Growth index, assessed with Ki-67 and ssDNA labeling, is a significant prognosticator for patients who underwent curative resection for hepatocellular carcinoma

Abstract

4084 Backgroud: The growth of tumor depends on the degree of imbalance between cell production and cell loss. Knowledge of such biological difference is of importance to understand aggressiveness of the cancer and to the management of cancer patients. This study was conducted to clarify a possible role of the modified prognosticator, Growth Index (GI), in patients who underwent curative resection for hepatocellular carcinoma (HCC). GI (%) was defined as a difference between a Ki-67 labeling index (%) and a single-stranded DNA (ssDNA) labeling index (%). Methods: HCC tissue specimens were obtained from 40 HCC patients (27 men and 13 women, range 45–80 years old) who underwent curative resection between April 1998 and March 2001. Immunohistochemical staining was perfomed using the avidin-biotin-peroxidase-complex method on formalin-fixed paraffin-embedded-tissues. Results: Ki-67 labeling index ranged from 0.20% to 29.10%, and ssDNA labeling index ranged from 0.22% to 4.20%. The GI ranged from -1.90% to 28.65% with a median of 3.73. GI was related with histologic grade (P = 0.014 by Kruskal-Wallis), pathologic T stage (P = 0.026 by Kruskal-Wallis), and intrahepatic metastasis (P = 0.048 by Mann-Whitney). The cumulative survival was poorer in patients with higher GI (≥ 3.73%, a median value) than those with lower GI (P = 0.014 by log-rank test). The univariate analysis demonstrated that GI, histologic grade, pathologic T stage, vascular invasion, intrahepatic metastasis, and age were significant factors affecting survival. The Cox multivariate analysis indicated that GI (P = 0.003) is an independent prognosticator along with intrahepatic metastasis (P = 0.003) and age (P = 0.018). Conclusions: Higher values of GI were significantly associated with histologically aggressive features of HCC, and GI was a significant independent prognosticator in HCC patients after curative resection. Assessing GI is feasible on routine paraffin sections and may provide additional prognostic information in those post-operative patients. No significant financial relationships to disclose.