CTCs as a prognostic factor in hepatocellular carcinoma patients and liver transplantation

Abstract

Introduction: New markers associated with angiogenesis and tumor metastasis, such as circulating tumor cells (CTCs), are opening up new avenues in cancer management. The aim of this work is to determine the number of CTCs in patients included in waiting list for liver transplantation of hepatocellular carcinoma, to study its possible association with the clinical variables and to compare the pre and post-transplant levels (at one month, six months, one year and two years). Method: Peripheral blood of 36 patients with hepatocellular carcinoma in waiting list for liver transplant was obtained. The CTCs immunomagnetic isolation was performed with anti-EpCAM antibodies by IsoFluxÔ system. Results: The average concentration of CTCs before transplant was 11.50 CTCs/10mL (RI = 2.25e42). A statistically significant positive correlation was found between the pre-transplant levels of CTCs and the days on waiting list (Rho = 0,376 p = 0,024). Differences in the levels of CTCs were found between the patients with and without vascular invasion (U = 0,00 p = 0,020). The concentration of the pretransplant levels of CTCs were 9 (RI = 1e72), and 4 (RI = 1e11), 2 (RI = 0e15), 2 (RI = 0e4) and 3 (RI = 1e42) CTCs/10 mL, after one month, 6 months and one year and two years after transplantation, respectively. Statistically significant differences were found between the pre-transplant levels of CTCs and the same levels one month (Z = À2,313 p = 0,021) and one year after being transplanted (Z = À2,629 p = 0,09). Conclusions: CTCs could be an unfavourable prognostic factor associated to longer waiting times and to the presence of vascular invasion by tumor with an increased risk of relapse and post-transplant metastasis.