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Open Access Research

Tissue expression of squamous cellular carcinoma antigen and Ki67 in hepatocellular carcinoma-correlation with prognosis: A historical prospective study

Hemda Schmilovitz-Weiss1, Ana Tobar2, Marisa Halpern3, Izhar Levy4, Esther Shabtai5 and Ziv Ben-Ari6*

Author affiliations

1 Gastroenterology Unit, Rabin Medical Center, Hasharon Hospital, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

2 Department of Histopathology, Rabin Medical Center, Beilinson Hospital, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv

3 Department of Histopathology, Rabin Medical Center, Hasharon Hospital, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

4 Liver Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

5 Statistical Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

6 Liver Institute, Rabin Medical Center Beilinson Hospital, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Citation and License

Diagnostic Pathology 2011, 6:121  doi:10.1186/1746-1596-6-121

Published: 7 December 2011

Abstract

Background

Squamous cellular carcinoma antigen (SCCA) is overexpressed in hepatocellular carcinoma (HCC) tissue and in sera of HCC patients. Our aim was to assess hepatic SCCA immunostaining in a series of HCCs and to correlate its presence with cell proliferation, apoptosis and clinical outcome.

Methods

Sixty-one HCC patients were included. Liver specimens were obtained either by biopsy (n = 17) or surgically (resection 27, transplantation 17). Immunostaining for AFP, Ki-67, SCCA and TUNEL assay were performed.

Results

SCCA staining was detected in 83.6% of specimens. A statistical significant correlation was found between negative SCCA staining and mortality (p = 0.026) and a higher immunostaining score for Ki67 (p = 0.017). Positive SCCA staining was associated with well and moderate differentiated tumors (p = 0.022). Using multiple logistic regression analysis, Ki67 and TUNEL assay were found to be significant independent predictors of negative SCCA immunostaining. The area under the receiver operator characteristic curve was 0.87. Kaplan-Meier survival analysis revealed a significant difference between the patient group with positive versus negative SCCA immunostaining relating to survival time (p = 0.0106). Cox proportional hazard regression analysis demonstrated that Ki67 immunostaining and liver transplantation or resection were independently associated with mortality.

Conclusions

SCCA is overexpressed in HCC. SCCA status is associated with cell proliferation, apoptosis and survival. SCCA and Ki67 staining can predict survival. Our study results support a potential association of negative SCCA expression with other markers of poor outcome in HCC. More studies are needed to clarify the role of SCCA in HCC and expand the knowledge of the SCCA antigen in HCC patients.

Keywords:
squamous cellular carcinoma antigen; immunostaining; Ki67; hepatocellular carcinoma; TUNEL assay