American Surgical Association
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AFPmRNA Detected in Bone Marrow by Real Time PCR Analysis Predicts Survival and Recurrence after Curative Hepatectomy for Hepatocellular Carcinoma
Toshiya Kamiyama, Dr*, Masato Takahashi, Dr*, Takahito Nakagawa, Dr*, Kazuaki Nakanishi, Dr*, Hirofumi Kamachi, Dr*, Tomomi Suzuki, Dr*, Tsuyoshi Shimamura, Dr*, Michiaki Matsushita, Dr*, Hiroyuki Furukawa, Dr*, Satoru Todo, Dr
Hokkaido University, Sapporo, Japan

Objectives
The presence of cancer cells in peripheral blood and/or bone marrow can predict the outcome of patients with malignant diseases. We analyzed whether detection of hepatocellular carcinoma (HCC) cells in bone marrow by real time PCR targeting AFPmRNA before curative hepatectomy correlates with HCC recurrence and patient survival.
Methods
Between 7/2000 and 6/2005, 193 consecutive HCC patients underwent primary hepatectomy; 136 received curative operation. Bone marrow collected preoperatively was subjected to real time PCR analysis using AFPmRNA as target molecule. Median follow up was 23 months (range, 6- 54). Patient survival (PS), disease-free survival (DFS), and clinicopathological features were compared between patients with positive- and negative-AFPmRNA.
Results
Twenty-four patients died (23 from HCC). HCC recurred in 66 patients (hepatic in 37 [56.1%]; hepatic and remote in 17 [25.8%] , and remote alone in 12 [18.2%]). Thirty-eight patients (27.9%) were positive for AFPmRNA; 98 (72.1%) were negative. One- and 3-year PS were 96.6% and 91.4%, respectively, with negative-AFPmRNA vs. 86.5% and 56.5%, respectively, with positive-AFPmRNA (p=0.0002). One- and 3-year DFS were 73.2% and 44.8%, respectively, with negative-AFPmRNA vs. 54.5% and 25.8%, respectively, with positive-AFPmRNA (p=0.0399). Portal vascular invasion, tumor size, multiple tumors, and tumor differentiation correlated with inferior PS and DFS by univariate analysis. Positive-AFPmRNA was the most important risk factor for PS (p=0.0009) and DFS (p=0.0165) by multivariate analysis. Positive-AFPmRNA correlated significantly with portal vein invasion.
Conclusion
AFPmRNA in bone marrow predicts patient survival and recurrence after curative hepatic resection for HCC.


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