Yi-Wei Li

Intratumoral Balance of Regulatory and Cytotoxic T Cells Is Associated With Prognosis of Hepatocellular Carcinoma After Resection

PURPOSE To investigate the prognostic value of tumor-infiltrating lymphocytes (TILs), especially regulatory T cells (Tregs), in hepatocellular carcinoma (HCC) patients after resection. PATIENTS AND METHODS CD3+, CD4+, CD8+, Foxp3-positive, and granzyme B-positive TILs were assessed by immunohistochemistry in tissue microarrays containing HCC from 302 patients. Prognostic effects of low- or high-density TIL subsets were evaluated by Cox regression and Kaplan-Meier analysis using median values as cutoff. RESULTS CD3+, CD4+, CD8+ TILs were associated with neither overall survival (OS) nor disease-free survival (DFS). The presence of low intratumoral Tregs in combination with high intratumoral activated CD8+ cytotoxic cells (CTLs), a balance toward CTLs, was an independent prognostic factor for both improved DFS (P = .001) and OS (P < .0001). Five-year OS and DFS rates were only 24.1% and 19.8% for the group with intratumoral high Tregs and low activated CTLs, compared with 64.0% and 59.4% for the group with intratumoral low Tregs and high activated CTLs, respectively. Either intratumoral Tregs alone (P = .001) or intratumoral activated CTLs (P = .001) alone is also an independent predictor for OS. In addition, high Tregs density was associated with both absence of tumor encapsulation (P = .032) and presence of tumor vascular invasion (P = .031). CONCLUSION Tregs are associated with HCC invasiveness, and intratumoral balance of regulatory and cytotoxic T cells is a promising independent predictor for recurrence and survival in HCC. A combination of depletion of Tregs and concomitant stimulation of effector T cells may be an effective immunotherapy to reduce recurrence and prolong survival after surgery.

PEBP1 downregulation is associated to poor prognosis in HCC related to hepatitis B infection

BACKGROUND & AIMS Phosphatidylethanolamine-binding protein 1 (PEBP1, also RKIP) plays a pivotal role in cancer by regulating multiple cellular signaling processes and suppressing metastasis in animal models. We examined whether PEBP1 expression in hepatocellular carcinoma (HCC) correlated with the risk of recurrence and survival after resection. METHODS A randomly selected cohort of 240 Chinese HCC patients, predominantly hepatitis B related, formed the basis of the study. PEBP1 expression levels were evaluated by immunohistochemistry and real-time reverse-transcriptase PCR. Survival analysis was performed by univariate and multivariate analyses. The results were further validated in an independent series of 403 patients. The relevance of PEBP1 to phospho-ERK was determined by Western blot analysis on clinical samples and hepatoma cell lines. RESULTS PEBP1, prevalently down-regulated in HCC, was significantly associated with tumor invasive characteristics (such as vascular invasion, lack of encapsulation, poor differentiation and large size). Both PEBP1 protein and mRNA levels were independent predictors for tumor recurrence (hazard ratio (HR) = 1.877, p=0.001; HR = 2.633, p = 0.001; respectively), and patient survival (HR = 1.796, p = 0.004; HR = 1.730, p = 0.044; respectively). The prognostic value of PEBP1 was then confirmed in the validation cohort. In addition, Western blot suggested that loss of PEBP1 led to hyperactivity of MAPK signaling. CONCLUSIONS Down-regulation of PEBP1 in HCC indicated aggressive tumor behaviors and predicted a worse clinical outcome, which may be a useful biomarker to identify the patients at high risk of post-operative recurrence.

Expression of TREM-1 in hepatic stellate cells and prognostic value in hepatitis B-related hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a typical inflammation‐related malignancy characterized by high postoperative recurrence and metastasis. Although several inflammatory cells and inflammatory signatures have been linked to poor prognosis, the inflammation‐associated molecular mechanisms of HCC development and progression are largely unknown. Here we show that triggering receptor expressed in myeloid cells (TREM)‐1, a transmembrane receptor expressing in myeloid cells, was also expressed in tumor‐activated hepatic stellate cells (HSCs) and associated with the aggressive behavior of HCC cells. Enzyme‐linked immunosorbent assay was used to measure the expression levels of soluble TREM‐1 (sTREM‐1) in activated hepatic stellate cells supernatant and 92 preoperative and postoperative plasmas of patients with malignancy and/or benign liver tumor/disease, respectively. Expression levels of TREM‐1 were assessed by immunohistochemistry in tissue microarray from 240 patients with HCC. As a result, increased secretion of sTREM‐1 from activated HSCs was observed after co‐culture with HCC cell lines (P < 0.001), and conditioned medium collected from activated HSCs/cancer associated myofibroblasts (CAMFs) with or without agonist/inhibitor of TREM‐1 significantly changed the migratory ability of HCC cells. The levels of sTREM‐1 were significantly higher in patients with HCC than those with benign liver tumors (P < 0.005). Peritumoral density of TREM‐1 was shown to be an independent prognosis predictor according to univariate (P < 0.001 for both overall survival and time to recurrence) and multivariate analysis (P = 0.008 for overall survival; P = 0.005 for time to recurrence). Thus, these observations suggest that TREM‐1 is related to the aggressive tumor behavior and has potential value as a prognostic factor for HCC. (Cancer Sci 2012; 103: 984–992)

Overexpression of galectin‐1 is associated with poor prognosis in human hepatocellular carcinoma following resection

Background and Aim:  The high expression of the galectin‐1 predicts poor patient outcome in several tumors. The aim of this study was to investigate its prognostic value in patients with hepatocellular carcinoma (HCC) after resection.

The clinical and prognostic implications of pluripotent stem cell gene expression in hepatocellular carcinoma

Recently, growing evidence has demonstrated that aberrant expression of pluripotent stem cell-related genes may confer primitive and aggressive traits and be associated with unfavorable clinical outcomes in certain solid cancers. However, the role of pluripotent stem cell gene expression in hepatocellular carcinoma (HCC) remains unexplored. We evaluated the expression of the pluri potent stem cell genes Oct4, Sox2 and Klf4, as well as that of the c-Myc, Nanog and Lin28 genes in HCC samples and corresponding adjacent non-tumor liver samples obtained from 57 patients using quantitative real-time reverse transcription-PCR (qRT-PCR). The results revealed that six pluripotent stem cell gene expression levels were upregulated in the tumor tissues compared with the corresponding adjacent non-tumor liver tissues. In HCC tissues, aberrant expression of Sox2 and Lin28 was associated with a large tumor size (P=0.02 and P=0.03, respectively), while increased expression levels of c-Myc (P=0.01) were correlated with vascular invasion. Moreover, high Klf4 expression levels were associated with aggressive tumor behaviors in terms of vascular invasion (P=0.02) and poor tumor differentiation (P=0.03). Survival analysis revealed that Klf4 expression was independently associated with overall survival [OS; hazard ratio (HR), 8.61; 95% confidential interval (CI), 2.7–27.5; P<0.001] and recurrence-free survival (RFS; HR, 3.96; 95% CI, 1.3–11.6; P=0.01). In conclusion, pluripotent stem cell genes are associated with HCC progression and a poor prognosis. The development of therapeutic strategies, including adjuvant therapy, that take cancer stem cell (CSC)-related markers into consideration is likely to be a key factor in further improvements of the prognosis of HCC patients undergoing curative liver resection.

Intratumoral regulatory T cells with higher prevalence and more suppressive activity in hepatocellular carcinoma patients

Regulatory T cells (Treg) play a vital role in immunosuppressive crosstalk; however, Tregs from different locations lead to different clinical outcomes. Our aim was, therefore, to compare the prevalences and suppressive phenotypes of Tregs in the peripheral blood, peritumor, and intratumor of patients with hepatocellular carcinoma (HCC).

Decreased Expression of GATA2 Promoted Proliferation, Migration and Invasion of HepG2 In Vitro and Correlated with Poor Prognosis of Hepatocellular Carcinoma

Background GATA family of transcription factors are critical for organ development and associated with progression of various cancer types. However, their expression patterns and prognostic values for hepatocellular carcinoma (HCC) are still largely unknown. Methods Expression of GATA transcription factors in HCC cell lines and tissues (n = 240) were evaluated by RT-qPCR, western blot and immunohistochemistry. Cellular proliferation, migration and invasion of HepG2 was evaluated by CCK-8 kit, scratch wound assay and transwell matrigel invasion assay, respectively. Results GATA2 expression was decreased in HCC cell lines (p = 0.056 for mRNA, p = 0.040 for protein) and tissues (p = 1.27E-25) compared with normal hepatocytes. Decreased expression of intratumoral GATA2 protein significantly correlated with elevated alpha feto-protein (p = 2.7E-05), tumor size >5 cm (p = 0.049), absence of tumor capsule (p = 0.002), poor differentiation (p = 0.005), presence of tumor thrombi (p = 0.005) and advanced TNM stage (p = 0.001) and was associated with increased recurrence rate and decreased overall survival rate by univariate (p = 1.6E-04 for TTR, p = 1.7E-04 for OS) and multivariate analyses (HR = 0.63, 95% CI = 0.43–0.90, p = 0.012 for TTR; HR = 0.67, 95% CI = 0.47–0.95, p = 0.026 for OS). RNAi-mediated knockdown of GATA2 expression significantly enhanced proliferation, migration and invasion of HepG2 cell in vitro. Conclusions Decreased expression of hematopoietic factor GATA2 was associated with poor prognosis of HCC following resection.

Combination of Intratumoral Invariant Natural Killer T Cells and Interferon-Gamma Is Associated with Prognosis of Hepatocellular Carcinoma after Curative Resection

Purpose To investigate the prognostic value of intratumoral invariant natural killer T (iNKT) cells and interferon-gamma (IFN-γ) in hepatocellular carcinoma (HCC) after curative resection. Experimental Design Expression of TRAV10, encoding the Vα24 domain of iNKT cells, and IFN-γ mRNA were assessed by quantitative real-time polymerase chain reaction in tumor from 224 HCC patients undergoing curative resection. The prognostic value of these two and other clinicopathologic factors was evaluated. Results Either intratumoral iNKT cells and IFN-γ alone or their combination was an independent prognostic factor for OS (P = 0.001) and RFS (P = 0.001) by multivariate Cox proportional hazards analysis. Patients with concurrent low levels of iNKT cells and IFN-γ had a hazard ratio (HR) of 2.784 for OS and 2.673 for RFS. The areas under the curve of iNKT cells, IFN-γand their combination were 0.618 vs 0.608 vs 0.654 for death and 0.591 vs 0.604 vs 0.633 for recurrence respectively by receiver operating characteristic curve analysis. The prognosis was the worst for HCC patients with concurrent low levels of iNKT cells and IFN-γ, which might be related with more advanced pTNM stage and more vascular invasion. Conclusions Combination of intratumoral iNKT cells and IFN-γ is a promising independent predictor for recurrence and survival in HCC, which has a better power to predict HCC patients’ outcome compared with intratumoral iNKT cells or IFN-γ alone.

An evaluation of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy on patients with peritoneal carcinomatosis: Final results of a phase II prospective and randomized clinical trial.

4051 Background: Our phase I study indicates that cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is feasible and may help improve the outcomes of pts with peritoneal carcinomatosis (PC). This randomized and prospective phase II study was to evaluate the efficacy and safety of CRS + IPHC using cisplatin (CDDP) and mitomycin C (MMC) for the PC. METHODS Pts eligibility criteria were: (1) PC from gastric and colorectal cancers without evidence of distant metastasis and expected survival of > 8 wk; (2) age between 25-70 yr old; (3) KPS>50; (4) routine laboratory workup found no significant changes limiting aggressive intervention; (5) good tolerance for major surgery; and (6) written informed consent. After randomization, pts were treated with CRS alone or CRS + IPHC using CDDP 120 mg and MMC 30 mg in 12,000 mL of normal saline at 43±0.5°C for 60-90 min. Survival and safety were studied. RESULTS A total of 89 pts with PC (68 from gastric cancer and 21 from colorectal cancer) were randomized into CRS group (n=44) and CRS + HIPEC group (n=45). The 2 groups were well-balanced in terms of major demographic data, KPS and PCI. At a median follow-up of 32.5 mo (7-83 mo), the median survival was 6.5 mo (95% CI 5.2-7.8 mo) in CRS group and 13.0 months (95% CI 9.0-17.0 mo) in the CRS + HIPEC group (P=0.001, log rank test). For gastric PC pts, the median survival was 6.5 months (95% CI 4.9-8.2 mo) in CRS group (n=34) and 11.0 mo (95% CI 9.0-12.9 mo) in the CRS+HIPEC group (n=34) (P=0.002, log rank test). For CRC PC pts, the median survival was 7.0 mo (95% CI 3.5-10.5 mo) in CRS group (n=11) and 15.5 mo (95% CI 4.9-26.1 mo) in the CRS+HIPEC group (n=10) (P=0.003, log rank test). HIPEC could increase the median survival by over 60%. No perioperative death occurred. Four pts (10.3%) in the CRS+HIPEC group and 2 (5.0%) pts in the CRS group developed SAE. CONCLUSIONS For PC pts from gastric and colorectal cancers, CRS plus HIPEC with MMC 30 mg and CDDP 120 mg could improve survival with acceptable safety.