The clinical utility of the proliferating cell nuclear antigen expression in patients with hepatocellular carcinoma.

Proliferating cell nuclear antigen (PCNA) has been suggested as a potential diagnostic biomarker for early hepatocellular carcinoma (HCC). However, its prognostic significance in HCC remains unclear. In the present study, we investigated the expression and significance of PCNA in HCC and then analyzed the role of PCNA in clinical outcomes. Our findings show that the expression intensity of PCNA is much higher in HCC tissues than that in paracarcinoma tissues and associated with AFP, albumin, tumor number, clinical grade, vascular invasion, and tumor-node-metastasis (TNM) stage (all p < 0.000). Kaplan-Meier analysis indicated that high PCNA expression was associated with poor disease-free survival (DFS) (p < 0.000) and overall survival (OS) (p < 0.000) in a training cohort of 76 HCC patients. Multiple Cox regression analysis indicated PCNA acts as an independent predictor for DFS (p = 0.002) and OS (p = 0.004) in HCC patients. Along with pathological results, our systematic review also identified the expression of PCNA was closely associated with DFS and OS (both p < 0.000). In conclusion, this study suggested that PCNA is increased in HCC patients and is indeed a novel unfavorable biomarker for prognostic prediction for patients with this deadly disease.