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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2016; 22(9): 2837-2843
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2837
Importance of SALL4 in the development and prognosis of hepatocellular carcinoma
Fei Yin, Xin Han, Shu-Kun Yao, Xiao-Ling Wang, Hui-Chai Yang
Fei Yin, Xin Han, Department of Gastroenterology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Shu-Kun Yao, Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
Xiao-Ling Wang, Hui-Chai Yang, Department of Pathology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Author contributions: Yin F and Yao SK conceived and designed the study and revised the manuscript; Wang XL and Yang HC guided the experimental operation and determined the experimental results; Han X contributed to the acquisition, analysis, and interpretation of data and drafted the manuscript.
Supported by the National Natural Science Foundation of China, No. 81072966/H2902; and the Natural Science Foundation of Hebei Province, China, No. C2011206134.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fei Yin, Professor, Department of Gastroenterology, the Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang 050011, Hebei Province, China. yinfei_4y@sina.com
Telephone: +86-13831120022 Fax: +86-311-66696211
Received: July 4, 2015
Peer-review started: July 6, 2015
First decision: July 19, 2015
Revised: September 19, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: March 7, 2016
Abstract

AIM: To detect the expression of sal-like protein 4 (SALL4) and to explore its relationship with clinicopathological characteristics and prognosis of hepatocellular carcinoma (HCC).

METHODS: One hundred and twenty-six samples of HCC tissue, 44 of adjacent noncancerous cirrhotic tissue and 10 of liver hemangioma tissue, were obtained from patients who underwent hepatectomy for HCC at the Fourth Hospital of Hebei Medical University. None of the patients had received any form of treatment before the operation. After resection, all the tissues were fixed in 10% neutral formaldehyde and embedded in paraffin. Expression of SALL4 was detected by immunohistochemistry. Patients were followed up for postoperative survival until February 2014. The relationships between SALL4 expression level and clinicopathological data and prognosis of HCC were analyzed.

RESULTS: SALL4 expression was negative in the 10 samples of tissue from liver hemangioma, was weakly positive in the two samples from adjacent noncancerous cirrhotic tissue, and positive in 58 samples of HCC tissues. The differences were statistically significant (P < 0.05). Expression of SALL4 was higher in patients with higher α-fetoprotein (AFP) levels, portal vein tumor thrombus, and later clinical stage based on the Barcelona Clinic Liver Cancer classification (P < 0.05). Among patients with negative expression, weakly positive expression, positive expression, and strongly positive expression of SALL4, the median survival time was 39, 25, 23, and 9 mo, respectively (P < 0.001). When both AFP and SALL4 were detected, patients who were negative for both AFP and SALL4, SALL4-positive only, AFP-positive only, and positive for both AFP and SALL4, had a median survival time of 41, 38, 31, and 12 mo, respectively (P < 0.001).

CONCLUSION: Expression of SALL4 is relevant to the prognosis of HCC patients. Patients with higher expression levels of SALL4 and AFP have worse prognosis.

Keywords: Sal-like protein 4, Hepatocellular carcinoma, Survival analysis, α-Fetoprotein, Prognosis

Core tip: Sal-like protein 4 (SALL4) is expressed as an oncogene in a variety of tumors, including germ cell tumors, breast cancer, and α-fetoprotein (AFP)-producing gastric cancer. However, there are few reports about the association between SALL4 expression and hepatocellular carcinoma (HCC). In this study, we found that SALL4 was actively expressed in HCC cells with stem cell characteristics and played an important role in predicting the prognosis of HCC patients. In addition, joint detection of SALL4 and AFP may have a more profound significance for the prognosis of HCC patients.