Value of reverse transcriptase polymerase chain reaction tests for detection of peripheral blood hepatocellular carcinoma cells

Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies. Tumor recurrence is, however, frequent and may be due to undetectable tumor cells. Reverse transcriptase polymerase chain reaction (RT-PCR) has been used to detect those tumor cells in peripheral blood but has several disadvantages. Methods: Peripheral blood from 47 patients (group A, 19 patients with newly diagnosed HCC; group B, 20 control patients with non-HCC liver lesions; Group C, 8 HCC aftercare patients) was tested for the presence of circulating HCC cells by demonstration of alpha-fetoprotein mRNA by the RT-PCR technique. Results: Six patients with newly diagnosed HCC tested positive for circulating HCC cells. No patient in the control group or the aftercare group was positive for alpha-fetoprotein mRNA. Conclusions: The specificity (100%) of alpha-fetoprotein mRNA as a marker for HCC cells in circulating blood was satisfactory but the sensitivity (31.6%) was disappointing. Our experience is that this method of detecting circulating HCC cells did not provide any clinically relevant information and that we should focus our interest on methods like the isolation by size of epithelial tumor cells for the detection of circulating tumor cells in the future.