Albumin mRNA in plasma predicts post-transplant recurrence of patients with hepatocellular carcinoma.
BACKGROUND
Currently, hepatocellular carcinoma (HCC) patients are selected for liver transplantation based on radiological assessment (size and number of tumor nodules) and/or pathological features (tumor grade and vascular invasion). The former criteria have limited power on prognosis, whereas the latter do not provide complete information until explant is available.


METHODS
This study aims to investigate whether quantitative measurement of plasma mRNA derived from cancer can provide preoperative prognostic information. Preoperative plasma samples obtained from 72 HCC patients who had undergone liver transplantation were studied. The patients were selected for liver transplantation largely based on the Milan criteria before 2002 and UCSF criteria after 2002. Real-time quantitative reverse transcriptase polymerase chain reaction with Taqman system was used to measure the albumin mRNA levels in plasma.


RESULTS
Fifteen patients (21%) had HCC recurrences. Patients with a high plasma albumin mRNA level (>14.6) had a significantly higher recurrence rate (log-rank test, P=0.001). High plasma albumin mRNA level predicted 2-year HCC recurrence with sensitivity and specificity of 73% and 70%, respectively. By multivariate analysis, plasma albumin mRNA level (adjusted hazard ratio=5.9, P=0.002) and vascular invasion (adjusted hazard ratio=6.0, P=0.001) were the only independent risk factors for prediction of HCC recurrence.


CONCLUSIONS
Plasma albumin mRNA quantification predicts posttransplant HCC recurrence. It may supplement the current selection criteria of HCC patients for liver transplantation.
Cheung
Siu Tim
ST
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
Fan
Sheung Tat
ST
Lee
Yuk Ting
YT
Chow
Jeremy P
JP
Ng
Irene O
IO
Fong
Daniel Y
DY
Lo
Chung Mau
CM
D000418:Albumins / Q000235:genetics* / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis; D011237:Predictive Value of Tests; D011379:Prognosis; D012333:RNA, Messenger / Q000097:blood*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D000418:Albumins; D012333:RNA, Messenger