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Article

Clearance of Circulating Tumor Cells in Patients with Hepatocellular Carcinoma Undergoing Surgical Resection or Liver Transplantation

1
Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain
2
Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, 14004 Córdoba, Spain
3
Centro de Investigación Biomédica en Red de Enfermedades hepáticas y digestivas (CIBERehd), 28029 Madrid, Spain
4
Pathology Department, Reina Sofía University Hospital, 14004 Córdoba, Spain
5
Department of Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, 14004 Córdoba, Spain
*
Author to whom correspondence should be addressed.
These two authors have contributed equally and may be considered co-senior authors in the present manuscript.
Academic Editors: Matias A. Avila, Shelly Chi-Loo Lu and Maria Luz Martinez-Chantar
Cancers 2021, 13(10), 2476; https://doi.org/10.3390/cancers13102476
Received: 16 April 2021 / Revised: 14 May 2021 / Accepted: 17 May 2021 / Published: 19 May 2021
Liver transplantation and surgical resection are potentially curative options in patients with liver cirrhosis and hepatocellular carcinoma. However, tumor recurrence is frequent, and it is associated with a poor prognosis. The selection of candidates is paramount to maximize survival while decreasing tumor recurrence rates, particularly regarding liver transplantation in a context of worldwide organ shortage. Circulating tumor cells are an attractive method of liquid biopsy that could represent a novel strategy to delineate the optimal therapeutic approach in hepatocellular carcinoma. This observational, prospective study aims to assess the role of circulating tumor cells in patients undergoing surgical resection or liver transplantation, as well as their potential association with other widely known surrogate markers of poor prognosis.
Background: In patients with hepatocellular carcinoma (HCC), a complete clearance of circulating tumor cells (CTCs) early after liver transplantation (LT) or surgical resection (LR) could prevent tumor recurrence. Methods: prospective pilot study including patients with HCC who underwent LR or LT from September 2017 to May 2020. Enumeration of CTCs was performed in peripheral blood samples (7 mL) using the Isoflux® system (Fluxion Biosciences) immediately before surgery, at post-operative day 5 and at day 30. A clinically relevant number of CTCs was defined as >30 CTCs/sample. Results: 41 HCC patients were included (mean age 58.7 ± 6.3; 82.9% male). LR was performed in 10 patients (24.4%) and 31 patients (75.6%) underwent LT. The main etiology of liver disease was chronic hepatitis C (31.7%). Patients undergoing LR and LT were similar in terms of preoperative CTC count (p = 0.99), but clearance of CTCs within the first month was more pronounced in the LT group. Clusters of CTCs at baseline were associated with incomplete clearance of CTCs at day 30 (54.2% vs. 11.8%, p = 0.005), which in turn impacted negatively on survival (p = 0.038). Conclusion: Incomplete clearance of CTCs after surgery could be a surrogate marker of HCC aggressiveness. View Full-Text
Keywords: hepatocellular carcinoma; liver transplantation; liver cancer; liquid biopsy; circulating tumor cell hepatocellular carcinoma; liver transplantation; liver cancer; liquid biopsy; circulating tumor cell
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MDPI and ACS Style

Amado, V.; González-Rubio, S.; Zamora, J.; Alejandre, R.; Espejo-Cruz, M.L.; Linares, C.; Sánchez-Frías, M.; García-Jurado, G.; Montero, J.L.; Ciria, R.; Rodríguez-Perálvarez, M.; Ferrín, G.; De la Mata, M. Clearance of Circulating Tumor Cells in Patients with Hepatocellular Carcinoma Undergoing Surgical Resection or Liver Transplantation. Cancers 2021, 13, 2476. https://doi.org/10.3390/cancers13102476

AMA Style

Amado V, González-Rubio S, Zamora J, Alejandre R, Espejo-Cruz ML, Linares C, Sánchez-Frías M, García-Jurado G, Montero JL, Ciria R, Rodríguez-Perálvarez M, Ferrín G, De la Mata M. Clearance of Circulating Tumor Cells in Patients with Hepatocellular Carcinoma Undergoing Surgical Resection or Liver Transplantation. Cancers. 2021; 13(10):2476. https://doi.org/10.3390/cancers13102476

Chicago/Turabian Style

Amado, Víctor, Sandra González-Rubio, Javier Zamora, Rafael Alejandre, María L. Espejo-Cruz, Clara Linares, Marina Sánchez-Frías, Gema García-Jurado, José L. Montero, Rubén Ciria, Manuel Rodríguez-Perálvarez, Gustavo Ferrín, and Manuel De la Mata. 2021. "Clearance of Circulating Tumor Cells in Patients with Hepatocellular Carcinoma Undergoing Surgical Resection or Liver Transplantation" Cancers 13, no. 10: 2476. https://doi.org/10.3390/cancers13102476

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