Epithelial-mesenchymal Transition (emt) Radical Resection Of Intrahepatic Recurrence Of Hepatocellular Carcinoma As Well As The Efficacy Of Transcatheter Arterial Chemoembolization Study

Purpose:Epithelial mesenchymal transition (EMT) plays an important role in tumor metastasis. This study is to investigate the relationship between EMT and early intrahepatic recurrence after curative resection of hepatocellular carcinoma(HCC), to evaluate the value of EMT in predicting the prognosis of these patients by testing the EMT markers in HCC tissues.Methods:463 patients who had undergone curative resection of HCC between Jan 1999 and Jan 2005 in Liver Cancer Institute, Zhongshan Hospital, Fudan University were retrospectively reviewed. All the patients had received adjuvant TACE in 2 months after operation. 149 patients had been proved early intrahepatic recurrence in one year after resection, depending on the postoperative hepatic anteriography,ultrasound,CT and MRI. In each group, we chose radomizely 60 patients. Their HCC specimens in situ were retrospectively examined for EMT markers(E-cadherin,Vimentin,Fibronectin) with immunochemistry staining . Multivariate (Logistic Regression) analysis was used for studying the independent risk factor of early intrahepatic recurrence. Log-rank method was used for analyzing survival curves among different EMT- marker-expression groups. Multivariate analysis was done by Cox model to investigate the independent risk factor of longterm survival.Results:Univariate analysis showed that down regulation of E-cadherin, cytosolic expression of vimentin,up regulation of Fibronectin,positive HBsAg,tumor size more than 10cm,multiple leisions,embolus in microvessles and incomplete envelope had close correlations with early intrahepatic recurrence. Multivariate analysis indicated that down regulation of E-cadherin and up regulation of Fibronectin were independent risks for early intrahepatic recurrence in addition to tumor size more than 10cm,microvessles involvement and incomplete envelope. Univariate analysis showed that negtive E-cadherin expression was a markable risk of late intrahepatic recurrence after curative resection. Multivariate analysis indicated that both negtive E-cadherin expression and multiple tumor leisions were independent risks of late intrahepatic recurrence .The longterm survivals were statistically different among different E-cadherin,Fibronectin- expression- groups in postoperative patients with early intrahepatic recurrence after TACE. Cox model showed that only the negative E-cadherin expression was the independent risk of longterm survival.Conclusion:The results proposed that EMT has close relation with intrahepatic recurrence after curative resection of HCC. Loss of E-cadherin expression and up regulation of Fibronectin are the independent risk factors of early intrahepatic recurrence after curative resection. Negtive E-cadherin expression is the independent risk factor of early intrahepatic recurrence after curative resection. EMT has close relation with the effect of TACE performed in the patients with early intrahepatic recurrence after curative resection of HCC.