Ann Surg Treat Res.  2016 Jul;91(1):23-28. 10.4174/astr.2016.91.1.23.

Positive immunostaining of Sal-like protein 4 is associated with poor patient survival outcome in the large and undifferentiated Korean hepatocellular carcinoma

• Jung YK
• Jang K
• Paik SS
• Kwon YJ
• Kim HJ
• Lee KG
• Park HK
• Choi D

• KMID: 2327413
• DOI: http://doi.org/10.4174/astr.2016.91.1.23

Abstract

PURPOSE
Previous studies have shown the role of Sal-like protein 4 (SALL4) as a biomarker in hepatocellular carcinoma (HCC), and some studies have shown the relationship between SALL4 and prognosis. Given the debates in study groups differences in terms of etiologic causes between Western and Asian HCC and detection methods, we attempted to verify the features of SALL4 immunoreactivity and its clinical correlation in Korean HCC patients.
METHODS
Immunohistochemical staining of SALL4 of tissue microarrays (TMAs) consisting of 213 surgically resected HCC patients' tissue were scored in a semiquantitative scoring system with immunoreactive score and the results analyzed with clinical outcome, in addition to general demographics and clinical characteristics.
RESULTS
SALL4 immunoreactivity was expressed in 50 cases. Relevance between SALL4 and α-FP correlated significantly (P = 0.002). Also, the SALL4-positive patients had considerably higher tumor grade (P < 0.001). The survival analysis showed negative correlation with SALL4 immunoreactivity in all HCC patient groups, but SALL4 immunoreactivity in T3 and T4 HCC correlated with poor prognosis.
CONCLUSION
Here, we found that positive immunostaining of SALL4 is correlated with poor patient survival outcome in large and undifferentiated Korean HCC. SALL4 expression showed close relationship with clinical outcomes of HCCs in Korean patients.

Keyword

SALL4 protein; Hepatocellular carcinoma; Prognosis; Immunohistochemistry; Microarray analysis

MeSH Terms

Asian Continental Ancestry Group
Carcinoma, Hepatocellular*
Demography
Humans
Immunohistochemistry
Microarray Analysis
Prognosis

Figure

• 

  Fig. 1 The representative sections of Sal-like protein 4 immunohistochemical staining in hepatocellular carcinoma. The nuclei of tumor cells shows negative (A), intermediate (B), and strong (C) immunoreactivity. No hepatocellular carcinoma revealed strongly positive immurnostaining, which is shown in germ cell tumor (×400).

• 

  Fig. 2 Comparison of Sal-like protein 4 immunostaining for different antigen retrieval methods. Strong positive staining in the nuclei of tumor cells of germ cell tumor (positive control) is observed in section treated with 30-minute autoclave heating (D), whereas intermediate staining is observed in the consecutive section treated with 12-minute microwave heating (A). Two representative sections from hepatocellular carcinoma also shows an enhanced immunoreactivity in sections treated with 30-minute autoclave heating (E, F), compared to 12-minute microwave method (B, C) (×400).

• 

  Fig. 3 Survival curve according to Sal-like protein 4 (SALL4) expression in large hepatocellular carcinoma (T3 and T4). Kaplan-Meier survival curve with log-rank test reveals that patients with SALL4-positive tumor have worsen overall survival.

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