Prognostic value of PUMA expression in patients with HBV-related hepatocellular carcinoma

OBJECTIVE: The p53 upregulated modulator of apoptosis (PUMA) is a potent apoptosis inducer that is downexpressed in various tumor types. The aim of this study was to explore the prognostic significance of PUMA expression in patients with hepatitis B virus-related hepatocellular carcinoma (HCC). MATERIALS AND METHODS: PUMA expressions were examined in 80 pairs of tissues to compare its expression between cancer tissues and paired noncancerous liver tissues using immunohistochemistry (IHC). Relationship between the PUMA expression level and clinicopathological characteristics and clinic outcomes was analyzed. RESULTS: PUMA protein was all positive in paired non-tumor tissue samples. PUMA were downregulated in 61.25% (49/80) of tumor tissues compared with non-tumor tissues. PUMA levels in cancer tissues were significantly lower than non-tumor in patients with recurrence-related factors and patients at higher stage (stage II, III) (p < 0.05). In addition, the expressions level in tumor tissues showed a significant correlation with advanced TNM stage (p = 0.013) and present of recurrence-related factors (p = 0.002). Furthermore, Kaplan-Meier survival analysis revealed that weak PUMA expression was associated with poor 3-year disease- free survival (DFS) and overall survival (OS) in HCC patients. Finally, multivariate analyses identified that PUMA was an independent poor-prognostic predictor for DFS and OS in patients with HBV-related HCC. CONCLUSIONS: Our results suggest that PUMA expression is a novel prognostic indicator in HBV-related HCC and may be a potential target for diagnosis and gene therapy.