CIRCULATING ALBUMIN MESSENGER-RNA IN HEPATOCELLULAR-CARCINOMA - RESULTS OF A MULTICENTER PROSPECTIVE-STUDY

The presence of circulating tumor cells might be an indicator of hemat ogenous spread of tumor cells leading to extrahepatic metastasis. Mess enger RNA (mRNA) expression of human albumin, as a liver specific cell marker, has been proposed for this purpose in hepatocellular carcinom a. We conducted a multicenter prospective study in 101 patients with b iopsy-proven hepatocellular carcinoma followed-up every 3 months for 1 year or until death. At entry into the study, albumin mRNA was detect ed in the blood by reverse transcription-polymerase chain reaction (RT -PCR). At entry into the study, 45% of the patients had a positive alb umin mRNA test, 53% a single tumor, 16% a portal or venous hepatic thr ombosis, and 16% had proven metastasis, After 1 year, there was no sig nificant difference in survival of patients with positive or negative albumin mRNA at entry (P = .16, log-rank test), When patients with met astasis at entry were excluded, again survival did not differ between the two groups (P = .20). Independent prognostic factors of survival w ere radical therapeutic procedures, metastasis, number of tumors, Chil d-Pugh score, and thrombosis, but not the albumin mRNA test. Taking th e presence of metastasis as a reference, the specificity of the test w as 56%, its sensitivity 50%, and its negative predictive value 85%. Th e present study shows that circulating albumin mRNA detected by means of RT-PCR fails to provide significant information in the diagnosis an d prognosis of hepatocellular carcinoma. Further studies are needed to determine whether the use of specific tumor markers could have clinic al relevance in this setting.