Abstract
Background and Aim The epithelial cell adhesion molecule (EpCAM) has been proposed as a marker for cancer stem cells in human hepatocellular carcinoma (HCC) as well as in the development of novel target therapies. This study aimed to investigate the immunohistochemical expression of EpCAM and alpha-fetoprotein (AFP) in HCC patients and their association with clinicopathological characteristics. Methods This study included Child-Pugh A HCC patients undergoing curative surgical resection. Results A significant difference was observed in the ratio between the different phenotypes (p = 0.002), identifying 12 (29.3%) EPCAM positive tumors and 29 (70.7%) negative tumors. EpCAM+ expression was associated with AFP + (OR = 12.5, 95% CI, 1.9-84.1, p<0.001). In univariate analysis, a significant association was observed between AFP+ and EPCAM+ and the serum AFP level. A diameter of ≤ 5 cm was associated with EPCAM+, while angiolymphatic invasion was associated with APF+. In a multivariate analysis, only tumors of ≤ 5 cm were significantly associated with EpCAM+ (OR = 8.7; 95%CI, 1.27-100.0; p = 0.022). The overall survival rate was 74.9%, 69.4%, 69.4%, and 53.5% at 12, 24, 36, and 48 months, respectively. Conclusion A considerable number of patients with EpCAM+ HCC would benefit from a specific target therapy.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the third in cancer-related mortality [1]
The chance of occurrence of positive epithelial cell adhesion molecule (EpCAM) expression when AFP is positive was 12.5 times the chance of positive EpCAM expression when AFP was negative (OR = 12.5, CI=95% 1.9-84.1, p
Angiolymphatic invasion was associated with APF+, while the hepatocellular carcinoma (HCC) diameter ≤ 5 cm was associated with EPCAM+
Summary
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the third in cancer-related mortality [1]. The so-called Cancer Stem Cells (CSC), a small distinct subpopulation of cells exhibiting consistent properties as stem cells, such as self-renewal, cell proliferation, and differentiation, have been demonstrated in HCC. These cells would be responsible for tumor initiation, as well as their biological behavioral patterns, including angiolymphatic invasion, metastasis, and recurrence [4]. Many surface proteins have been suggested as biomolecular markers of CSC in HCC, including the epithelial cell adhesion molecule (EpCAM) [4, 5]. The epithelial cell adhesion molecule (EpCAM) has been proposed as a marker for cancer stem cells in human hepatocellular carcinoma (HCC) as well as in the development of novel target therapies. A considerable number of patients with EpCAM+ HCC would benefit from a specific target therapy
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