Prognostic significance of combined PCPE-1 and α-fetoprotein for hepatocellular carcinoma.

PURPOSE: Procollagen C-proteinase enhancer 1 (PCPE-1) is associated with liver fibrosis, a major risk factor of hepatocellular carcinoma (HCC). However, its role in HCC remains unclear. MATERIALS AND METHODS: The mRNA and protein expression levels of PCPE-1 were analyzed using publicly available datasets of HCC tissues and matched normal tissues. Western blotting was performed to determine PCPE-1 levels in 7 paired HCC tumor and normal tissues. Immunohistochemistry was used to detect PCPE-1 levels in 155 HCC patients. The ROC curve was employed to determine the optimal cutoff value of PCPE-1. Univariate and multivariate analyses identified independent risk factors associated with overall survival (OS) of HCC patients. Kaplan-Meier analysis assessed the relationship between PCPE-1 expression and OS, and a prognostic model was constructed. RESULTS: PCPE-1 protein was upregulated in HCC tissues compared to normal tissues and positively correlated with the expression of several procollagens. 78 out of 155 HCC patients exhibited elevated PCPE-1 expression with cytoplasmic staining. High PCPE-1 expression significantly correlated with tumor necrosis (P = 0.045), poorer histologic grade (G3-G4, P = 0.008), and higher α-fetoprotein (AFP) level (>20 ng/ml, P = 0.043). Both univariate and multivariate analyses showed a significant association between elevated PCPE-1 and poorer overall survival (P < 0.001 in both analyses). Remarkably, combined prognostic model with PCPE-1 and AFP effectively stratified the risk for OS in HCC. CONCLUSION: Our results demonstrate for the first time that PCPE-1 serves as an independent prognostic marker for HCC, and the combined prognostic model involving PCPE-1 and AFP emerges as a valuable tool for predicting patient outcomes.