title: Clinical significance of combination study of apoptotic factors and proliferating cell nuclear antigen in estimating the prognosis of hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) is one of the most common recurrence diseases, which affects the patient's prognosis. The aim of this report is to evaluate recurrence risk after primary treatment by the combination study with the clinical features and immunohistological findings.
  
  
  METHODS
  153 removable HCCs were examined by immunohistochemical study of the proliferating cell nuclear antigen (PCNA), p53, or Bax. The relationships of these factors with histological grades, the presence of intra-hepatic metastasis (IM), tumor size, value of serum alpha-fetoprotein (AFP), and prognosis were studied. PCNA labeling index (LI) was calculated to count positive nuclei in 1,000 cells.
  
  
  RESULTS
  PCNALI was significantly higher in cancer and correlated with tumor size. PCNALI and the tumor diameter in themselves could be a good predictor for patient prognosis and the combination study of them was an even stronger indicator. The value of AFP was significantly higher in positive p53 cases. The incidence of p53 was associated with histological types. The presence of IM was found in negative Bax cases of main tumors. The appearance of Bax was not correlated with histological types. The incidence of p53 or Bax was indicated to distinguish the patient prognosis of the lower grade histological cases, in which differences could not be found by the routine histological study.
  
  
  CONCLUSIONS
  The combination study of the immunohistochemical findings and the clinical features could be one of the most important aids in interpreting the status of HCC.
authors.affiliation: Second Department of Surgery, Gifu University School of Medicine, Tsukasamachi, Gifu City, Japan. sting@cc.gifu-u.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Osada
authors.forename: Shigetoyo
authors.initials: S
authors.lastname: Saji
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kuno
mesh_terms: D000368:Aged; D017209:Apoptosis; D006528:Carcinoma, Hepatocellular / Q000737:chemistry / Q000401:mortality / Q000473:pathology*; D002455:Cell Division; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000737:chemistry / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis*; D011518:Proto-Oncogene Proteins / Q000032:analysis; D019253:Proto-Oncogene Proteins c-bcl-2; D012307:Risk Factors; D015996:Survival Rate; D016159:Tumor Suppressor Protein p53 / Q000032:analysis; D000509:alpha-Fetoproteins / Q000032:analysis; D051028:bcl-2-Associated X Protein
chemical_list: C494826:BAX protein, human; D018809:Proliferating Cell Nuclear Antigen; D011518:Proto-Oncogene Proteins; D019253:Proto-Oncogene Proteins c-bcl-2; D016159:Tumor Suppressor Protein p53; D000509:alpha-Fetoproteins; D051028:bcl-2-Associated X Protein