Circulating tumor cells predict recurrence risk in early HCC treated with local ablative therapy

Background: Early hepatocellular carcinoma (HCC) has a recurrence rate exceeding 50% following local ablation. Current imaging criteria are insufficient to detect micrometastases within the first two years post-therapy. The aim of this study was to assess the utility of serial EpCAM-positive circulating tumor cell (CTC) testing in identifying patients at higher risk of recurrence after local ablation.

Methods: A total of 43 patients (mean age 68±8 years) undergoing local ablation between 2021 and 2023 were prospectively enrolled. Blood samples were collected pre-treatment and at follow-up visits (3, 6, 12, and 24 months) and processed using the CellSearch™ system. Baseline samples were obtained from both proximal and distal sites. The primary endpoint was recurrence-free survival (RFS).

Results: Recurrence was observed in 18 patients (42%) within 24 months. Patients with CTC positivity at 6 months exhibited a significantly higher risk of recurrence (HR: 6.55, p=0.007) and reduced RFS (p=0.0018). When CTC were combined with alpha-fetoprotein (AFP) levels, CTC-positive status at baseline (proximal blood only), 3 months, and 6 months was associated with an elevated risk of recurrence, with HR of 2.60 (p=0.057; 95% CI, 0.95-7.10), 3.49 (p=0.014; 95% CI, 1.23-9.49), and 3.26 (p=0.023; 95% CI, 1.10-8.84), respectively.

Conclusion: CTC detection at 6 months post-ablation is a strong indicator of increased recurrence risk. The combination of CTC and AFP improves risk stratification, demonstrating prognostic value at CTC when collected at baseline, 3 months, and 6 months post-therapy.

Publication History

Article published online:
20 January 2025