Oncofetal gene SALL4 in aggressive hepatocellular carcinoma.

Abstract

To the Editor: The study by Yong et al. (June 13 issue)1 shows the usefulness of SALL4 in identifying hepatocellular carcinoma with a progenitor-like phenotype. These data provide prognostic information and identify patients who are likely to benefit from targeted therapies. The identification of SALL4-positive tumors requires patients to undergo a biopsy.2 Current guidelines of the American Association for the Study of Liver Diseases do not recommend routine biopsy for the diagnosis of hepatocellular carcinoma3 because of the risk of bleeding, tumor seeding, and — rarely — death.4 Determining SALL4 status therefore places patients at additional risk. Alpha-fetoprotein is a serum marker of a subtype of hepatocellular carcinoma associated with progenitor-like phenotype and poor prognosis.5 Measurement of serum alpha-fetoprotein levels is noninvasive, inexpensive, and routine in patients at risk for hepatocellular carcinoma. The authors identify a significant association between a serum alpha-fetoprotein level of 100 ng per milliliter or more and high tumoral SALL4 gene expression (P<0.01). We ask the authors to estimate the sensitivity and specificity of the serum alpha-fetoprotein level in predicting the SALL4 status of their patients. These data would help to avoid additional risks associated with tumor biopsy in patients with SALL4-negative tumors.