Upregulation of bone morphogenetic protein 4 is associated with poor prognosis in patients with hepatocellular carcinoma.

Bone morphogenetic protein (BMP) 4 plays a crucial role in tumor invasion and metastasis of various human cancers. However, little is known about the correlation of BMP4 expression with clinical aggressiveness and prognosis in hepatocellular carcinoma (HCC). The aim of this study was to investigate the expression of BMP4 in HCC and determine its correlation with tumor progression and prognosis. Immunohistochemistry assay was used to determine the expression of BMP4 in HCC and corresponding paracarcinomatous tissues from 156 patients. The potential prognostic value of BMP4 was investigated by comparing the survival rates between the BMP4-positive and BMP4-negative HCC patients. Immunohistochemically, BMP4 protein expression in the HCC tissues (120/156, 76.9%) was significantly higher than that in the paracarcinomatous tissues (19/156, 12.2%, P < 0.01). The expression of BMP4 in HCC was associated with number of tumor nodules (P = 0.02), Edmondson grade (P = 0.03), TNM stage (P = 0.009), and vascular invasion (P = 0.006). In univariate survival analysis, the significant associations of the BMP4 protein overexpression with shortened patients' overall and disease-free survival were found (P = 0.001 and 0.006, respectively). Furthermore, its expression was found to be an independent factor for predicting both overall (P = 0.009) and disease-free survival (P = 0.022) of HCC in multivariate analysis. Our data suggest for the first time that BMP4 is overexpressed in HCC tissues and may also act as a novel marker for predicting the recurrence and prognosis of HCC patients after surgery.