Iterion. In immunohistochemical evaluation, the score with the shortest distance from the curve to the point with both maximum sensitivity and specificity, i.e., the point (0.0, 1.0), was selected as the cutoff score leading to the largest number of tumors correctly classified as having or not having the clinical outcome [22,23]. At SIRT3 score, the sensitivity and specificity for each outcome under study was plotted, thus generating various ROC curves. The count was selected as the cutoff value, which was 1676428 closest to the point with both maximum sensitivity and specificity. Cases 256373-96-3 defined as highSIRT3 as a Prognostic Biomarker in HCCFigure 4. Reverse association of SIRT3 expression in HCC tissue with tumor differentiation. A. Representative micrographic images were shown to present the correlation between SIRT3 expression in HCC and differentiation. B. Percentages of high SIRT3 expressions in differentiated HCC were indicated by histogram. doi:10.1371/journal.pone.0051703.gSIRT3 expression were those with the scores below or equal to the cutoff value, while low SIRT3 expression represented those with scores above the value. In order to perform ROC curve analysis, clinicopathological features were dichotomized: tumor multiplicity (single vs multiple), tumor size (,5 cm vs 5 cm), AFP level (,20 ng/ml vs 20 ng/ml), tumor differentiation (well-moderate vs poor-undifferentiated), stage (I+II vs III+IV), vascular invasion (yes vs no), relapse (yes vs no) and survival status (dead vs alive).Results SIRT3 Expression in HCC Cell Lines and Tissues by qRTPCR and Western BlotTo determine the expression pattern of SIRT3 in HCC, we firstly examine its level in immortalized liver cell lines and HCC cell lines. Results showed that SIRT3 was noticeably decreased in HCC cell lines, compared to the MiHA cell line, at both mRNA (Fig. 1A) and protein (Fig. 1B) levels. Decrease of SIRT3 was further investigated in 16 paired fresh tissue samples. SIRT3 mRNA was significantly downregulated in 10 out of 16 cases in HCC tissues, compared to the corresponding adjacent liver tissues (Fig. 1C). Consistently, expression of SIRT3 protein was noticeably lower in HCC than that in paracarcinoma tissue in 68.8 of cases (Fig. 1E). The Calciferol site differential expression of SIRT3 in tumor and adjacent nontumor tissues appeared statistically significant (Fig. 1D and 1F).Statistical AnalysisStatistical analyses were performed using the SPSS 16.0 software (SPSS,Chicago, IL, USA). ROC curve analysis was applied to determine the cutoff value for high expression of SIRT3 by the 0,1-criterion, and the areas under curve (AUC) were calculated. Mann-Whitney U test was used for comparison between groups. Wilcoxon matched paired test was used to determine the significance of SIRT3 expression in fresh HCC and normal liver tissues. x2 test was performed to analyze the correlation between SIRT3 expression and clinicopathological parameters. Kaplan-Meier method (the log-rank test) was utilized for survival analysis and univariate analysis. Independent analyses were performed according to the selected population: overall population and different morphological and pathological subgroups. Cox proportional hazards regression model was used to identify the independent prognostic factors. P,0.05 (two-tailed) was considered statistically significant.Definition of Cutoff Score for Low SIRT3 Expression in HCCIn order to better assess the expression of SIRT3 in HCC, we employed ROC curve analysis to define an.Iterion. In immunohistochemical evaluation, the score with the shortest distance from the curve to the point with both maximum sensitivity and specificity, i.e., the point (0.0, 1.0), was selected as the cutoff score leading to the largest number of tumors correctly classified as having or not having the clinical outcome [22,23]. At SIRT3 score, the sensitivity and specificity for each outcome under study was plotted, thus generating various ROC curves. The count was selected as the cutoff value, which was 1676428 closest to the point with both maximum sensitivity and specificity. Cases defined as highSIRT3 as a Prognostic Biomarker in HCCFigure 4. Reverse association of SIRT3 expression in HCC tissue with tumor differentiation. A. Representative micrographic images were shown to present the correlation between SIRT3 expression in HCC and differentiation. B. Percentages of high SIRT3 expressions in differentiated HCC were indicated by histogram. doi:10.1371/journal.pone.0051703.gSIRT3 expression were those with the scores below or equal to the cutoff value, while low SIRT3 expression represented those with scores above the value. In order to perform ROC curve analysis, clinicopathological features were dichotomized: tumor multiplicity (single vs multiple), tumor size (,5 cm vs 5 cm), AFP level (,20 ng/ml vs 20 ng/ml), tumor differentiation (well-moderate vs poor-undifferentiated), stage (I+II vs III+IV), vascular invasion (yes vs no), relapse (yes vs no) and survival status (dead vs alive).Results SIRT3 Expression in HCC Cell Lines and Tissues by qRTPCR and Western BlotTo determine the expression pattern of SIRT3 in HCC, we firstly examine its level in immortalized liver cell lines and HCC cell lines. Results showed that SIRT3 was noticeably decreased in HCC cell lines, compared to the MiHA cell line, at both mRNA (Fig. 1A) and protein (Fig. 1B) levels. Decrease of SIRT3 was further investigated in 16 paired fresh tissue samples. SIRT3 mRNA was significantly downregulated in 10 out of 16 cases in HCC tissues, compared to the corresponding adjacent liver tissues (Fig. 1C). Consistently, expression of SIRT3 protein was noticeably lower in HCC than that in paracarcinoma tissue in 68.8 of cases (Fig. 1E). The differential expression of SIRT3 in tumor and adjacent nontumor tissues appeared statistically significant (Fig. 1D and 1F).Statistical AnalysisStatistical analyses were performed using the SPSS 16.0 software (SPSS,Chicago, IL, USA). ROC curve analysis was applied to determine the cutoff value for high expression of SIRT3 by the 0,1-criterion, and the areas under curve (AUC) were calculated. Mann-Whitney U test was used for comparison between groups. Wilcoxon matched paired test was used to determine the significance of SIRT3 expression in fresh HCC and normal liver tissues. x2 test was performed to analyze the correlation between SIRT3 expression and clinicopathological parameters. Kaplan-Meier method (the log-rank test) was utilized for survival analysis and univariate analysis. Independent analyses were performed according to the selected population: overall population and different morphological and pathological subgroups. Cox proportional hazards regression model was used to identify the independent prognostic factors. P,0.05 (two-tailed) was considered statistically significant.Definition of Cutoff Score for Low SIRT3 Expression in HCCIn order to better assess the expression of SIRT3 in HCC, we employed ROC curve analysis to define an.