High level of intercellular adhesion molecule-1 affectsprognosis of patients with hepatocellular carcinoma

AIM To determine the cut-off value of intercellularadhesion molecule-1 （ICAM-1） and assess the correlationof ICAM-1 with clinicopathological featuresand the prognosis of hepatocellular carcinoma （HCC）patients who underwent surgical resection.METHODS： We prospectively collected clinicopathologicaldata from 236 HCC patients who had undergonesuccessful hepatectomy. Receiver operatingcharacteristic curve analysis was performed to determinethe optimal cut-off value of ICAM-1. Enzymelinkedimmunosorbent assay was used to measure theconcentration of ICAM-1 in 236 serum samples isolatedfrom HCC patients and the stratified analysis was usedto compare the serum level of ICAM-1 in different HCCsubgroups. Immunohistochemistry was performedto test the expression level of the ICAM-1 protein in76 cases of HCC tissues and their adjacent normalliver tissues （ANLT）. The survival probability of HCCpatients was estimated using Kaplan-Meier plots anddifferences between the groups were obtained usingthe log-rank test. Furthermore, independent indicators of the prognosis were acquired using a stepwiseCox proportional hazard model to analyze a seriesof predictors that were associated with disease-freesurvival （DFS） and overall survival （OS） in HCC patients.RESULTS： Our findings suggested that ICAM-1promotes HCC metastasis and high serum ICAM-1 issignificantly associated with alpha-fetoprotein （AFP）（P = 0.022）, clinical tumor-node-metastasis stage （P〈 0.001）, portal vein tumor thrombus （P = 0.005）,distant metastasis （P = 0.016） and recurrence （P= 0.034）. We further detected the ICAM-1 proteinin HCC specimens and found that 56 of 76 （73.7%）HCC tissues had ICAM-1 positive staining while only23 of 76 （30.3%） ANLT were positively stained （P 〈0.0001）. Survival analysis indicated that HCC patientswith increased ICAM-1 concentrations had significantlyshorter DFS and OS after resection. A multivariateanalysis showed that ICAM-1 〉 684 ng/mL was anindependent factor for DFS （HR = 1.643; 95%CI：1.125-2.401; P = 0.010） and OS （HR = 1.692; 95%CI：1.152-2.486; P = 0.007）.CONCLUSION： ICAM-1 may be a promising serologicalbiomarker for HCC diagnosis and an independentpredictor of DFS and OS after surgical resection andmay provide a useful reference for the prediction ofintra- and extrahepatic metastasis.