title: The significance of DNA image cytometry and Edmondson-Steiner grading on prognosis after curative resection of hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) is the commonest primary cancer of the liver. Hepatic resection remains the main curative option, although the incidence of disease recurrence in the remaining hepatic parenchyma is high and accounts for the leading cause of death post resection. For this reason, the need to identify prognostic factors which may determine treatment response and survival is of paramount importance. In this study we assessed whether DNA image cytometry and Edmondson-Steiner grading could be used as prognostic factors in a cohort of patients with HCC undergoing radical hepatic resection.
  
  
  METHODS
  Forty-four patients with HCC who underwent radical resection were retrospectively analyzed. Histological grading according to Edmondson and Steiner and DNA ploidy using DNA image cytometry, were the two parameters analyzed. Pearson's x(2) or Fisher's exact tests were used to test for any associations between categorical variables. Univariate semi-parametric Cox proportional hazard regression models were used to assess the effect of explanatory variables on death. All reported p values were based on two-sided tests and compared to a significance level of 0.05.
  
  
  RESULTS
  In univariate Cox regression analysis, adverse survival outcome was strongly associated with high DNA score and advanced histological grading. Patients with ploidy score >2.2 had 3.95 times higher probability of death, as compared to those with ploidy score ≤ 2.2. Edmondson-Steiner grades III and IV were also associated with 20.49 and 34.47 higher probability of death respectively as compared to grade I.
  
  
  CONCLUSIONS
  Our results validate the prognostic significance of DNA image cytometry and Edmondson-Steiner grading following curative resection of HCC.
authors.affiliation: First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Petrou
authors.forename: I D
authors.initials: ID
authors.lastname: Xynos
authors.forename: K
authors.initials: K
authors.lastname: Tsigritis
authors.forename: G
authors.initials: G
authors.lastname: Agrogiannis
authors.forename: K
authors.initials: K
authors.lastname: Mihas
authors.forename: A
authors.initials: A
authors.lastname: Manzelli
authors.forename: E
authors.initials: E
authors.lastname: Prassas
authors.forename: N
authors.initials: N
authors.lastname: Brennan
authors.forename: N
authors.initials: N
authors.lastname: Kavantzas
authors.forename: E
authors.initials: E
authors.lastname: Felekouras
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004273:DNA, Neoplasm / Q000032:analysis*; D006801:Humans; D019044:Image Cytometry; D008113:Liver Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011003:Ploidies; D011379:Prognosis; D012307:Risk Factors
chemical_list: D004273:DNA, Neoplasm