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Original articles
CLEC14A was up-regulated in hepatocellular carcinoma and may function as a potential diagnostic biomarker
Lang Yan1, Xiang Li1, Yunfeng Yuan
Corresponding author
yyf666180@hotmail.com

Corresponding author.
Chongqing University Three Gorges Hospital, Chongqing, China
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great efforts have been made to identify biomarkers for the early diagnosis of HCC&#46; For example&#44; Luo et&#160;al&#46; identified and verified several new serum metabolite biomarkers which have shown good diagnostic value for HCC <a class="elsevierStyleCrossRef" href="#bib0010">&#91;10&#93;</a>&#46; Moreover&#44; by using mass spectrometry technology&#44; Li et&#160;al&#46; found that inter-alpha-trypsin inhibitor heavy chain four may be used for the early diagnosis of HCC <a class="elsevierStyleCrossRef" href="#bib0011">&#91;11&#93;</a>&#46; Furthermore&#44; Qin et&#160;al&#46; suggested that the serum expression of ST8SIA6-AS1 may be a potential diagnostic biomarker for HCC <a class="elsevierStyleCrossRef" href="#bib0012">&#91;12&#93;</a>&#46;</p><p id="para0012" class="elsevierStylePara elsevierViewall">The C-type Lectin-like receptors &#40;CLECs&#41; family consist of different transmembrane pattern recognition receptors <a class="elsevierStyleCrossRefs" href="#bib0013">&#91;13&#8211;15&#93;</a>&#46; Previous studies suggested that CLECs play key roles in different biological events&#46; For example&#44; regulating the growth of cancer cells&#44; maintaining body hemostasis&#44; facilitating cell communication&#44; etc <a class="elsevierStyleCrossRefs" href="#bib0016">&#91;16&#8211;18&#93;</a>&#46; CLEC14A is a newly discovered CLEC protein&#44; and reports on the roles of CLEC14A in different diseases were rate&#46; Studies on CLEC14A were mainly focused on the regulator roles of CLEC14A in immune cells and angiogenesis <a class="elsevierStyleCrossRefs" href="#bib0019">&#91;19&#8211;21&#93;</a>&#46;</p><p id="para0013" class="elsevierStylePara elsevierViewall">The roles of CLEC14A in some types of cancers&#44; for example&#44; renal clear cell carcinoma <a class="elsevierStyleCrossRef" href="#bib0022">&#91;22&#93;</a> lung adenocarcinoma <a class="elsevierStyleCrossRef" href="#bib0023">&#91;23&#93;</a>&#44; uterine carcinosarcoma <a class="elsevierStyleCrossRef" href="#bib0024">&#91;24&#93;</a>&#44; have been discussed previously&#46; However&#44; up to now&#44; the potential roles of CLEC14A in hepatocellular carcinoma still need to be explored&#46; Therefore&#44; the authors designed the present study to investigate the potential clinical value of CLEC14A in hepatocellular carcinoma&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Materials and methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Sample collection and clinical information</span><p id="para0014" class="elsevierStylePara elsevierViewall">In the present study&#44; the authors enrolled a total of 105 patients with HCC&#46; Patients were all pathological diagnosed with HCC by biopsy at Chongqing University Three Gorges Hospital&#46; None of the patients received anti-tumor therapies before diagnosis&#46; The HCC tumor samples&#44; as well as the adjacent non-tumorous normal tissues &#40;3&#8210;5 cm from the tumor samples&#41; of 105 patients were collected during the surgery process&#46; The PBMCs of the patients and healthy controls were also collected&#46; All tissue and serum samples were stored at -80&#176;C until needed&#46; The content of the current work has been approved by the ethical committee of Chongqing University Three Gorges Hospital &#40;n&#176; 500032175&#41;&#44; and each patient signed the informed consent&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Real-time quantitative polymerase chain reaction &#40;RT-qPCR&#41;</span><p id="para0015" class="elsevierStylePara elsevierViewall">RNA of the liver tissues&#44; PBMCs&#44; and cells was extracted by TRIzol&#174; reagent &#40;Invitrogen&#59; Thermo Fisher Scientific&#44; Inc&#46;&#41;&#46; Reverse transcription and qPCR were carried out using One Step SuperRT-PCR Mix Kit &#40;T2240&#59; Solarbio&#41; on Mastercycler&#174; nexus &#40;6330000072&#59; Eppendorf&#44; Inc&#46;&#41;&#46; All primers used in the present study were designed and synthesized by Genewiz Inc&#46; GAPDH was used as the internal reference gene&#46; The thermocycling conditions were as follows&#58; denaturation at 94&#176;C for 60s&#44; then annealing at 37&#176;C for 60s for 30 cycles&#46; At last&#44; the extension was at 72&#176;C for 120s&#46; The 2<span class="elsevierStyleSup">&#916;&#916;Ct</span> method was used for calculating the fold change in gene expression level&#46; The sequences of the primers were&#58; CLEC14A forward primer&#44; 5&#8217;-CTGCACCACGCTACCATGAA-3&#8217;&#59; CLEC14A reverse primer&#44; 5&#8217;-CCAGGAGAAACCCCGCAAA-3&#8217;&#59; GAPDH forward primer&#44; 5&#8217;-TGTGGGCATCAATGGATTTGG-3&#8217;&#59; GAPDH reverse primer&#44; 5&#8217;- ACACCATGTATTCCGGGTCAAT-3&#8217;&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Cell culture</span><p id="para0016" class="elsevierStylePara elsevierViewall">Human normal liver cell line L02 cells&#44; as well as HCC cell lines&#44; including HuH-7 and SK-HEP-1 were purchased from the Cell Bank of China &#40;Shanghai&#44; China&#41;&#46; The cells were maintained by PRMI-1640 medium containing 10&#37; FBS as well as penicillin-streptomycin &#40;Beyotime&#44; Shanghai&#44; China&#41;&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Transfection</span><p id="para0017" class="elsevierStylePara elsevierViewall">CLEC14A siRNA was obtained from Genepharma &#40;Shanghai&#44; China&#41;&#46; To knock down CLEC14A expression in HuH-7 cells&#44; the cells were transfected with 50 nM CLEC14A siRNA using Lipofectamine 3000 &#40;Invitrogen&#41; based on the protocols provided by the manufacturer&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Cell viability assay</span><p id="para0018" class="elsevierStylePara elsevierViewall">To determine the effects of CLEC14A on the viability of HCC cells&#44; CCK-8 proliferation analysis was performed&#46; Briefly&#44; HuH-7 cells have been seeded onto 96-well plates &#40;1&#160;&#215;&#160;10<span class="elsevierStyleSup">4</span> cells&#47;well&#41; and transfected with or without CLEC14A siRNA&#46; To detect the cell viability&#44; each well was treated by CCK-8 reagent at a different time point&#44; and the OD value at 450 nm was recorded by a microplate reader&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Cell apoptosis assay</span><p id="para0019" class="elsevierStylePara elsevierViewall">Annexin V&#47;PI cell apoptosis kit was used to determine the effects of CLEC14A on the apoptosis of HuH-7 cells&#46; Briefly&#44; cells were maintained in a 6-well plate and treated with Annexin V and PI according to the instructions provided by the manufacturer&#46; The apoptosis of the cells in each sample has been determined using a flow cytometer &#40;FACSCalibur Flow Cytometer&#44; BD&#44; CA&#44; USA&#41;&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Statistical analysis</span><p id="para0020" class="elsevierStylePara elsevierViewall">Statistical analysis has been carried out by SPSS 23&#46;0 &#40;Chicago&#44; IL&#44; USA&#41;&#46; Data were shown as a mean &#177; SD&#46; Comparison between two groups was analyzed by student <span class="elsevierStyleItalic">t</span>-test&#46; Receiver Operating Characteristic &#40;ROC&#41; was used for evaluating the potential diagnostic value of CLEC14A&#46; If the p-value is less than 0&#46;05&#44; the authors considered the comparison between the two groups were significantly different&#46;</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Results</span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Over-expression of CLEC14A was in HCC</span><p id="para0021" class="elsevierStylePara elsevierViewall">Firstly&#44; the expression of CLEC14A in HCC tumor tissue&#44; as well as non-tumorous adjacent tissues&#44; was examined and compared&#46; The clinical information of the patients is shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table&#160;1</a>&#46; Increased expression of CLEC14A was correlated with tumor size &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;0423&#41; and differentiation &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;0255&#41;&#46; The authors found that CLEC14A mRNA expression was dramatically increased in HCC tumor tissues in comparison with the adjacent non-tumorous tissues &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46;&#160;1</a>A&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;01&#41;&#46; Moreover&#44; CLEC14A mRNA expression was also significantly increased in PBMCs of HCC patients &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46;&#160;1</a>B&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;01&#41;&#44; and the levels of CLEC14A in HCC tumors and PBMCs were positively correlated &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46;&#160;1</a>C&#59; <span class="elsevierStyleItalic">r</span>&#160;&#61;&#160;0&#46;3502&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;0002&#41;&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">CLEC14A may function as a potential diagnostic biomarker for HCC</span><p id="para0022" class="elsevierStylePara elsevierViewall">Next&#44; the potential diagnostic value of CLEC14A for HCC was determined by ROC analysis&#46; The authors found that the AUC value of CLEC14A expression in tissue samples for the diagnosis of HCC was 0&#46;8571 &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46;&#160;2</a>A&#44; 95&#37; CI&#160;&#61;&#160;0&#46;8032 to 0&#46;9109&#41;&#44; and for CLEC14A expression in PBMCs for the diagnosis of HCC was 0&#46;8145 &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46;&#160;2</a>B&#44; 95&#37; CI&#160;&#61;&#160;0&#46;7542 to 0&#46;8748&#41;&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">Over-expression of CLEC14A was in HCC cells</span><p id="para0023" class="elsevierStylePara elsevierViewall">Furthermore&#44; expressions of CLEC14A in human normal liver cell line L02 cells&#44; HCC cell lines HuH-7 and SK-HEP-1 were examined and compared&#46; The authors found that the expression of CLEC14A was significantly increased in both HuH-7 and SK-HEP-1 cells in comparison with L02 cells &#40;<a class="elsevierStyleCrossRef" href="#fig0003">Fig&#46;&#160;3</a>&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;01&#41;&#46; Because HuH-7 has shown a higher CLEC14A level than SK-HEP-1&#44; it has been used for further analysis&#46;</p><elsevierMultimedia ident="fig0003"></elsevierMultimedia></span><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0021">Knockdown of CLEC14A decreased the viability and increased the apoptosis of HuH-7 cell</span><p id="para0024" class="elsevierStylePara elsevierViewall">Finally&#44; to further investigate the roles of CLEC14A in the pathogenesis of HCC&#44; the authors cultured HuH-7 cells with CLEC14A siRNA&#44; and the effects of CLEC14A on the cell growth as well as apoptosis was determined by MTT and flow cytometry methods&#46; Results of the MTT assay indicated that CLEC14A siRNA-transfected cells had shown decreased cell viability on 24h&#44; 48h&#44; and 72h &#40;<a class="elsevierStyleCrossRef" href="#fig0004">Fig&#46;&#160;4</a>A&#41;&#46; Moreover&#44; down-regulation of CLEC14A also significantly promoted the apoptosis of HuH-7 cells <span class="elsevierStyleItalic">in vitro</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0004">Fig&#46;&#160;4</a>B&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;01&#41;&#46;</p><elsevierMultimedia ident="fig0004"></elsevierMultimedia></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0022">Discussion</span><p id="para0025" class="elsevierStylePara elsevierViewall">In the present study&#44; the authors have explored the roles of CLEC14A in HCC&#46; The present study&#39;s results proved that CLEC14A may function as an oncogene in HCC&#44; and CLEC14A may exert its carcinogenic effects via increasing the viability and decreasing the apoptosis of HCC cells&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">In recent years&#44; CLEC family proteins were found to be up-regulated in several cancers&#44; and the roles of CLEC14A as onco-genes have been investigated in different works &#91;<a class="elsevierStyleCrossRef" href="#bib0020">20</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0024">24</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0025">25</a>&#93;&#44; However&#44; little was known about the function of CLEC14A in HCC&#46; In the present study&#44; the authors have observed that CLEC14A was significantly up-regulated in HCC tumors on both mRNA and protein levels&#59; moreover&#44; results of the clinical analysis showed the levels of CLEC14A in HCC patients were positively correlated with tumor size and differentiation&#46; Interestingly&#44; the results of ROC analysis &#40;AUC 0&#46;8571 for tissue and 0&#46;8145 for PBMCs&#41; indicated that the expression of CLEC14A can distinguish the tumor tissue and the non-tumor adjacent tissue&#46; In a previous study&#44; it has been reported that the AUC of Alpha-Fetoprotein &#40;AFP&#41;&#44; which is a currently used cancer biomarker for HCC&#44; is 0&#46;646&#44; and for ITIH4&#44; it is 0&#46;667 <a class="elsevierStyleCrossRef" href="#bib0011">&#91;11&#93;</a>&#46; Therefore&#44; CLEC14A has shown better diagnostic value than the above biomarkers for the diagnosis of HCC&#46; Taken together&#44; the present study&#39;s data suggested that CLEC14A may function as an oncogene in HCC&#44; and the levels of CLEC14A were positively correlated with the severity and progression of HCC&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">The CLEC family proteins have been known to play critical roles in the proliferation and apoptosis of cancer cells &#91;<a class="elsevierStyleCrossRef" href="#bib0021">21</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0026">26</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0027">27</a>&#93;&#46; To further investigate the roles of CLEC14A in the pathogenesis of HCC&#44; the authors cultured HCC cells with CLEC14A siRNA&#44; and the effects of CLEC14A on the viability and apoptosis of HuH-7 cells were examined&#46; The authors observed that CLEC14A siRNA-transfected cells had shown decreased cell viability as well as increased apoptosis&#44; suggesting that CLEC14A can regulate the growth and apoptosis of HCC cells <span class="elsevierStyleItalic">in vitro</span>&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">The present study has several limitations&#46; The authors only performed clinical analysis and cell studies&#44; and in the future&#44; the roles of CLEC14A in HCC should also be further explored using animal models&#46; Also&#44; current work was based on the Asian population&#44; and the roles of CLEC14A in other races should also be evaluated&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">In conclusion&#44; the authors proved that CLEC14A was up-regulated in HCC&#44; and CLEC14A can regulate the growth as well as apoptosis of HCC cells in vitro&#46; The present data have provided novel evidence for the treatment of HCC&#46;</p><span id="sec0016" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0023">Authors&#39; contributions</span><p id="para0030" class="elsevierStylePara elsevierViewall">Lang Yan was responsible for the organization and coordination of the trial&#46; Xiang Li was the chief investigator and was responsible for the data analysis&#46; Lang Yan&#44; Xiang Li&#44; and Yunfeng Yuan developed the trial design&#46; All authors contributed to the writing of the final manuscript&#46;</p></span></span></span>"
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              "titulo" => "Over-expression of CLEC14A was in HCC"
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              "titulo" => "CLEC14A may function as a potential diagnostic biomarker for HCC"
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              "titulo" => "Over-expression of CLEC14A was in HCC cells"
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              "titulo" => "Knockdown of CLEC14A decreased the viability and increased the apoptosis of HuH-7 cell"
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    "fechaRecibido" => "2021-07-05"
    "fechaAceptado" => "2021-11-09"
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    "highlights" => array:2 [
      "titulo" => "Highlights"
      "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara007" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">&#8226;</span><p id="para0002" class="elsevierStylePara elsevierViewall">Over-expression of CLEC14A was in HCC&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">&#8226;</span><p id="para0003" class="elsevierStylePara elsevierViewall">CLEC14A may function as a potential diagnostic biomarker for HCC&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">&#8226;</span><p id="para0004" class="elsevierStylePara elsevierViewall">Over-expression of CLEC14A was in HCC cells&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0004"><span class="elsevierStyleLabel">&#8226;</span><p id="para0005" class="elsevierStylePara elsevierViewall">Knockdown of CLEC14A decreased the viability and increased the apoptosis of HuH-7 cell&#46;</p></li></ul></p></span>"
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    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Objective</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">The current work aimed to investigate the expression and potential clinical significance of C-type Lectin domain family 14 &#40;CLEC14A&#41; in hepatocellular carcinoma&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Methods</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">The relative expressions of CLEC14A in the Hepatocellular Carcinoma &#40;HCC&#41; tissue and adjacent normal tissue of 105 HCC patients were examined using RT-qPCR methods&#46; Furthermore&#44; Receiver Operating Characteristic &#40;ROC&#41; curve was drawn for exploring the diagnostic value of CLEC14A&#46; Next&#44; the expressions of CLEC14A in HCC cell lines and normal liver epithelial cells were compared&#44; and the effects of knockdown of CLEC14A on the growth and apoptosis of HCC cells were examined&#46;</p></span> <span id="abss0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Results</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">The authors found that the expression of CLEC14A was markedly increased in hepatocellular carcinoma tumors in comparison with the adjacent tissue&#44; and the expression level of CLEC14A was positively correlated with the size and differentiation of the tumor&#46; Moreover&#44; results of ROC analysis showed CLEC14A might function as a sensitive diagnostic biomarker for HCC&#46; Furthermore&#44; CLEC14A was up-regulated in HCC cell lines&#44; and transient over-expression of CLEC14A decreased the proliferation and increased the apoptosis of HCC cells <span class="elsevierStyleItalic">in vitro</span>&#46;</p></span> <span id="abss0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Conclusions</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Our results suggested that CLEC14A was up-regulated in HCC and might function as a potential diagnostic marker&#46;</p></span>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0005"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;6865&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">&#8805; 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">&#60; 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;8049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Tumor size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;0423<span class="elsevierStyleSup">a</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">&#60; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">&#8805; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">TNM stage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;1989&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">I-II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">III-IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0053"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Tumor nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;6962&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">&#8805; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;5237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Differentiation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;0255<span class="elsevierStyleSup">a</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Well-moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0089"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Metastasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;0985&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0093"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
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