Effects of pre-operative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma: Implication of circulating cancer cells by detection of α-fetoprotein mRNA

Abstract

Abstract. transcatheter arterial chemoembolization (tacE) is useful for the treatment of multiple hepatocellular carcinomas (hccs). pre-operative tacE is used to reduce recurrence caused by peri-and post-operative spread of cancer cells; however, the efficacy is controversial. In this study, we evaluated the efficacy of pre-operative TACE for HCC and the implication of circulating cancer cells, retrospectively. We analyzed 495 patients with hcc who had undergone hepatectomy between 1980 and 2006, including 252 patients (50.9%) who received pre-operative tacE. the median follow-up period was 49.9 months. We compared the survival of tacE and non-tacE groups and also performed subgroup analysis. α-fetoprotein (AFP) mRNA was quantified to represent circulating cancer cells. pre-operative tacE prolonged disease-free survival after hepatectomy in patients with hccs greater than 5 cm (5-year disease-free survival of the pre-operative tacE and no-tacE groups was 37.3 vs. 14.8%, p<0.05). patients with tumors showing 70% or greater necrosis had a significantly more favorable survival, and those with complete necrosis were all aFp mrna-negative. the survival of the aFp mrna-positive patients was worse than that of the aFp mrna-negative patients. Pre-operative TACE may be beneficial for patients with tumors larger than 5 cm, and AFP mRNA quantification may be useful for the prediction of survival after surgery in tacE-treated patients. Introductionhepatocellular carcinoma (hcc) is one of the most common solid neoplasms worldwide, and the prognosis of patients is often poor (1). although hepatectomy or transplantation provides better results for local control of hcc than other therapies, survival has not been satisfactory, particularly for large tumors, since both intrahepatic and extrahepatic recurrences often occur after hepatectomy even in patients who undergo a curative resection. hematologic spread or the presence of micrometastases is thought to be the major cause of early recurrence after liver resection. Several investigators have tried to detect the presence of circulating cancer cells hematologically (2-4). Our group previously described the use of quantitative reverse transcriptase-polymerase chain reaction (qrt-pcr) to detect α-fetoprotein (aFp) mrna as a marker of circulating cancer cells during liver resection (5-8).transcatheter arterial chemoembolization (tacE) has been used widely in patients with multiple hccs. this procedure involves injection of ionized oil and chemotherapeutic agents into the tumor-feeding artery followed by particulate embolization. Several investigators, including some clinical trials, have used this technique as neoadjuvant therapy for resectable hcc, with the hope of minimizing post-operative recurrence and prolonging survival after hepatectomy (9-29). The efficacy of TACE, however, is still controversial, with some investigators suggesting that pre-operative tacE may be useful in several selected groups (9-19). For these reasons, we hypothesized that pre-operative tacE may regulate ...

Preoperative MRI features and clinical laboratory indicators for predicting the early therapeutic response of hepatocellular carcinoma to transcatheter arterial chemoembolization combined with High-intensity focused ultrasound treatment

“…Previous research on TACE clarified that a higher AFP value was an independent risk factor for tumor recurrence and metastasis. 26,27 In our study, abnormal AFP values were demonstrated to be a significant predictor only in group C, but not in the other two groups. AFP is secreted by cancerous or regenerated hepatocytes, 28 and decreasing AFP values after transarterial therapies were considered to be the result of tumor hypoxia and necrosis 29 and were thought to indicate a positive response to treatment.…”

Role of the Hypoxia-Related Gene, JMJD1A, in Hepatocellular Carcinoma: Clinical Impact on Recurrence after Hepatic Resection

“…1 Advances in surgical techniques and perioperative care have greatly improved the outcome of hepatic resection for HCC. [2][3][4] Nonetheless, long-term survival after hepatectomy remains unsatisfactory, due to the high incidence of recurrence or metastasis. For these recurrent HCCs, inducing hypoxia by intercepting the hepatic arterial blood flow, i.e., transarterial chemoembolization (TACE), has achieved a pronounced therapeutic effect.…”

The Clinical Significance of Alpha-Fetoprotein mRNAs in Patients with Hepatocellular Carcinoma

“…In liver transplant recipients with HCC, preoperative AFP mRNA positivity is a risk factor for recurrence [12] , while the detection of AFP mRNA before surgery in patients undergoing TACE is associated with worse survival [13] . In addition to these risks associated with preoperative AFP mRNA, many authors have demonstrated that the rate of AFP mRNA positivity is increased after hepatectomy, as was shown in our data [1-3, 6, 14-16] .…”