title: Glutamine synthetase predicts adjuvant TACE response in hepatocellular carcinoma.
abstract: BACKGROUND
  Adjuvant transcatheter arterial chemoembolization (TACE) is associated with better outcome and reduced tumor recurrence in hepatocellular carcinoma (HCC) patients. This study aimed to investigate the relationship between glutamine synthetase (GS) expression and survival of HCC patients after postoperative adjuvant TACE.
  
  
  METHODS
  We retrospectively analyzed 554 HCC patients in two independent cohorts who underwent curative resection. Immunohistochemistry assay was used to investigate the expression of GS protein and evaluate the association with survival and the response to adjuvant TACE.
  
  
  RESULTS
  In training cohort, patients with low GS expression who received postoperative adjuvant TACE showed a better overall survival (OS) (P<0.001) and less early phase recurrence (P=0.016). Adjuvant TACE was an independent prognostic factor for 5-year OS (HR=0.408, 95% CI 0.261-0.639, P<0.001) and early phase recurrence (HR=0.592, 95% CI 0.376-0.931, P=0.023). The same result was confirmed in validation cohort. Patients with high GS expression in both cohorts did not have a significant response to adjuvant TACE in OS and early phase recurrence.
  
  
  CONCLUSIONS
  GS status in tumor might be a useful tool in the selection of HCC patients who would be likely to benefit from postoperative adjuvant TACE.
authors.affiliation: Department of Health Statistics, The Second Military Medical UniversityShanghai 200433, China; Center for Disease Control and Prevention, Jinan Military Area CommandJinan 250014, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University Shanghai 200438, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
authors.affiliation: National Center for Liver Cancer, Eastern Hepatobiliary Surgery Institute, The Second Military Medical University Shanghai 200438, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: National Center for Liver Cancer, Eastern Hepatobiliary Surgery Institute, The Second Military Medical University Shanghai 200438, China.
authors.forename: Liwei
authors.initials: L
authors.lastname: Dong
authors.affiliation: Department of Health Statistics, The Second Military Medical University Shanghai 200433, China.
authors.forename: Zhichao
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Health Statistics, The Second Military Medical University Shanghai 200433, China.
authors.forename: Xinji
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University Shanghai 200438, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xue
authors.affiliation: Department of Health Statistics, The Second Military Medical UniversityShanghai 200433, China; Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS)Shanghai 200031, China.
authors.forename: Jia
authors.initials: J
authors.lastname: He
keywords: Glutamine synthetase; hepatocellular carcinoma; prognosis; survival; transcatheter arterial chemoembolization