Preoperative circulating tumor cells to predict microvascular invasion and dynamical detection indicate the prognosis of hepatocellular carcinoma

Abstract

Background: This study explored the diagnostic power of preoperative circulating tumor cells (CTCs) for the presence of microvascular invasion (MVI) and the relationship between dynamic changes in postoperative CTCs and prognosis. Methods: A total of 137 patients were recruited for the study. Preoperative blood samples of all patients were collected to detect CTC. The time points for blood collection were before the operation, during operation, and at one week, one month, two months, three months, six months, and one year after surgery. The power of predicting the presence of MVI was analyzed by the receiver operating characteristic curve (ROC). According to the survival status, 137 patients were divided into three groups: no recurrence, early recurrence, and non-early recurrence. Results: A threshold CTC value of 5 showed the most significant power to predict the existence of MVI. In a multivariate analysis, the parameters of preoperative CTCs, alpha-fetoprotein (AFP) and tumor diameter were independent predictors of MVI ( P < 0.05). A CTC value greater than or equal to 5 has better predictive value than AFP > 400μg/L or tumor diameter > 5 cm. The number of intraoperative CTCs in the three groups did not increase compared to before surgery ( P > 0.05). The number of CTC in the non-recurrent group and the non-early recurrent group decreased significantly one week after surgery compared with intraoperative values ( P < 0.001), although there was no statistical significance in the group with early recurrence ( P = 0.95). Patients with mean CTC ≥ 5 had significantly worse long-term outcome than those with mean CTC < 5 ( P <0.001).Conclusion: The preoperative CTC counts in peripheral blood of patients with HCC is closely correlated to MVI. Intraoperative manipulation for the lesion by the surgeon does not increase the number of CTC in peripheral blood. Surgical removal of the tumor decreases the number of CTC. The persistence of CTC at a high level (≥ 5) after surgery suggests a risk of early recurrence.