Does surgical resection of hepatocellular carcinoma accelerate cancer dissemination?

摘要： <正> AIM:This study was to investigate whether surgery couldincrease cancer dissemination and postoperative recurrencein patients with hepatocellular carcinoma (HCC) by detectionof human α-fetoprotein messenger RNA (hAFP mRNA),hAFPmRNA in the peripheral blood of patients with HCC has beenconsidered as a surrogate marker for circulating tumor cells.METHODS:Eighty-one consecutive patients who underwentcurative resection for HCC entered this prospective cohortstudy.We examined hAFP mRNA from the peripheral bloodobtained preoperatively,perioperatively,and postoperativelyto correlate the prognosis after curative resections from HCCpatients and from the control subjects.Detection of hAFPmRNA by reverse transcriptase and polymerase chain reactionamplification (RT-PCR) was performed with primersspecifically.The relations between the clinical variables (age,sex,associated liver cirrhosis,hepatitis B virus infection,hepatitis C virus infection,serum α-fetoprotein and Child-Pugh class),the histological variables (size,capsule,vascularpermeation,grade of differentiation,and daughter nodules),hAFP mRNA in peripheral blood of 3 different sessions,andpostoperative course (recurrence,and recurrence relateddeath) were analysed.RESULTS:No hAFP mRNA was detected in control groupsubjects.Twenty-two (27%),24 (30%) and 19 (23%) of 81HCC patients had hAFP mRNA positivity in the preoperative,perioperative and postoperative peripheral blood.Thepreoperative presence did not influence the risk of HCCrecurrence (55% vs 41%,P=0.280).In contrast,patientswith postoperative presence had a significantly higherrecurrence (90% vs 31%,P<0.001;odds ratio 19.2;95%confidence interval:4.0-91.7).In the multivariate analysisby COX proportional hazards model,postoperative positivity had a significant influence on recurrence (P=0.067) andrecurrence related mortality (P=0.017).Whereas,theperioperative positivity of hAFP mRNA did not increase HCCrecurrence (58% vs.39%,P=0.093).The correlation betweenperioperative hAFP mRNA positivity and recurrence relatedmortality had no statistical significance (P=0.836).CONCLUSION:From our study,perioperative detection ofhAFP mRNA in peripheral blood of patients has no clinicalrelevance and significant role in the prediction of HCCrecurrence.Surgical resection itself may not accelerate cancerdissemination and does not increase postoperativerecurrence significantly either. ... （共6頁）