Real-time quantification of AFP mRNA to assess hematogenous dissemination after transarterial chemoembolization of hepatocellular carcinoma.
OBJECTIVE
To determine whether the number of hepatocytes containing AFP mRNA shed into the bloodstream during transarterial chemoembolization (TAE) affects the incidence and pattern of recurrence of hepatocellular carcinoma (HCC).


METHODS
We developed a Taqman procedure to quantify AFP mRNA prospectively in 52 consecutive patients before and after TAE. Results are expressed in hepatocytes /mL.


RESULTS
Thirteen of the patients (24.5%) were positive for AFP mRNA (42 +/- 19 hepatocytes/mL) before TAE and 13 (24.5%) (80 +/- 32 hepatocytes/mL) after TAE; the difference was not significant. The presence of AFP mRNA in the bloodstream before TAE was associated with larger nodules (85.2 +/- 73.8 mm versus 34.8 +/- 26.1 mm; P = 0.006). Six of the patients were excluded from the analysis because they underwent curative surgery or were lost to follow-up. The circulating levels of AFP mRNA released in the 46 remaining patients after TAE did not affect metastasis-free survival. A significant number of extrahepatic metastases were found in patients exhibiting at least 1 AFP mRNA-positive blood sample either before or after TAE. However, the TAE procedure did not increase the risk of extrahepatic recurrences.


CONCLUSIONS
Cells containing AFP mRNA are inconsistently released into the circulation during TAE. The amount of these cells released does not affect the recurrence of HCC.
Gross-Goupil
Marine
M
Service de Biochimie et Biologie Moléculaire-INSERM 268, France.
Saffroy
Raphaël
R
Azoulay
Daniel
D
Precetti
Sophie
S
Emile
Jean-François
JF
Delvart
Valérie
V
Tindilière
Fréderic
F
Laurent
Alexis
A
Bellin
Marie-France
MF
Bismuth
Henri
H
Debuire
Brigitte
B
Lemoine
Antoinette
A
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000556:secondary* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D003196:Computer Graphics; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011446:Prospective Studies; D012333:RNA, Messenger / Q000097:blood*; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D000509:alpha-Fetoproteins / Q000032:analysis*
D012333:RNA, Messenger; D000509:alpha-Fetoproteins