PIVKA-II and biochemical parameters in patients with hepatocellular carcinoma on waiting list for liver transplantation
Felipe Alconchel1,5, Francisco Villalba-López5, Luis Francisco Sánez-Mateos3,5, Pedro Antonio Cascales-Campos1,5, Virginia de la Orden García4, Laura Martínez1,5, José Antonio Pons2,5, Francisco Sánchez-Bueno1,5, Ricardo Robles1,5, Pablo Ramírez1,5.
1Surgery and Organ Transplantation, Clinical University Hospital Virgen de la Arrixaca, Murcia, Spain; 2Hepatology, Clinical University Hospital Virgen de la Arrixaca, Murcia, Spain; 3Clinical Analysis Laboratory, Rafael Méndez Hospital, Lorca, Spain; 4Genetracer Biotech, Fuenlabrada Hospital, Madrid, Spain; 5Biomedical Research Institute of Murcia (IMIB-Virgen de la Arrixaca), Murcia, Spain
Hepatocellular carcinoma (HCC) is the most frequent primary neoplasm of the liver, with an important significance given its incidence and mortality. It is currently the sixth most prevalent neoplasm in the world and the third most common cause of death from cancer.
Liver transplantation (LT) is considered the treatment of choice for hepatocellular carcinoma, especially in cases associated with liver disease. Despite this, more than 10% of liver transplant patients with hepatocellular carcinoma have recurrences within the first year after transplantation. This fact suggests the existence of circulating tumor cells (CTC), which are associated with metastasis and recurrence of hepatocellular carcinoma, and which could be a good tool for the diagnosis, monitoring, and prognosis of these patients.
The aim of our work is to evaluate the effectiveness of predicting post-transplant recurrence of pre-transplant circulating tumor cell levels in patients with hepatocellular carcinoma.
Peripheral blood was obtained from 27 patients with HCC waiting for liver transplantation. Immunomagnetic isolation of CTC was performed by the IsoFlux® System. The cell enrichment was stained with anti-CK, Hoechst 33342 and anti-CD45, performing the cell count on a fluorescence microscope. These patients were monitored clinically and analytically after LT for two years. Statistical analysis was performed using SPSS 23.0 (IBM®) software. A ROC curve was made in order to know the effectiveness of predicting post-transplant HCC recurrence of pre-transplant CTC levels.
After the elaboration of the ROC curve for the determination of the efficacy of prediction of recurrence/metastasis post-LT of the levels of pre-LT CTC, an area under the curve (AUC) of 0.728 (72.8%) was identified (CI 95%, 0.506-0.950; p=0.152).
The cut-off point for CTC levels to predict post-transplant recurrence/metastasis with better sensitivity and specificity, corresponding to the maximum Youden index (0.5), was established at ≥ 9 CTC/10 mL with a sensitivity of 100% and a specificity of 52.2%.
Pre-LT CTC levels could be a good predictive marker for the recurrence of HCC metastases and relapses during the post-LT period.
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