title: Triple positive tumor markers for hepatocellular carcinoma are useful predictors of poor survival.
abstract: OBJECTIVE
  To determine the importance of the expression pattern of multiple tumor markers for hepatocellular carcinoma (HCC) with regard to the tumor malignancy and patient survival.
  
  
  BACKGROUND
  Several studies have indicated that HCC tumor markers, including alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of AFP and des-γ-carboxy prothrombin were predictors of HCC malignancy. However, few reports have shown the relevance of the expression pattern of these 3 tumor markers with regard to patient prognosis. We herein reported the influence of the expression pattern of these 3 tumor markers on HCC malignancy and patient prognosis.
  
  
  METHODS
  This retrospective study analyzed 185 patients who underwent hepatectomy for HCC between January 1999 and May 2009. The relationships between clinical parameters and these 3 tumor markers were analyzed. Cox proportional hazards regression analyses were performed to estimate risk factors for recurrence and survival. Furthermore, the relationships between pathological parameters and the expression patterns of the 3 tumor markers were analyzed.
  
  
  RESULTS
  From clinical parameters, expression patterns of 3 tumor markers were related to maximum tumor size and macrovascular invasion in image findings. Multivariate analyses revealed independent risk factors for recurrence or survival to be the Child-Pugh score, the presence of multiple tumors, and triple positive tumor marker expression. From pathological findings, microvascular invasion and an Edmondson-Steiner classification of III or IV were related to the expression patterns of the 3 tumor markers.
  
  
  CONCLUSIONS
  Triple positive tumor markers for HCC showed poor prognosis and invasive characteristics in pathological findings. Examination of these markers would be useful for predicting the degree of HCC malignancy.
authors: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors: Shigehisa
authors: S
authors: Kiriyama
authors: Kazuhisa
authors: K
authors: Uchiyama
authors: Masaki
authors: M
authors: Ueno
authors: Satoru
authors: S
authors: Ozawa
authors: Shinya
authors: S
authors: Hayami
authors: Masaji
authors: M
authors: Tani
authors: Hiroki
authors: H
authors: Yamaue