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HURP Expression-Assisted Risk Scores Identify Prognosis Distinguishable Subgroups in Early Stage Liver Cancer 1,2 1 1,2 Ming-Ling Chang , Shi-Ming Lin , Chau-Ting Yeh * 1 Liver Research Center and Department of Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, 2 Graduate Institute of Clinical Medical Sciences, Chang Gung University, College of Medicine, Taoyuan, Taiwan Abstract Background: Hepatoma up-regulated protein (HURP) is a component of the chromatin-dependent pathway for spindle assembly. We examined the prognostic predictive value of HURP in human hepatocellular carcinoma (HCC). Methods: HURP expression was evaluated by immunocytochemistry of fine needle aspirated hepatoma cells in 97 HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage A. Subsequently, these patients underwent partial hepatectomy (n = 18) or radiofrequency ablation (n = 79) and were followed for 2 to 35 months. The clinicopathological parameters were submitted for survival analysis. Results: HURP expression in aspirated HCC cells was detected in 19.6% patients. Kaplan-Meier survival analysis showed that positive HURP expression (P = 0.023), cytological grading $3 (P = 0.008), AFP $35 ng/mL (P = 0.039), bilirubin $1.3 mg/dL (P = 0.010), AST $50 U/L (P = 0.003) and ALT $35 U/L (P = 0.005) were all associated with a shorter disease-free survival. A stepwise multivariate Cox proportional hazard model revealed that positive HURP expression (HR, 2.334; 95% CI, 1.165– 4.679, P = 0.017), AST $50 U/L (HR, 3.697; 95% CI, 1.868–7.319, p ,0.001), cytological grade $3 (HR, 4.249; 95% CI, 2.061– 8.759, P,0.001) and tumor number .1 (HR, 2.633; 95% CI, 1.212–5.722, P = 0.014) were independent predictors for disease- free survival. By combining the 4