Tissue expression of human chorionic gonadotropin ? predicts outcome in colorectal cancer: A comparison with serum expression

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Abstract
Production of the glycoprotein hormone human chorionic gonadotropin β (hCGβ) has been associated with more aggressive behavior in non‐trophoblastic tumors. In this study, the prognostic value of immunohistochemical hCGβ expression was evaluated in 239 patients with colorectal cancer. Paraffin‐embedded, formalin‐fixed specimens were stained with hCGβ‐specific monoclonal antibody, and the results were compared with serum levels determined with an assay based on the same antibody. hCGβ immunoreactivity was seen in 52 of 239 tumors (22%). The difference in survival time between patients with histologically hCGβ‐negative (median survival 94 months) and ‐positive (median survival 27 months) tumors was statistically significant (p = 0.014). The risk ratio during follow‐up for patients with positive hCGβ tissue expression was 1.65 (95% CI 1.11–2.46). In a Cox multivariate analysis, Dukes' stage, hCGβ and age remained independent prognostic factors. There was moderate agreement between immunohistochemical and serum expression levels of hCGβ (κ = 0.30). Using a combination of histological and serum levels of hCGβ, the difference between survival rates was highly significant (p < 0.001). The accuracy when predicting 5‐year survival status with the combined results of serum and tissue expression was 1.3% higher compared to hCGβ tissue expression alone. Our results show that hCGβ expression in both tumor tissue and serum has prognostic significance independent of other clinicopathological variables. Positive tumor staining does not always occur together with elevated serum levels, and the prognostic accuracy can slightly be increased by combining the results.

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