SOX2 and Bcl-2 as a Novel Prognostic Value in Hepatocellular Carcinoma Progression.

Zahra Hosseini-Khah,Magali Cucchiarini,Abolghasem Ajami,Henning Madry,Alireza Rafiei,Behrooz Nikbin,Nasser Rakhshani,Mohsen Tehrani,Mohammad Reza Babaei

doi:10.3390/curroncol28040264

Abstract

Sex-determining region Y-box 2 (SOX2) is a stem cell transcription factor and a major regulator of self-renewal and pluripotency of cancer stem cells (CSCs). In many types of cancer, SOX2 is dysregulated due to overexpression associated with tumor progression and low survival rate. Many HCC cases encounter recurrence and metastasis which might be due to CSCs and also apoptosis. Since little is known about the expression pattern of SOX2 and apoptotic genes in HCC, we aimed to determine the prognostic significance of SOX2, Bax, and Bcl-2 in clinicopathological features, tumor progression, and survival rate of the HCC patients. The expression of SOX2, Bax, and Bcl-2 were evaluated using qRT-PCR in 53 formalin-fixed, paraffin-embedded tissues (FFPE) of patients and 44 controls. Correlation of these genes was analyzed with clinicopathological features and tumor progression. The correlationship between SOX2 expression and ALBI grade as prognostic indicators were calculated. Survival rates were determined by Kaplan–Meier survival curves. SOX2 and Bcl-2 were remarkably overexpressed in HCC patients compared to controls (p = 0.04 and p = 0.003, respectively). A significant association was found for both SOX2 and Bcl-2 overexpression with TNM staging (p = 0.02, p = 0.04) and tumor grading (p = 0.01, p = 0.003), respectively. A significant correlation was observed: patients with SOX2 overexpression had a lower 5-year overall survival rate (p = 0.04); however, there was no significant association between Bcl-2 and survival (p = 0.5). Collectively, overexpression of SOX2 and Bcl-2, alone or combined, may be a potential marker to evaluate prognosis and response to HCC treatment.

Highlights

Hepatocellular carcinoma (HCC) is the fifth common malignancy and the third cancerleading death in the world [1]
HCC patients had a nearly two-fold increase in AST, ALT, and ALP compared to the controls
We examined the correlation between Sex-determining region Y-box 2 (SOX2), Bax, or Bcl-2 expression with liver function tests (LFT), including AST, ALT, ALP, as well as alpha-fetoprotein (AFP) tumor marker

Summary

Introduction

Hepatocellular carcinoma (HCC) is the fifth common malignancy and the third cancerleading death in the world [1]. Most HCC-related deaths might be due to inappropriate early diagnosis, lack of effective treatment [2], or extremely aggressive and metastatic phenotypes of the tumor [3] Conventional therapies, such as surgical resection, chemotherapy, radiotherapy, and multimodality therapies improve the survival rate of HCC patients, many cases encounter recurrence, intrahepatic spread, and extrahepatic metastasis [4]. This may be due to the presence of a small population of cancer cells with different biological characteristics, so-called cancer stem cells (CSCs). This supports the association of stemness trait with aberrant expression of ESC genes which may be related to specific cancers [8]

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