title: The role of liver cancer stem cells in donor liver allocation for patients with hepatocellular carcinoma.
abstract: Previous criteria for liver transplantation in patients with hepatocellular carcinoma (HCC) has predominantly emphasized the size and number of existent tumors; however, criteria have not included tumor biology, which may comprise a critical factor for predicting patient prognosis. This issue has been recognized in the Hangzhou criteria, which take tumor histopathologic grade and pre-transplant α-fetoprotein (AFP) level into consideration. However, neither histopathologic grading nor AFP level are precise enough to adequately represent tumor biology in patients with HCC. Recent research has indicated that the development and progression of HCC are driven by a subpopulation of liver cells with stem cell features (cancer stem cells, [CSCs]). Liver CSCs with cluster of differentiation (CD)133 antigen positivity show a high tumorigenic capacity, and the increase in the percentage of CD133+ liver cancer cells is consistent with increased levels of serum AFP. In addition, the number of CD90+ cells increases with the tumorigenicity of HCC, and a positive correlation between the number of circulating CD90+ liver CSCs and disease progression has been observed. As liver CSCs can be detected using the CD profile and could more accurately represent tumor biology in HCC, we hypothesized that liver CSCs with specific phenotypes could be used for modifying the Hangzhou criteria, thereby providing valuable guidance for the development of more accurate prognosis prediction algorithms for patients with HCC being considered for liver transplantation. We provide reliable evidence supporting this hypothesis, and offer proposals for future applications in transplant practice.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Hu
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Li
authors.forename: Pengfei
authors.initials: P
authors.lastname: Yu
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.forename: ShuSen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000071916:AC133 Antigen; D015703:Antigens, CD / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D006023:Glycoproteins / Q000378:metabolism; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D026503:Low Density Lipoprotein Receptor-Related Protein-1 / Q000378:metabolism; D014411:Neoplastic Stem Cells / Q000473:pathology; D010455:Peptides / Q000378:metabolism; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000071916:AC133 Antigen; C097353:AFP protein, human; D015703:Antigens, CD; D006023:Glycoproteins; C475476:LRP1 protein, human; D026503:Low Density Lipoprotein Receptor-Related Protein-1; C000606023:PROM1 protein, human; D010455:Peptides; D000509:alpha-Fetoproteins