Presence of alpha-fetoprotein mRNA in blood correlates with outcome in patients with hepatocellular carcinoma

Background/Aims: Since hematogenous spread of tumor cells may adversely aff ect the prognosis of patients with hepatocellular carcinoma, we prospective ly analyzed whether the presence of alpha-fetoprotein (AFP) messenger RNA ( mRNA) in blood, used as a marker of circulating hepatocellular carcinoma ce lls, correlates with outcome. Methods: Eighty-eight patients were enrolled between December 1993 and Augu st 1995, and 81 were followed until the end of 1997, All patients were trea ted with percutaneous ethanol injection therapy and/or transarterial emboli zation during follow-up. The status of AFP mRNA in blood was serially deter mined, Cumulative metastasis-free survival and overall survival were analyz ed in relation to AFP mRNA and other clinical and laboratory variables, Results: Among 81 patients followed, 54 were positive for AFP mRNA at entry and 27 were negative, Extrahepatic metastasis developed more frequently am ong the AFP mRNA-positive patients (13 of 54) than among the AFP mRNA-negat ive patients (2 of 27) (p=0.0296). After treatment, AFP mRNA became negativ e in 24 of 54 patients (44%), Cumulative metastasis-free survival and overa ll survival were significantly better in the 24 patients whose AFP mRNA bec ame negative after treatment than in the 30 patients with persistently posi tive AFP mRNA (p=0.0001 and p<0.0001, respectively). Conclusions: The presence or absence of AFP mRNA in blood is a predictor of outcome in patients with hepatocellular carcinoma.