Long-term dynamics of circulating tumor cells and their prognostic relevance after liver resection in patients with hepatocellular carcinoma

Background Liver resection remains the most effective and practical treatment for HCC patients. In patients with metastatic or newly diagnosed HCC, the presence of CTC is an independent predictive factor for recurrence -free (RFS) and overall survival (OS). HCC recurrence frequently occurs within the first year after resection, probably due to CTCs that have been shed from the primary tumor before resection.

Aim The aim of the study is to determine if the presence of CTC prior to and during post-surgery follow-up is related to RFS and OS.

Methods We evaluated the efficacy of pre-surgery and post-surgery CTCs as biomarkers for resectable HCC. Fluorescence-activated cell sorting (FACS) was performed on 28 patients with HCC who underwent surgery. Multicolor flow cytometry was used to detect the number of CTCs (CD45-/CD146+/ASGPR+) in the peripheral circulation of 28 HCC patients 1 day before tumor resection. The patients were monitored by CT or MRI for recurrence every 6 months.

Results In our pilot study CTC (³1/ml) was detected in 46.42% HCC patients (n=13/28, mean0.46± 0.80) before tumor resection and in 46.42% (n=13/28, mean0.51± 0.94) at the same day after tumor resection. However, the detection rate increased significantly up to 95% (n=19/20, p<0.003, mean2.31± 2.60) six months later and to 88% (n=15/17, p<0.006, mean2.15± 2.49) twelve months after tumor resection. Fourteen (50%) patients had recurrence after a median follow-up period of 12 months. Patients with CTC counts before surgery tend to have significantly lower OS (p=0.05) and lower RFS (p=0.02) compared to patients with no detected CTCs. No relationship between tumor size and CTC counts before tumor resection was determined.

Conclusions Monitoring CTCs has a high accuracy in predicting post-surgery HCC recurrence. They may be the target of eradication in the prevention of post-surgery HCC metastasis and recurrence.

Publikationsverlauf

Artikel online veröffentlicht:
19. August 2022