Clinical significance of alpha-fetoprotein mRNA in blood of patients with hepatocellular carcinoma

• Published in: Clinica chimica acta Vol. 347; no. 1; pp. 129 - 138
• Main Authors: Cillo, Umberto, Navaglia, Filippo, Vitale, Alessandro, Molari, Alfiero, Basso, Daniela, Bassanello, Marco, Brolese, Alberto, Zanus, Giacomo, Montin, Umberto, D'Amico, Francesco, Ciarleglio, Francesco Antonio, Carraro, Amedeo, Bridda, Alessio, Burra, Patrizia, Carraro, Paolo, Plebani, Mario, D'Amico, Davide Francesco
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-09-2004
• Subjects: Adult; Aged; Aged, 80 and over; alpha-Fetoproteins - biosynthesis; Biomarkers, Tumor; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - pathology; Cell Line, Tumor; Cholestatic index; Colonic Neoplasms - blood; DNA Primers; DNA, Neoplasm - biosynthesis; DNA, Neoplasm - isolation & purification; Electrophoresis, Agar Gel; Female; Grading; Humans; Liver Cirrhosis - blood; Liver Neoplasms - blood; Liver Neoplasms - pathology; Male; Middle Aged; Neoplasm Recurrence, Local - blood; Nodule size; Pancreatic Neoplasms - blood; Prognosis; Prospective Studies; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger - blood; Survival Analysis; Vascular invasion; AST; ALP; Nodule size; ALT; HCC; mRNA; AFP; GGT; OLT; RT-PCR; Cholestatic index; Vascular invasion; Grading
• ISSN: 0009-8981; 1873-3492
• DOI: 10.1016/j.cccn.2004.04.032

Background: Alpha-fetoprotein (AFP) messenger RNA (mRNA) in the blood reflects the presence of circulating hepatocellular carcinoma (HCC) cells and is a sensitive marker of HCC extrahepatic metastases. The specificity of this molecular marker and its correlation with the main HCC clinical–pathological parameters remains controversial, however.
Methods: AFPmRNA was determined in 50 HCC patients and in 50 patients with diagnosis of cirrhosis (6), or colon (24) or, pancreatic (20) carcinoma. HCC patients with clinically evident extrahepatic metastasis were excluded. HCC diagnosis was confirmed in all patients by histology on percutaneous biopsies or surgical specimens; pathological grading was assessed at the same time.
Results: AFPmRNA was positive in 20 HCC patients (40%) and in 18 patients without HCC (36%). The presence of AFPmRNA in the blood correlated significantly with cholestatic indices (
p<0.01), nodule size (
p=0.03), vascular invasion (
p=0.006) and moderately or poorly differentiated HCC (
p<0.0001). Moreover, survival analysis showed a significant impact of AFPmRNA detection on overall (
p=0.04) and recurrence-free survival (
p=0.0007) after a median follow-up of 17 months.
Conclusions: Although AFPmRNA is frequently detected in the blood, even in benign liver diseases or gastroenteric tumors, in HCC patients without clinical evidence of extrahepatic metastases it seemed to identify the biologically more aggressive tumors.