简介：Althoughthyroidcarcinomaisarelativelycommonformofmalignancy,metastaticspreadtotheskullisrare.Here,wereportacaseofpapillarythyroidcarcinomawithfrontalandparietalmetastasis.A61-year-oldChinesewomanpresentedwithaoneyearhistoryofagrowingmassonthecenterofthefrontalandparietalbone,initiallythoughttobemeningioma.Biopsyoftheskullbasemassafterintracalvariumexcision,indicatedatumorofthyroidorigin.Onemonthlaterthepatientunderwentatotalthyroidectomy.Pathologicalexaminationconfirmedadiagnosisofpapillarythyroidcarcinomawithfrontalandparietalbonemetastasis.Basedonthisexperience,thekeytosuccessfulmanagementoftheskullmetastasisofthyroidcarcinomaispromptdiagnosisandappropriatetreatment.Skullmetastasisshouldbeconsideredattheoutsetoftheclinicalcourseofpapillarythyroidcancer.Tofacilitatethis,patientsshouldbemeticulouslyinvestigatedbyamultidisciplinaryteamtoimprovequalityoflife.

简介：Objective:Puremucinousbreastcarcinoma(PMBC)isanuncommonhistologicaltypeofbreastcancercharacterizedbyalargeamountofmucinproduction.MicroRNA(miRNA)isalargeclassofsmallnoncodingRNAofabout22ntinvolvedintheregulationofvariousbiologicalprocesses.ThisstudyaimstoidentifythemiRNAexpressionprofileinPMBC.Methods:MiRNAexpressionprofilesin11PMBCswereanalyzedbymiRNA-microarrayandreal-timepolymerasechainreaction(PCR).Thirty-onePMBCsand27invasiveductalcarcinomaofnospecialtypes(IDC-NSTs)wereassessedbyimmunohistochemistryusingantibodiesagainstER,PR-progesteronereceptor,HER2,Ki-67,Bcl-2,p53,PCNA,andCK5and6.Results:WeanalyzedthemiRNAexpressionin11PMBCsandcorrespondingnormaltissuesusingmiRNA-microarrayandreal-timePCR,andfoundthatmiR-143andmiR-224-5pweresignificantlydownregulatedinmucinouscarcinomatissue.ComparedwithIDC-NSTs,PMBCshowedasignificantlyhigherERpositiverate,lowerHER-2positiverate,andlowercellproliferationrates.Conclusions:Toourknowledge,thisisthefirststudytodemonstratethemiRNAexpressionprofileofPMBC,andourfindingsmayleadtofurtherunderstandingofthistypeofbreastcancer.

简介：Thymidinephosphorylase(TP)isakeyenzymethatcontributestothecompositionanddecompositionofpyrimidinenucleotides.TPseemshomologoustoplatelet-derivedendothelialcellgrowthfactor,anditseffectsoninducingvascularizationandanti-apoptosisarecloselyrelatedtogrowthandmetastasisofcolorectalcarcinoma.Inaddition,TPisakeyenzymethatcatalyzesthetransformationfrom5-fluorouracil(FU)prodrugsof5′-deoxy-5-fluorouridine(5′-DFUR)to5-FU.TheactivityofTPiscloselyrelatedtothesensitivityofcolorectalcarcinomacellstofluorouracildrugsandtargetedtherapy.GiventheimportantfunctionsofTPingrowth,metastasis,tumortreatment,andprognosis,determiningitsexpressionmechanismissignificant.ThisarticlesummarizestheresearchdevelopmentofTPexpressionincolorectalcarcinoma,tumorneovascularization,cytotoxicityactivationof5′-DFUR,andcolorectalcarcinomatherapy.

简介：Gingivaladenoidcysticcarcinoma(ACC)isararemalignancy.Wedescribethediagnosisandtreatmentofa43year-oldwomanwhopresentedwithapersistentoralulcerforapproximately1year,andsubsequentpainintheleftposteriormaxillaryregion.Clinicalexaminationrevealedanulcerintheleftuppermolargingiva,withswellingintheregionfromthesecondpremolartothethirdmolar.X-rayimagesdemonstratedtheinvolvementofthemaxillaryalveolarbone.ThehistopathologicalandimmunohistochemicalfeatureswerediagnosticofACC.ACCisoftenpresentedasagingivallesion;thus,itmayeasilybeneglectedbypatients.Theidentificationofthistumorusingspecificpathologicalanalysespreventsmisdiagnosisandenablesclinicianstodeterminetheappropriatetreatment.Inthiscase,norecurrenceordistantmetastasiswasobservedafter2yearsoffollow-up.

简介：Apocrinecarcinomaisararemalignantadnexalneoplasm.Thedifferentialdiagnosisbetweenapocrinecarcinomaandcutaneousmetastasisisoftendifficult.Here,wereportacaseoflocallyrecurrentpenileapocrinecarcinomainitiallydiagnosedasmetastaticadenocarcinomaofthecolon.A75-year-oldmanwithahistoryofsurgicalresectionduetosigmoidcoloncancerandpenilemetastasistwoyearspriortothisstudypresentedwithanoduleattheleftpenilebase.Heunderwentawidelocalresectionofthepenilemassunderasuggestedpreoperativediagnosisofextra-mammaryPaget’sdisease(EMPD)associatedwithprevioussigmoidcoloncancer.However,thepreviouslyandcurrentlyresectedpenilemasseswereidentifiedasprimaryapocrinecarcinomauponhematoxylinandeosin(H&E)stainingandimmunohistochemicalstaining.Althoughtheincidenceisextremelyrare,bothcliniciansandpathologistsshouldbealerttothepossibilityofsynchronousdoubleprimaryapocrinecarcinomaincancerpatientswithmalignantcutaneouslesions.

简介：Giventhehighincidenceofcervicallymphnodemetastasisindifferentiatedthyroidcancer(DTC)andtherapidlyincreasedimportanceofneckdissectioninDTC,thejournalofGlandSurgeryislaunchingaspecialissueon'NeckDissectioninDifferentiatedThyroidCarcinoma'inNovemberIssueof2013,

简介：Objectives:ToexploretheprognosticrelevanceofthenumberandratioofmetastaticlymphnodesinresectedCarcinomaoftheampullaofVater(CAV).Methods:Theclinicaldataof155patientswhounderwentpancreaticoduodenectomy(PD)forcanceroftheampullaofVaterbetweenJanuary1990andDecember2010wereretrospectivelyanalyzed.KaplanMeiermethodwasusedinsurvivalanalysisandLogrankmethodincomparison.MultivariateanalysiswasperformedusingCoxproportionalhazardsmodel.Results:Amongthese155patients,thein-hospitalmortalityratewas4.5%,lymphnodepositivediseasewas21.3%,andthe5-yearsurvivalratewas51.6%.Patientswithalymphnoderatio(LNR)>20%weremorelikelytohavetumordifferentiation,depthofduodenalinvolvement,depthofpancreaticinvasion,T-stageandTNM-Stage.ThenumberofthemetastaticlymphnodesisimportantprognosticfactorsoftheCAV.Univariateanalysisshowedthatthefactorsassociatedwiththeprognosisincludedtumorsize(P=0.036),tumordifferentiation(P=0.019),LNR(P=0.032),numberofmetastaticlymphnodes(P=0.024),lymphnodemetastasis(P=0.03),depthofpancreaticinvasion(P=0.001),T-stage(P=0.002),TNMstage(P=0.001),elevatedCA19-9(P=0.000),andjaundice(P=0.021).Multivariateanalysisshowedthatthefactorsassociatedwiththeprognosiswerethenumberofmetastaticlymphnodes(P=0.032;RR:1.283;95%CI:1.022-1.611),tumorsize(P=0.043;RR:1.736;95%CI:1.017-2.963),andelevatedCA19-9(P=0.003;RR:3.247;95%CI:1.504-7.010).Conclusions:LNRisausefulfactorforpredictingtheprognosisoftheradicaltreatmentforCAV,whereasthenumberofmetastaticlymphnodesisthemostimportantfactor.Furtherresearchonthelocations,number,andLNRwillbeclinicallymeaningfultoimprovesurvivalinpatientswithCAV.

简介：Objective:Inthisstudy,weexaminetheeffectsofrecombinantadenovirus-p53(rAd-p53)onthepancreaticcarcinomacelllineSW1990.Specifically,wedetermineifexpressionofrAd-p53sensitizesthesecellstoradiation.Methods:FollowingtransfectionofSW1990cellswithrAd-p53,wemeasuredexpressionofP53,P21andBaxbyimmunocytochemistry.Bothtransfectedandcontrolcelllineswereirradiatedwitharangeofdoses,andthesurvivalfractions(SF)werecalculated.Dosesurvivalcurveswereconstructedandmodeledforcomparison.Results:TransfectionofSW1990cellswithrAd-p53resultedinincreasedexpressionofP53,P21andBaxinatime-dependentmanner.At96haftertransfection,89.92%ofcellsexpressedP53,56.8%expressedP21,and76.50%expressedBax.TheSFfollowingradiationwaslowerintherAd-p53transfectedcellscomparedtothecontrolcells,suggestingthatrAd-p53sensitizesSW1990cellstoradiation(D0fortheexperimentalandcontrolgroupswas2.199and2.462,respectively).Conclusions:UseoftheadenoviralvectorisaneffectivemeansoftransfectingSW1990cellswithwild-typeP53,andthissensitizesthecelllinetoirradiation.ThisworksuggeststhatcombiningrAd-p53withradiationtherapyinpancreaticcancermaybetherapeuticallybeneficial.

简介：Objective:ToassesstheeffectofantiviraltherapyforhepatitisBvirus(HBV)-relatedhepatocellularcarcinoma(HCC)afterradicalhepatectomy.Methods:Atotalof478HBV-relatedHCCpatientstreatedbyradicalhepatectomywereretrospectivelycollected.Patientsinthetreatmentgroup(n=141)receivedpostoperativelamivudinetreatment(100mg/d),whereaspatientsinthecontrolgroup(n=337)didnot.Recurrence-freesurvival(RFS)rates,overallsurvival(OS)rates,treatmentsforrecurrentHCCandcauseofdeathwerecomparedbetweenthetwogroups.Propensityscorematching(PSM)analysiswasalsoconductedtoreduceconfoundingbiasbetweenthetwogroups.Results:The1-,3-,and5-yearRFSratesdidn’tsignificantlydifferbetweenthetwogroups(P=0.778);however,the1-,3-,and5-yearOSratesinthetreatmentgroupweresignificantlyhigherthanthoseinthecontrolgroup(P=0.002).Similarresultswereobservedinthematcheddata.SubgroupanalysisshowedthatantiviraltreatmentconferredasignificantsurvivalbenefitforBarcelonaClinicalLiverCancerstageA/Bpatients.FollowingHCCrecurrence,morepeopleinthetreatmentgroupwereabletochoosecurativetreatmentsthanthoseinthecontrolgroup(P=0.031).Forcauseofdeath,fewerpeopleinthetreatmentgroupdiedofliverfailurethanthoseinthecontrolgroup(P=0.041).Conclusion:PostoperativeantiviraltherapyincreaseschancesofreceivingcurativetreatmentsforrecurrentHCCandpreventsdeathbecauseofliverfailure,therebysignificantlyprolongingOS,especiallyinearly-orintermedian-stagetumors.

简介：Extrapulmonarysmallcellcarcinoma(EPSCC)isarareneoplasmcomprising2.5%to5%ofsmallcellcarcinomas(SCCs).BladderSCCisthemostcommonsiteofgenitourinarytract.PrimaryrenalSCCisextremelyrare.WereportacaseofprimarySCCofthekidneywhichisrarelyreportedintheurinarytractandpresentsanaggressiveclinicalpicture.A59-year-oldfemalevisitedaurologicclinicwithcomplaintofpersistentleftflanksoreness10yearsafterundergoingrenaltransplantation.Abdominalcomputedtomographyshowedaleftrenalpelvistumor.Afterthepatientreceivedleftnephroureterectomywithbladdercuffresection,herpathologyresultsshowedSCC.Aftersurgery,shereceivedadjuvantsystemicchemotherapy,andherrecoveryhasbeenuneventfulasof8months.PrimaryrenalSCCpresentswithanadvancedtumorstageandashortmediansurvivalperiod,thereforeearlyinterventionandclosefollow-uparerecommended.

简介：Objective:RecentevidenceindicatesthatdysregulationofmicroRNA(miRNA)biogenesisisimplicatedincancerdevelopmentandprogression.BasedontheimportantroleofmiRNAbiogenesisgenesincarcinogenesis,wehypothesizedthatgeneticvariationsofthemiRNAbiogenesisgenesmaymodulatesusceptibilitytocervicalcancer.Methods:Weidentifiedthreesinglenucleotidepolymorphisms(SNPs)locatedinthe3’-untranslatedregions(3’-UTR)ofofmiRNAbiogenesiskeygenes(rs1057035inDICER,rs3803012inRANandrs10773771inHIWI)andgenotypedtheseSNPsinacase-controlstudyof1,486cervicalcancercasesand1,549cancer-freecontrolsinChinesewomen.Results:LogisticregressionanalysesshowedthatnosignificantassociationswereobservedbetweenthethreeSNPsandcervicalcancerrisk[rs3803012inRANAG/GGvs.AAadjustedOR=1.104,95%confidenceinterval(CI):0.859-1.419;rs1057035inDICERCT/CCvs.TTadjustedOR=0.962,95%CI:0.805-1.149;rs10773771inHIWICT/CCvs.TTadjustedOR=0.963,95%CI:0.826-1.122].Conclusions:Thefindingsdidnotsuggestthatgeneticvariantsinthe3’-UTRofRAN,DICERandHIWIofmiRNAbiogenesisgeneswereassociatedwiththeriskofcervicalcancerinthisChinesepopulation.

简介：Hepatocellularcarcinoma(HCC)isoneofthemostdeadlyhumancancers,butitisverydifficulttoestablishananimalmodelbyusingsurgicalspecimens.Inthepresentexperiment,histologicallyintactfreshsurgicalspecimensofHCCweresubcutaneouslytransplantedinnon-obesediabetic/severecombinedimmunodeficienccy(NOD/SCID)mice.Thebiologicalcharacteristicsoftheoriginalandthecorrespondingtransplantedtumorsandcelllineswereinvestigated.Theresultsshowedthat5newanimalmodelsand2primarycelllinesweresuccessfullyestablishedfromsurgicalspecimens.Hematoxylin-eosinstainingshowedthatxenograftsretainedmajorhistologicalfeaturesoftheoriginalsurgicalspecimens.Thetwonewcelllineshadbeencultivatedfor3yearsandsuccessivelypassagedformorethan100passagesinvitro.Themorphologicalcharacteristicsandbiologicfeaturesofthetwocelllinesweregeneticallysimilartotheoriginaltumor.Thesubcutaneoustransplantanimalmodelswithhistologicallyintacttumortissueandprimarycelllinescouldbeusefulforinvivoandinvitrotestingofanti-cancerdrugsandbeidealmodelstostudyvariousbiologicfeaturesofHCC.

简介：<正>DearSir,IamDongHyunJi,fromtheDepartmentofOphthalmologyofSt.Vincent’sHospital,Suwon,Korea.Iwritetopresentaveryseverelyrecurrentbasalcellcarcinoma(BCC)inlowerlidinvadingleftorbitandwholehemiface,

简介：Objective:Toinvestigatetherecurrencesites,riskfactors,andprognosisofpatientswithpersistentorrecurrentsquamouscellcarcinoma(SCC)ofthecervixwithinoneyearafterundergoingconcurrentchemoradiotherapy(CCRT).Methods:Clinicaldataof30patientswithpersistentorrecurrentSCCofthecervixwithinoneyearafterCCRTbetweenJuly2006andJuly2011wereanalyzedretrospectively.Thesedatawerecomparedwiththoseof35SCCcaseswithnosignsofrecurrenceaftercompleteremission.These35patientsweretreatedduringthesameperiod(between2006and2011)andselectedrandomly.Results:Amongthese30patients,25exhibiteddistantmetastasesofwhich14wereobservedwithin6monthsafterCCRT.Univariateanalysisshowedhigherincidenceofpelvicorpara-aorticlymphadenectasisandSCC-ag>10ng/mLinthegroupwithpersistentorrecurrentdiseasebeforetreatment(P<0.01).Multivariateanalysisbylogisticregressionrevealedthatthepre-therapeuticpelvicorpara-aorticlymphnodeenlargementandSCC-ag>10ng/mLweretheindependentriskfactors.Palliativechemotherapywasthemaintreatmentoptionforpatientswithpersistentorrecurrentdisease.The2-yearsurvivalratewas21.7%,andthemediansurvivaltimewas17months.Conclusion:PatientswithpersistentorrecurrentSCCofthecervixafterCCRTexhibitedahighrateofdistantmetastasiswithpoorprognosis.Thepre-therapeuticpelvicorpara-aorticlymphnodeenlargementandSCC-ag>10ng/mLwereidentifiedastheindependentriskfactorsforpersistentorrecurrentSCCwithin1yearafterCCRT.

简介：Objective:Toexploretherelationshipbetweenperoxisomeproliferatoractivatedreceptor-gamma(PPARγ)andperoxisomeproliferator-activatedreceptor-gammacoactivator-1(PGC-1)expressioningastriccarcinoma(GC),andanalyzetheircorrelationswithclinicopathologicalfeaturesandclinicaloutcomesofpatients.Methods:Thetwo-stepimmunohistochemicalmethodwasusedtodetecttheexpressionofPPARγandPGC-1in179casesofGC,and108casesofmatchednormalgastricmucosa.Besides,16casesoffreshGCspecimensandcorrespondingnormalgastricmucosaweredetectedforPGC-1expressionwithWesternblotting.Results:ThepositiveratesofPPARγandPGC-1expressionweresignificantlylowerinGC(54.75%,49.16%)thaninnormalgastricmucosa(70.37%,71.30%),respectively(P<0.05).ThedecreasedexpressionofPGC-1inGCwasconfirmedinourWesternblotanalysis(P=0.004).PPARγandPGC-1expressionswererelatedtoLauren’stypesofGC(P<0.05).PositivecorrelationwasfoundbetweenPPARγandPGC-1expressioninGC(rk=0.422,P<0.001).ThesurvivaltimeofPPARγnegativeandpositivepatientswas36.6±3.0vs.38.5±2.7months,andnostatisticaldifferencewasfoundbetweenthe5-yearsurvivalratesoftwogroups(34.4%vs.44.1%,P=0.522,log-ranktest);thesurvivaltimeofPGC-1negativeandpositivepatientswas36.2±2.8vs.39.9±2.9months,whilenostatisticaldifferencewasfoundbetweenthe5-yearsurvivalratesofthetwogroups(32.0%vs.48.2%,P=0.462,log-ranktest)Conclusions:DecreasedexpressionofPPARγandPGC-1inGCwasrelatedtotheLauren’sclassification.TheirexpressionsinGCwerepositivelycorrelated,indicatingthattheirfunctionsingastriccarcinogenesismaybecloselyrelated.

简介：Objective:Thisstudyaimstoinvestigatetheclinicopathologicsignificanceoflymphaticvesselinvasion(LVI)labeledbyD2-40monoclonalantibodyinesophagealsquamouscellcarcinoma(ESCC).Methods:ImmunohistochemicalassaywasusedtodetecttheexpressionofD2-40andLVIin107ESCCpatients.Then,thecorrelationbetweentheclinicopathologicfeatureandtheoverallsurvivaltimeofthepatientswasanalyzed.Results:Thelymphnodemetastasisrateswere70%and21%intheLVI-positiveandLVI-negativegroups,respectively.ThenodalmetastasisratewashigherintheLVI-positivegroupthanintheLVI-negativegroup.MultivariateregressionanalysisshowedthatLVIwasrelatedtonodalmetastasis(P<0.001).Themediansurvivaltimeofthepatientswas26and43monthsintheLVI-positiveandLVI-negativegroups,respectively.Althoughunivariateregressionanalysisshowedsignificantdifferencebetweenthetwogroups(P=0.014),multivariateregressionanalysisrevealedthatLVIwasnotanindependentprognosticfactorforoverallsurvivalintheESCCpatients(P=0.062).Lymphaticnodemetastasis(P=0.031),clinicalstage(P=0.019),andresidualtumor(P=0.026)weretheindependentprognosticfactors.Conclusion:LVIlabeledbyD2-40monoclonalantibodyisariskfactorpredictiveoflymphnodemetastasisinESCCpatients.

简介：Objectives:Toinvestigatetheeffectsofadenovirus-mediatedinduciblenitricoxidesynthasegenetransfectiononbladdertransitionalcellcarcinomaT24cells,andtoprovidenovelinsightsandapproachestoclinicaltherapiesagainstbladdertransitionalcellcarcinoma.Methods:Firstly,constructrecombinantadenovirusvectorpAd-iNOSofiNOS,followedbytransfectionofpAd-iNOSintoHECK293packagingcells.Thirdly,harvestrecombinantadenovirusrAd-iNOSafteramplificationandpurificationprocedures.Finally,transfecttherecombinantadenovirusrAd-iNOSintohumanbladdercarcinomaT24cellsandexaminetheeffectofrAd-iNOStransfectiononapoptosisofT24andpossiblemechanism.Results:Asshownbythisstudy,therecombinantadenovirusrAd-iNOSwasconstructedsuccessfully.Thevirustiterwas5.8×108PFU/mLandrecombinantwasverifiedbyPCRanalysis.TransfectionofadenovirusrAd-iNOSintoT24cellscouldinducesecretionofhighNOconcentration,P53proteinexpressionupregulation,aswellaspromotionofT24cellapoptosis.Conclusions:ThetransfectionofhumanbladdercarcinomaT24cellsfromrecombinantadenovirusrAdiNOSwasconfirmedtoinduceintracellulariNOSover-expression,highproductionofNO,up-regulationofintracellularP53expressionandpromotionofcellapoptosis.

简介：Objective:TheaimofthepresentstudywastoinvestigateantioxidantandtheanticancerigenactivityofamethanolextractfromArtemisiaprincepsvar.orientalis(APME),awell-knowntraditionalherbalmedicineinAsia,inhepatocellularcancercells.Methods:ToevaluatetheantioxidantactivityofAPME,reactiveoxygenspecies(ROS)andtheantioxidantenzymes,superoxidedismutase(SOD)andcatalasewereinvestigatedinHepG2cellsexposedtoAPME(5,100,and200μg/mL)for72h.Then,toevaluatetheanticanceractivityofAPME,weinvestigatedtheproliferationandapoptosisinductionofHepG2andHep3BcellsexposedtoAPME(1-200μg/mL)for24,48,and72h.Results:APMEdose-dependentlyreducedthegenerationofROSinthepresenceofH2O2comparedwithcontrolcells.Furthermore,itincreasedcatalaseandSODactivity.Moreover,APMEinhibitedcellproliferationinadose-andtime-dependentmanner,butatconcentrationslowerthan100μg/mL,theinhibitionwaslessdose-dependentthantime-dependent.HepG2andHep3Bcellsexposedto5,100,and200μg/mLAPMEfor72hunderwentcellcyclearrestandapoptosis.ExposuretoAPMEresultedinasignificantincreaseinthenumberofcellsinG1phaseandadecreaseintheG2/Mphasecellpopulation.Inaddition,APMEinducedP53expressionofHepG2cellsinadose-dependentmanner,andplayedaroleinthedownregulationofBcl-2andupregulationofBaxinbothHepG2andHep3Bcells.Conclusions:TheseresultsindicatethepotentialroleofAPMEasanantioxidantandanticancerigenagentinhepatocarcinomacelllines.

简介：Granulocyte巨噬细胞刺激殖民地的因素(GM-CSF)secreting细胞的肿瘤疫苗在鼠科的模型和病人受不了癌症贡献有势力antitumor免疫者回答的正式就职。Hepatocellular癌(HCC)是在中国的最经常、恶意的癌症之一。第一次，我们描述释放向与这类癌症作斗争代表步的疫苗的策略的GM-CSF。在这研究，一个旁观者对鼠科的HCC的基于房间的GM-CSFsecreting疫苗，Hepa1-6/B78H1-GM-CSF，与cyclophosphamide(CY)的低剂量被共同管理。在与肿瘤和种痘质问以后，免疫学的试金证明细胞的antitumor免疫者回答高效地被激活并且肿瘤开发显著地被延迟，它依赖于有CY的协同作用。在鼠科的模型的anti-HCC疫苗的有希望的结果表明未来的可行性为在HCC病人的这治疗的临床的申请。

简介：Objectiveandbackground:Althoughp21rashasbeenreportedtobeupregulatedinhepatocellularcarcinomacomplicatingchronichepatitisCtypeI,p21rashasadifferentroleinadvancedstages,asithasbeenfoundtobedownregulated.Thegoalofthisstudywastoinvestigatethestatusofp21rasinearly-stage/low-gradeandlate-stage/high-gradehepatocellularcarcinomaanditspossiblelinktoapoptosis.Materialandmethods:Thirty-fivecaseseachofchronicHCVhepatitistype4(groupI)andcirrhosiswithhepatocellularcarcinoma(HCC)complicatingchronicHCVhepatitis(groupsIIandIII)wereimmunohistochemicallyevaluatedusingap21raspolyclonalantibody.Theapoptoticindexwasdeterminedinhistologicsectionsusingtheterminaldeoxynucleotidyltransferase-mediatedd-UTPbiotinnickendlabeling(TUNEL)assay.Results:Significantdifferences(P=0.001)weredetectedinp21rasproteinexpressionbetweenthethreegroups.Anear2-foldincreaseinp21rasstainingwasobservedinthecirrhoticcasescomparedtothehepatitiscases,andp21rasexpressionwasdecreasedintheHCCgroup.p21rasexpressioncorrelatedwithstage(r=0.64,P=0.001)andgrade(r=-0.65,P=0.001)intheHCCgroupandgradeintheHCVgroup(r=0.44,P=0.008).Bothp21rasexpressionandTUNEL-LIweresignificantlylowerinlargeHCCscomparedtosmallHCCs(P=0.01each).TheTUNELvalueswerenegativelycorrelatedwithstageintheHCCgroup(r=-0.85,P=0.001).TheTUNELvalueswerealsonegativelycorrelatedwithgradeinboththeHCVandHCCgroups(r=0.89,P=0.001andr=-0.53,P=0.001,respectively).Thep21rasscoresweresignificantlycorrelatedwiththeTUNEL-LIvaluesintheHCCgroup(r=0.63,P=0.001)andHCVgroup(r=0.88,P=0.001).Conclusions:p21rasactsasaninitiatorinHCCcomplicatingtype4chronicHCVandisdownregulatedwithHCCprogression,whichmostlikelypromotestumorcellsurvivalbecauseitfacilitatesthedownregulationofapoptosiswithtumorprogression.