The Predictive and Prognostic Significance of c-erb-B2, EGFR, PTEN, mTOR, PI3K, p27, and ERCC1 Expression in Hepatocellular Carcinoma


Nuray Bassullu 1 , * , Ilknur Turkmen 1 , Murat Dayangac 2 , Pinar Yagiz Korkmaz 3 , Reyhan Yasar 3 , Murat Akyildiz 4 , Onur Yaprak 5 , Yaman Tokat 5 , Yildiray Yuzer 5 , Gulen Bulbul Dogusoy 3

1 Department of Pathology, Istanbul Bilim University Medical Faculty,, Turkey

2 Department of General Surgery, Florence Nigthingale Hospital, Turkey

3 Department of Pathology, Florence Nigthingale Hospital, Turkey

4 Department of Gastroenterology, Istanbul Bilim University Medical Faculty, Turkey

5 Department of General Surgery, Florence Nigthingale Hospital, Turkey

How to Cite: Bassullu N , Turkmen I , Dayangac M , Yagiz Korkmaz P , Yasar R , et al. The Predictive and Prognostic Significance of c-erb-B2, EGFR, PTEN, mTOR, PI3K, p27, and ERCC1 Expression in Hepatocellular Carcinoma, Hepat Mon. 2012 ; 12(10):7492. doi: 10.5812/hepatmon.7492.


Hepatitis Monthly: 12 (10); 7492
Published Online: October 11, 2012
Article Type: Research Article
Received: June 17, 2012
Accepted: July 17, 2012




Background: Hepatocellular carcinoma (HCC) is the fifth most common fatal cancer and an important healthcare problem worldwide. There are many studies describing the prognostic and predictive effects of epidermal growth factor receptor 2 (c-erb-B2) and epidermal growth factor receptor 1 (EGFR), transmembrane tyrosine kinases that influence cell growth and proliferation in many tumors.

Objectives: The current study aimed to investigate the expression levels of c-erb-B2, EGFR, PTEN, mTOR, PI3K, p27, and ERCC1 in hepatocellular carcinoma (HCC) and their correlation with other clinicopathologic features.

Patients and Methods: Fifty HCC cases were stained immunohistochemically with these markers. Correlations between the markers and clinicopathologic characteristics and survival rates were analyzed.

Results: No membranous c-erb-B2 staining was seen, whereas cytoplasmic positivity was present in 92% of HCC samples, membranous EGFR was observed in 40%, PI3K was found in all samples, and mTOR was seen in 30%, whereas reduced or absent PTEN expression was observed in 56% of samples and loss of p27 was seen in 92% of the cases. c-erb-B2 and mTOR overexpression, as well as reduced expression of p27, all correlated with multiple tumors (P = 0.041, P < 0.001, and P < 0.001, respectively). P27 loss, and mTOR and EGFR positivity were significantly correlated with AFP (P = 0.047, P = 0.004, and P = 0.008, respectively). Angiolymphatic invasion was more commonly seen in EGFR- and ERCC1-positive cases (P = 0.003 and P = 0.005). EGFR was also correlated with histological grade (P = 0.039). No significant correlations were found among PTEN , PI3K, and the clinicopathological parameters. Disease-free or overall survival rates showed significant differences among therapy modalities, AFP levels, angiolymphatic or lymph node invasions, and ERCC1 and p27 expression levels (P < 0.05).

Conclusions: c-erb-B2, EGFR, mTOR, ERCC1 overexpression levels, and loss of p27 may play roles in hepatocarcinogenesis and may be significant predictors of aggressive tumor behavior. These markers were found to be correlated with certain clinicopathologic features, therapy modalities, and survival rates in the current study. These findings may help in planning new, targeted treatment strategies .


Carcinoma Hepatocellular Immunohistochemistry

© 2012, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

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