Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2837
Peer-review started: July 6, 2015
First decision: July 19, 2015
Revised: September 19, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: March 7, 2016
Processing time: 242 Days and 3.4 Hours
AIM: To detect the expression of sal-like protein 4 (SALL4) and to explore its relationship with clinicopathological characteristics and prognosis of hepatocellular carcinoma (HCC).
METHODS: One hundred and twenty-six samples of HCC tissue, 44 of adjacent noncancerous cirrhotic tissue and 10 of liver hemangioma tissue, were obtained from patients who underwent hepatectomy for HCC at the Fourth Hospital of Hebei Medical University. None of the patients had received any form of treatment before the operation. After resection, all the tissues were fixed in 10% neutral formaldehyde and embedded in paraffin. Expression of SALL4 was detected by immunohistochemistry. Patients were followed up for postoperative survival until February 2014. The relationships between SALL4 expression level and clinicopathological data and prognosis of HCC were analyzed.
RESULTS: SALL4 expression was negative in the 10 samples of tissue from liver hemangioma, was weakly positive in the two samples from adjacent noncancerous cirrhotic tissue, and positive in 58 samples of HCC tissues. The differences were statistically significant (P < 0.05). Expression of SALL4 was higher in patients with higher α-fetoprotein (AFP) levels, portal vein tumor thrombus, and later clinical stage based on the Barcelona Clinic Liver Cancer classification (P < 0.05). Among patients with negative expression, weakly positive expression, positive expression, and strongly positive expression of SALL4, the median survival time was 39, 25, 23, and 9 mo, respectively (P < 0.001). When both AFP and SALL4 were detected, patients who were negative for both AFP and SALL4, SALL4-positive only, AFP-positive only, and positive for both AFP and SALL4, had a median survival time of 41, 38, 31, and 12 mo, respectively (P < 0.001).
CONCLUSION: Expression of SALL4 is relevant to the prognosis of HCC patients. Patients with higher expression levels of SALL4 and AFP have worse prognosis.
Core tip: Sal-like protein 4 (SALL4) is expressed as an oncogene in a variety of tumors, including germ cell tumors, breast cancer, and α-fetoprotein (AFP)-producing gastric cancer. However, there are few reports about the association between SALL4 expression and hepatocellular carcinoma (HCC). In this study, we found that SALL4 was actively expressed in HCC cells with stem cell characteristics and played an important role in predicting the prognosis of HCC patients. In addition, joint detection of SALL4 and AFP may have a more profound significance for the prognosis of HCC patients.