Prognostic impact of proliferation in hepatocellular carcinoma

Background: The prognosis of patients with curatively resectable hepatocell ular carcinoma depends mainly on anatomic extent of the tumour and on the g eneral condition of the patient. Given the growing evidence that proliferat ion indices may be of prognostic significance in hepatocellular carcinomas, identification and quantitation of proliferative capacity may be of progno stic importance. Methods: We have compared four different methods to assess proliferation in a series of 193 curatively (RO-) resected hepatocellular carcinomas: Mitot ic count, immunohistochemical assessment of the MIB-1- (Ki-67-), Antigen Pr oliferating Cell Nuclear Antigen (PCNA) and silverstained nucleolar organis er regions (AgNOR). The results obtained were compared with pathohistologic al stage (according to UICC), Edmondson Grade and with survival rate. Results: In each carcinoma, we could demonstrate mitotic figures, MIB-1, PC NA and AgNOR dots in variable proportions. Significant statistical correlat ions were seen between Mitotic Index, the rate of nuclear positivity for MI B-1 and PCNA and the number of AgNOR dots. In univariate survival analysis tumour stage and Edmondson Grade, Mitotic Index, MIB-1 and PCNA Index and m ean AgNOR-number were significant patients' survival influencing factors. P erforming multivariate Cox survival analysis, Mitotic Index, concomitant ci rrhosis, Edmondson Grade and patient age were the only significant independ ent prognostic factors. Conclusion: These results indicated that Mitotic Index is an additional pro gnostic parameter which could provide auxiliary information for patients' o utcome.