title: Molecular refinement of clinical staging in hepatocellular carcinoma patients evaluated for potentially curative therapies.
abstract: OBJECTIVE
  VEGF and AFP mRNA determinations in the blood are promising prognostic factors for patients with HCC. This study explores their potential prognostic synergy in a cohort of HCC patients evaluated for potentially curative therapies.
  
  
  METHODS
  One hundred twenty-four patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were: (a) histological diagnosis of HCC and assessment of tumour grade and (b) determination of AFP mRNA status and VEGF levels in the blood before therapy.
  
  
  RESULTS
  At baseline evaluation, 40% of the study group had AFP mRNA in the blood (AFP mRNA positive), and 35% had VEGF>23 pg ml(-1) (VEGF positive). Surgery was performed in 58 patients (47%), 54 (43%) had tumour ablation, and 12 had chemoembolisation (10%). Median follow-up and survival of the study group were 19 and 26 months (range, 1 to 60), respectively. The association of AFP mRNA and VEGF proved to be prognostically more accurate than their single use in discriminating the risk of death (ROC curve analysis) and survival probability (Cox analysis). In particular, we identified 3 main molecular stages (p<0.0001): both negative (3-year survival = 63%), one positive (3-year survival = 40%), both positive (3-year survival = 16%). Multivariate analysis identified BCLC staging, surgery, and molecular staging as the most significant survival variables.
  
  
  CONCLUSIONS
  The preoperative determination of AFP mRNA status and VEGF may potentially refine the prognostic evaluation of HCC patients and improve the selection process for potentially curative therapies.
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Dipartimento di Chirurgia Generale e Trapianti d'Organo, Università di Padova, Padova, Italy. alessandro.vitale@unipd.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.forename: Filippo
authors.initials: F
authors.lastname: Navaglia
authors.forename: Rafael
authors.initials: R
authors.lastname: Ramírez Morales
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Daniela
authors.initials: D
authors.lastname: Basso
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Amico
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.forename: Pasquale
authors.initials: P
authors.lastname: Bonsignore
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigoletto
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D016019:Survival Analysis; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000235:genetics
chemical_list: C097353:AFP protein, human; D012333:RNA, Messenger; D042461:Vascular Endothelial Growth Factor A; D000509:alpha-Fetoproteins