Presence of alpha-fetoprotein mRNA in blood correlates with outcome in patients with hepatocellular carcinoma.
OBJECTIVE
Since hematogenous spread of tumor cells may adversely affect the prognosis of patients with hepatocellular carcinoma, we prospectively analyzed whether the presence of alpha-fetoprotein (AFP) messenger RNA (mRNA) in blood, used as a marker of circulating hepatocellular carcinoma cells, correlates with outcome.


METHODS
Eighty-eight patients were enrolled between December 1993 and August 1995, and 81 were followed until the end of 1997. All patients were treated with percutaneous ethanol injection therapy and/or transarterial embolization during follow-up. The status of AFP mRNA in blood was serially determined. Cumulative metastasis-free survival and overall survival were analyzed in relation to AFP mRNA and other clinical and laboratory variables.


RESULTS
Among 81 patients followed, 54 were positive for AFP mRNA at entry and 27 were negative. Extrahepatic metastasis developed more frequently among the AFP mRNA-positive patients (13 of 54) than among the AFP mRNA-negative patients (2 of 27) (p=0.0296). After treatment, AFP mRNA became negative in 24 of 54 patients (44%). Cumulative metastasis-free survival and overall survival were significantly better in the 24 patients whose AFP mRNA became negative after treatment than in the 30 patients with persistently positive AFP mRNA (p= 0.0001 and p<0.0001, respectively).


CONCLUSIONS
The presence or absence of AFP mRNA in blood is a predictor of outcome in patients with hepatocellular carcinoma.
Matsumura
M
M
The Institute for Adult Diseases, Asahi Life Foundation, Department of Internal Medicine, University of Tokyo, Japan. m-matsumura@asahi-life.or.jp
Shiratori
Y
Y
Niwa
Y
Y
Tanaka
T
T
Ogura
K
K
Okudaira
T
T
Imamura
M
M
Okano
K
K
Shiina
S
S
Omata
M
M
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000235:genetics* / Q000628:therapy; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000379:methods; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000235:genetics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012333:RNA, Messenger / Q000097:blood*; D016019:Survival Analysis; D000509:alpha-Fetoproteins / Q000096:biosynthesis*
D015415:Biomarkers; D012333:RNA, Messenger; D000509:alpha-Fetoproteins; D000431:Ethanol