Bo Zhou, Guowei Yang, Jianhua Wang

InterventionalRadiology, Fudan University Zhongshan Hospital

Objective:To evaluate the potential utility ofcirculating tumor cells (CTCs) measurements in predicting prognosis ofhepatocellular carcinoma (HCC) patients received trans arterialchemoembolization (TACE) treatments, including their differences in differentvein sites and the immediate and delayed impact of TACE on CTCs. Method: CTCsfrom consecutive patients with HCC were quantified before and immediately and6-8 weeks after TACE. CTCs were examined in both samples derived from the peripheralvein (PV) and the hepatic vein (HV). Result: A total of 46 consecutivepatients with HCC were recruited into the prospective study and 38 wereanalyzed at last. CTCs counts in HV were significantly higher than in PV (P<0.001).TACE led to a statistically significant immediate fall in CTCs numbers,especially in HV (P<0.001). Patients with CTCs levels ≥2 in PV or ≥8in HV at baseline per 7.5 ml blood samples, compared with the group with fewerCTCs in PV or HV, had a shorter median progression-free survival (PFS, 5.2months vs. 12.0 months, P=0.01; 5.2 months versus 9.5 months, P=0.003,respectively). At the 6-8 weeks after TACE, patients with CTCs ≥2 in PV or ≥3in HV had a similarly shorter PFS (5.0 months vs. 12.0 months, P<0.001,respectively). Further analysis showed that patients with higher CTC levelsalso had a higher intrahepatic metastasis rate. The multivariate Cox regressionanalyses and ROC curves showed that the levels of CTCs at baseline and 6-8weeks after TACE were significant independent prognostic factors of PFS. Conclusion:The number of CTCs in peripheral and hepatic vein before and 6-8 weeksafter TACE are independent predictors of PFS in HCC patients received TACEtreatments. TACE immediately reduces the number of CTCs get into the bloodcirculation.

Key Words: hepatocellularcarcinoma  circulating tumor cells