Decrease of Bcl-xL/Bcl-2-associated death promoter in hepatocellular carcinoma indicates poor prognosis

Bcl-xL/Bcl-2-associated death promoter (Bad) is a proapoptotic member of Bcl-2 family and plays a key role in tumor development. To explore the expression of Bad and its clinical significance in hepatocellular carcinoma (HCC), we analyzed a large cohort of 437 HCC samples by tissue microarray (TMA)-based immunohistochemistry. Our data showed that Bad expression was markedly decreased in 50.6% (221/437) of HCC tissues, compared with the adjacent nontumorous tissues. Bad expression was closely associated with adverse clinical characters such as clinical stage (P=0.007), tumor size (P=0.008), vascular invasion (P=0.024), tumor differentiation (P=0.018) and AFP level (P=0.039). Furthermore, Kaplan-Meier analysis indicated that low Bad expression was significantly correlated to overall survival (P<0.0001) but not disease-free survival (P=0.587) and recurrence-free survival (P=0.707) of patients with HCC. Stratified survival analysis further confirmed the prognostic value of Bad. Moreover, multivariate analyses revealed that Bad was an independent indicator of overall survival in HCC (hazard ration=0.589, 95% confidence interval: 0.483-0.717, P<0.0001). Collectively, our data suggest that Bad is down-regulated in HCC and serves as a promising biomarker for poor prognosis of patients with this fatal disease.