologic and molecular features, which was absent in the primary HCC tumors. Our study directly demonstrates the pathologic evolution of HCC during advanced tumor development, providing the first evidence that tumors with mixed HCC and CC features, or at least a subset of these tumors, represent a more advanced developmental stage of HCC. Finally, liver cancer organoid-generated high-grade tumors exhibited significantly increased extracellular vesicle secretion, suggesting that identifying tumor-specific extracellular vesicle proteins in plasma may be a promising tool for liver cancer detection.
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14
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Lee CW, Lin SE, Tsai HI, Su PJ, Hsieh CH, Kuo YC, Sung CM, Lin CY, Tsai CN, Yu MC. Cadherin 17 is related to recurrence and poor prognosis of cytokeratin 19-positive hepatocellular carcinoma. Oncol Lett 2017; 15:559-567. [PMID: 29387234 DOI: 10.3892/ol.2017.7320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/20/2017] [Indexed: 12/15/2022] Open
Abstract
A previous study demonstrated that cytokeratin 19 (CK19) expression in hepatocellular carcinoma (HCC) is an indicator of HCC invasiveness, including lymph node metastasis (LNM), tumor infiltration/non-encapsulation and poor prognosis. The exact mechanism by which CK19 expression results in poor prognosis remains unclear. Through the use of an Affymetrix U133A oligonucleotide microarray [20 patients with hepatitis B virus (HBV)-HCC], it was demonstrated that cadherin 17 (CDH17) significantly correlated with CK19 expression (R2, 0.867; P<0.001) in HBV-HCC. Immunohistochemical analysis (114 patients with HBV-HCC) also demonstrated a significant correlation between CK19 and CDH17 expressions in primary tumor tissue (R2, 0.414; P<0.001). In addition, CK19 and CDH17 expressions levels revealed a significant association with LNM (P<0.001). Cox regression multivariate analysis demonstrated that indocyanine green retention at 15 min >10% and CDH17 expression were independent prognostic factors for disease free survival (P=0.010 and 0.002, respectively). In vitro studies showed that epidermal growth factor can induce the expression of both CK19 and CDH17, and CDH17 in turn can enhance the expression of CK19 in HCC. In summary, this study demonstrated that the early recurrence and poor prognosis of CK19(+) HCC may be due to the expression of CDH17, a gene known to be associated with vascular invasion, tumor metastasis, and advanced tumor stage of HCC. Thus, novel therapeutics by targeting CDH17 may be beneficial for CK19(+) HCC.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C
| | - Sey-En Lin
- Department of Pathology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan, R.O.C
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Po-Jung Su
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C.,Graduate Institute of Data Science, Taipei Medical University, Taipei 11031, Taiwan, R.O.C
| | - Chia-Hsun Hsieh
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Yung-Chia Kuo
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Chang-Mu Sung
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Cheng-Yu Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C
| | - Chi-Neu Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, R.O.C.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C
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15
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Feng J, Chen J, Zhu R, Yu L, Zhang Y, Feng D, Kong H, Song C, Xia H, Wu J, Zhao D. Prediction of early recurrence of hepatocellular carcinoma within the Milan criteria after radical resection. Oncotarget 2017; 8:63299-63310. [PMID: 28968990 PMCID: PMC5609922 DOI: 10.18632/oncotarget.18799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 06/02/2017] [Indexed: 02/07/2023] Open
Abstract
Approximately 50% hepatocellular carcinoma patients meeting the Milan criteria utilized to develop an improved prognostic model for predicting the recurrence in these patients. Using univariate and multivariate analysis, cytokeratin-19 and glypican-3 expression patterns, tumor number and histological grading from eight putative prognostic factors comprised the risk factor scoring model to predict the tumor recurrence. In the training cohort, the area under roc curve (AUC) value of the model was 0.715 [95% confidence interval (CI) = 0.645-0.786, P<0.001], which was the highest among all the parameters. The performance of the model was assessed using an independent validation cohort, wherein the AUC value was 0.760 (95% CI=0.647-0.874, P<0.001), which was higher than the other factors. The results indicated that model had high performance with adequate discrimination ability. Moreover, it significantly improved the predictive capacity for the recurrence in patients with hepatocellular carcinoma within the Milan criteria after radical resection.
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Affiliation(s)
- Jiliang Feng
- Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, Beijing, China
| | - Junmei Chen
- Medical Laboratory Center, Beijing You-An Hospital, Capital Medical University, Beijing, China
| | - Ruidong Zhu
- Surgical Center, Beijing You-An Hospital, Capital Medical University, Beijing, China
| | - Lu Yu
- Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, Beijing, China
| | - Yan Zhang
- Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, Beijing, China
| | - Dezhao Feng
- College of Life Science, Sichuan University, Chengdu, China
| | - Heli Kong
- Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, Beijing, China
| | - Chenzhao Song
- Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, Beijing, China
| | - Hui Xia
- Surgical Center, The 304th Hospital of PLA, Beijing, China
| | - Jushan Wu
- Surgical Center, Beijing You-An Hospital, Capital Medical University, Beijing, China
| | - Dawei Zhao
- Medical Imaging Department, Beijing You-An Hospital, Capital Medical University, Beijing, China
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16
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Takano M, Shimada K, Fujii T, Morita K, Takeda M, Nakajima Y, Nonomura A, Konishi N, Obayashi C. Keratin 19 as a key molecule in progression of human hepatocellular carcinomas through invasion and angiogenesis. BMC Cancer 2016; 16:903. [PMID: 27863477 PMCID: PMC5116168 DOI: 10.1186/s12885-016-2949-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/13/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Keratin (K) 19-positive hepatocellular carcinoma (HCC) is well known to have a higher malignant potential than K19-negative HCC: However, the molecular mechanisms involved in K19-mediated progression of HCC remain unclear. We attempted to clarify whether K19 directly affects cell survival and invasiveness in association with cellular senescence or epithelial-mesenchymal transition (EMT) in K19-positive HCC. METHODS K19 expression was analysed in 136 HCC surgical specimens. The relationship of K19 with clinicopathological factors and survival was analysed. Further, the effect of K19 on cell proliferation, invasion, and angiogenesis was examined by silencing K19 in the human HCC cell lines, HepG2, HuH-7, and PLC/PRF/5. Finally, we investigated HCC invasion, proliferation, and angiogenesis using K19-positive HCC specimens. RESULTS Analysis of HCC surgical specimens revealed that K19-positive HCC exhibited higher invasiveness, metastatic potential, and poorer prognosis. In vitro experiments using the human HCC cell lines revealed that K19 silencing suppressed cell growth by inducting apoptosis or upregulating p16 and p27, resulting in cellular senescence. In addition, transfection with K19 siRNA upregulated E-cadherin gene expression, significantly inhibited the invasive capacity of the cells, downregulated angiogenesis-related molecules such as vasohibin-1 (VASH1) and fibroblast growth factor 1 (FGFR1), and upregulated vasohibin-2 (VASH2). K19-positive HCC specimens exhibited a high MIB-1 labelling index, decreased E-cadherin expression, and high microvessel density around cancer foci. CONCLUSION K19 directly promotes cancer cell survival, invasion, and angiogenesis, resulting in HCC progression and poor clinical outcome. K19 may therefore be a novel drug target for the treatment of K19-positive HCC.
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Affiliation(s)
- Masato Takano
- Departments of Diagnostic Pathology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | - Keiji Shimada
- Department of Pathology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Tomomi Fujii
- Department of Pathology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Kohei Morita
- Departments of Diagnostic Pathology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Maiko Takeda
- Departments of Diagnostic Pathology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Yoshiyuki Nakajima
- Department of Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Akitaka Nonomura
- Hokuriku CPL, 15-36 Ninomiya-cho, Kanazawa, Ishikawa, 920-0067, Japan
| | - Noboru Konishi
- Department of Pathology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Chiho Obayashi
- Departments of Diagnostic Pathology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
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Lee SH, Lee JS, Na GH, You YK, Kim DG. Immunohistochemical markers for hepatocellular carcinoma prognosis after liver resection and liver transplantation. Clin Transplant 2016; 31. [PMID: 27653235 DOI: 10.1111/ctr.12852] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2016] [Indexed: 12/21/2022]
Abstract
AIM There were differences in progression and prognosis of hepatocellular carcinoma (HCC) after surgery between liver resection (LR) and liver transplantation (LT). In this study, immunohistochemical (IHC) markers associated with the prognosis of HCC were assessed. METHODS Data were collected from 167 patients who underwent LT (n=41) or LR (n=126) for HCC. IHC markers including alpha-fetoprotein (AFP), p53, Ki-67, cytokeratin 7 (CK7), and cytokeratin 19 (CK19) were compared between the treatment methods in tumor tissue. RESULTS AFP- and p53-negative patients had a significantly higher survival rate than AFP- and p53-positive patients (AFP: disease-free survival [DFS] P=.006, overall survival [OS] P=.016; p53: DFS P=.005, OS P=.038) in the LR group. CK19 was related to DFS (P=.005), while CK7 (P=.014) and CK19 (P=.06) were related to OS in the LT group. When we combined factors that were significant in both groups (LR: AFP and p53, LT: CK7 and CK19), all-negative patients had a higher survival rate (LR: DFS P=.025, OS P=.043, LT: DFS P=.034, OS P=.008). CONCLUSION p53 and AFP were predictors for poor prognosis of HCC after LR; CK7 and CK19 could be predictors for poor prognosis of patients with HCC after LT.
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Affiliation(s)
- Soo-Ho Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jun-Suh Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Gun-Hyung Na
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Young-Kyoung You
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Dong-Goo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
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CK19 and Glypican 3 Expression Profiling in the Prognostic Indication for Patients with HCC after Surgical Resection. PLoS One 2016; 11:e0151501. [PMID: 26977595 PMCID: PMC4792431 DOI: 10.1371/journal.pone.0151501] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/29/2016] [Indexed: 12/16/2022] Open
Abstract
This retrospective study was designed to investigate the correlation between a novel immunosubtyping method for hepatocellular carcinoma (HCC) and biological behavior of tumor cells. A series of 346 patients, who received hepatectomy at two surgical centers from January 2007 to October 2010, were enrolled in this study. The expressions of cytokeratin 19 (CK19), glypican 3 (GPC3), and CD34 were detected by immunohistochemical staining. The clinical stage was assessed using the sixth edition tumor-node-metastasis (TNM) system (UICC/AJCC, 2010).Vascular invasion comprised both microscopic and macroscopic invasion. The tumor size, lymph node involvement, and metastasis were determined by pathological as well as imaging studies. Recurrence was defined as the appearance of new lesions with radiological features typical of HCC, seen by at least two imaging methods. Survival curves for the patients were plotted using the Kaplan-Meier method, and differences between the curves were assessed using the log-rank test. Significant differences in morphology, histological grading, and TNM staging were observed between groups. Based on the immunohistochemical staining, the enrolled cases were divided into CK19+/GPC3+, CK19-/GPC3+ and CK19-/GPC3- three subtypes. CK19+/GPC3+ HCC has the highest risk of multifocality, microvascular invasion, regional lymph node involvement, and distant metastasis, followed by CK19-/GPC3+ HCC, then CK19-/GPC3-HCC. CK19+/GPC3+ HCC has the shortest recurrence time compared to other immunophenotype HCCs. CK19 and GPC3 expression profiling is an independent prognostic indicator in patients with HCC, and a larger sample size is needed to further investigate the effect of this immunosubtyping model in stratifying the outcome of HCC patients.
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Sun DW, Zhang YY, Sun XD, Chen YG, Qiu W, Ji M, Lv GY. Prognostic value of cytokeratin 19 in hepatocellular carcinoma: A meta-analysis. Clin Chim Acta 2015; 448:161-9. [PMID: 26164382 DOI: 10.1016/j.cca.2015.06.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 06/25/2015] [Accepted: 06/27/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although many studies have investigated the relationship between cytokeratin 19 (CK-19) and hepatocellular carcinoma (HCC), the prognostic value of CK-19 in HCC remains inconclusive. METHODS Eligible studies were sought in PubMed, Embase, Web of Science, Cochrane Library and Wanfang databases. Pooled hazard ratios (HRs) and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated. RESULTS 17 studies with 2943 patients were included in this meta-analysis. Meta-analysis results showed that CK-19 over-expression was significantly associated with overall survival (OS) (HR=1.60, 95% CI: 1.32-1.93, univariate analysis; HR=2.25, 95% CI: 1.79-2.83, multivariate analysis) and disease-free survival (DFS) (HR=1.68, 95% CI: 1.35-2.10, univariate analysis; HR=1.97, 95% CI: 1.54-2.53, multivariate analysis). Meanwhile, CK-19 over-expression was also correlated with decreased 1-year OS rate (OR=0.32, 95% CI: 0.21-0.50), 5-year OS rate (OR=0.44, 95% CI: 0.14-0.87) and 1-year DFS rate (OR=0.51, 95% CI: 0.34-0.76), but not with 5-year DFS rate (OR=0.62, 95% CI: 0.35-1.10). These results suggested that CK-19 over-expression was significantly associated with poor survival rate and early tumor recurrence rate in HCC patients. CONCLUSIONS CK-19 can serve as an indicator of poor prognosis as well as a novel target for treatment in HCC.
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Affiliation(s)
- Da-wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin Province, China
| | - Ying-yi Zhang
- Department of Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-dong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-guo Chen
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin Province, China
| | - Wei Qiu
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin Province, China
| | - Min Ji
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin Province, China
| | - Guo-yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin Province, China.
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Niu ZS, Niu XJ, Wang M. Management of hepatocellular carcinoma: Predictive value of immunohistochemical markers for postoperative survival. World J Hepatol 2015; 7:7-27. [PMID: 25624992 PMCID: PMC4295195 DOI: 10.4254/wjh.v7.i1.7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/02/2014] [Accepted: 11/10/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) accounts for over 90% of all primary liver cancers. With an ever increasing incidence trend year by year, it has become the third most common cause of death from cancer worldwide. Hepatic resection is generally considered to be one of the most effective therapies for HCC patients, however, there is a high risk of recurrence in postoperative HCC. In clinical practice, there exists an urgent need for valid prognostic markers to identify patients with prognosis, hence the importance of studies on prognostic markers in improving the prediction of HCC prognosis. This review focuses on the most promising immunohistochemical prognostic markers in predicting the postoperative survival of HCC patients.
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Liu H, Lou G, Li C, Wang X, Cederbaum AI, Gan L, Xie B. HBx inhibits CYP2E1 gene expression via downregulating HNF4α in human hepatoma cells. PLoS One 2014; 9:e107913. [PMID: 25238230 PMCID: PMC4169590 DOI: 10.1371/journal.pone.0107913] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/21/2014] [Indexed: 12/23/2022] Open
Abstract
CYP2E1, one of the cytochrome P450 mixed-function oxidases located predominantly in liver, plays a key role in metabolism of xenobiotics including ethanol and procarcinogens. Recently, down-expression of CYP2E1 was found in hepatocellular carcinoma (HCC) with the majority to be chronic hepatitis B virus (HBV) carriers. In this study, we tested a hypothesis that HBx may inhibit CYP2E1 gene expression via hepatocyte nuclear factor 4α (HNF4α). By enforced HBx gene expression in cultured HepG2 cells, we determined the effect of HBx on CYP2E1 mRNA and protein expression. With a bioinformatics analysis, we found a consensus HNF-4α binding sequence located on −318 to −294 bp upstream of human CYP2E1 promoter. Using reporter gene assay and site-directed mutagenesis, we have shown that mutation of this site dramatically decreased CYP2E1 promoter activity. By silencing endogenous HNF-4α, we have further validated knockdown of HNF-4α significantly decreased CYP2E1expression. Ectopic overexpression of HBx in HepG2 cells inhibits HNF-4α expression, and HNF-4α levels were inversely correlated with viral proteins both in HBV-infected HepG2215 cells and as well as HBV positive HCC liver tissues. Moreover, the HBx-induced CYP2E1 reduction could be rescued by ectopic supplement of HNF4α protein expression. Furthermore, human hepatoma cells C34, which do not express CYP2E1, shows enhanced cell growth rate compared to E47, which constitutively expresses CYP2E1. In addition, the significantly altered liver proteins in CYP2E1 knockout mice were detected with proteomics analysis. Together, HBx inhibits human CYP2E1 gene expression via downregulating HNF4α which contributes to promotion of human hepatoma cell growth. The elucidation of a HBx-HNF4α-CYP2E1 pathway provides novel insight into the molecular mechanism underlining chronic HBV infection associated hepatocarcinogenesis.
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Affiliation(s)
- Hongming Liu
- Department of Hepatobiliary Surgery, Daping Hospital & Institute of Surgery Research, The Third Military Medical University, Chongqing, China
| | - Guiyu Lou
- Department of Biochemistry and Molecular Biology, The Third Military Medical University, Chongqing, China
| | - Chongyi Li
- Department of Biochemistry and Molecular Biology, The Third Military Medical University, Chongqing, China
| | - Xiaodong Wang
- Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Chongqing Biomean Technology Co., Ltd, Chongqing, China
| | - Arthur I. Cederbaum
- Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lixia Gan
- Department of Biochemistry and Molecular Biology, The Third Military Medical University, Chongqing, China
- * E-mail: (LG); (BX)
| | - Bin Xie
- Department of Hepatobiliary Surgery, Daping Hospital & Institute of Surgery Research, The Third Military Medical University, Chongqing, China
- * E-mail: (LG); (BX)
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