title: Increased Expression of Circulating Cancer Stem Cell Markers During the Perioperative Period Predicts Early Recurrence After Curative Resection of Hepatocellular Carcinoma.
abstract: BACKGROUND
  This study was designed to investigate the correlation between postoperative recurrence of hepatocellular carcinoma (HCC) and perioperative expression and dynamic changes in cancer stem cell (CSC) markers in tumors and peripheral blood.
  
  
  METHODS
  In HCC patients who underwent curative resection (n = 64) or liver transplantation (LT) (n = 17), mRNA levels for K19, EpCAM, and CD44 in peripheral blood and HCC tissues before and after operation were examined using real-time RT-PCR. Postoperative recurrence was analyzed in patients who underwent resection. Study participants were divided into high and low ratio groups, according to the ratio of postoperative to preoperative mRNA levels for each marker.
  
  
  RESULTS
  K19 and CD44 mRNA levels in HCC tissues were higher in patients with recurrence than those without recurrence (p < 0.05 for all). Preoperative peripheral levels of K19 and EpCAM mRNA were higher in LT patients than in resection patients, and they were also significantly higher in cirrhotic patients of Child-Pugh Class B or C than those of Child-Pugh Class A (p < 0.05 for all). A high ratio of K19 mRNA was associated with lower relapse-free rate. Additionally, a high ratio for both K19 and CD44 mRNA was an independent poor prognostic factor for relapse-free survival (hazard ratio = 3.382, p = 0.016).
  
  
  CONCLUSIONS
  Preoperative peripheral levels of K19 and EpCAM mRNA were influenced by background liver status and HCC. Additionally, the ratio of postoperative to preoperative mRNA levels for CSC markers, especially K19 and CD44, was shown to be important to predict HCC recurrence.
authors: Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752, Korea.|Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors: Gi Hong
authors: GH
authors: Choi
authors: Department of Pathology and Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Korea.
authors: Gwang Il
authors: GI
authors: Kim
authors: Department of Pathology and Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Korea.
authors: Jeong Eun
authors: JE
authors: Yoo
authors: Department of Pathology and Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Korea.
authors: Deuk Chae
authors: DC
authors: Na
authors: Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752, Korea.|Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors: Dai Hoon
authors: DH
authors: Han
authors: Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
authors: Yun Ho
authors: YH
authors: Roh
authors: Department of Pathology and Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Korea. young0608@yuhs.ac.|BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. young0608@yuhs.ac.|Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea. young0608@yuhs.ac.
authors: Young Nyun
authors: YN
authors: Park
authors: Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752, Korea. Choi5491@yuhs.ac.|Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea. Choi5491@yuhs.ac.
authors: Jin Sub
authors: JS
authors: Choi
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007124:Immunoenzyme Techniques; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D014411:Neoplastic Stem Cells / Q000378:metabolism / Q000473:pathology*; D059035:Perioperative Period; D011379:Prognosis; D011446:Prospective Studies; D012333:RNA, Messenger / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D012333:RNA, Messenger