title: Circulating messenger RNA of alpha-fetoprotein: a possible risk factor of recurrence after resection of hepatocellular carcinoma.
abstract: OBJECTIVE
  Isolated tumor cells may be associated with micrometastasis. Circulating alpha-fetoprotein messenger RNA (AFP mRNA) in patients with hepatocellular carcinoma (HCC) has been considered to represent isolated tumor cells. We propose that circulating AFP mRNA may have prognostic value after curative resection of HCC.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Referral center.
  
  
  METHODS
  Eighty-one consecutive patients who underwent curative resection of HCC.
  
  
  METHODS
  A nested reverse-transcriptase polymerase chain reaction (RT-PCR) assay for circulating AFP mRNA before and again 12 weeks after surgery in 81 patients and in a control group. Clinicopathological variables and postoperative course (recurrence and recurrence-free survival) were examined for correlation with the levels of circulating AFP mRNA.
  
  
  RESULTS
  Of the 81 patients, 22 (27.2%) and 19 (23.4%) had AFP mRNA detected preoperatively and postoperatively, respectively. The recurrence-free survival at 1, 2, and 3 years after resection was significantly shorter in the latter patients (52.6%, 15.6%, and 0%, respectively; P<.001) but not in the former (81.8%, 54.5%, and 29.2%; P = .28). In univariate analysis, a significantly higher recurrence rate was found in patients with liver cirrhosis (P = .03), Edmondson-Steiner differentiation grade III or IV (P<.001), incomplete or absent capsule (P = .001), vascular invasion (P<.001), daughter nodules (P = .003), or a positivity for postoperative circulating AFP mRNA (P<.001). Postoperative positivity for circulating AFP mRNA remained a significant risk factor (P = .002; hazard ratio 3.13; 95% confidence interval, 1.52-6.47) in the multivariate analysis.
  
  
  CONCLUSIONS
  The detection of circulating AFP mRNA 12 weeks postoperatively is associated with an increased and earlier risk of HCC recurrence.
authors.affiliation: Department of Surgery, Mackay Memorial Hospital, Chang-Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Kuo-Shyang
authors.initials: KS
authors.lastname: Jeng
authors.forename: I-Shyan
authors.initials: IS
authors.lastname: Sheen
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Tsai
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D011446:Prospective Studies; D012333:RNA, Messenger / Q000097:blood*; D012307:Risk Factors; D000509:alpha-Fetoproteins / Q000235:genetics*
chemical_list: D012333:RNA, Messenger; D000509:alpha-Fetoproteins