Purpose: Detection of AFP mRNA in peripheral blood is considered a useful predictor of HCC recurrence after resection. However, its interpretation and clinical significance remains to be determined. This study was designed to evaluate the clinical significance of detecting AFP mRNA positive cells in peripheral blood. Methods: A total of 153 patients without macroscopic vascular invasion, who underwent liver resection, were prospectively enrolled in this study. The pattern of HCC recurrence was confirmed by image studies and divided into four types: (1) no recurrence (control group, n = 68); (2) intrahepatic single recurrence (SR group, n = 28); (3) intrahepatic multiple recurrences (MR group, n = 38); and (4) extrahepatic HCC recurrence (EX group, n = 19). Results: HCC recurrence was identified in 85 (55.6%) patients during a follow-up of 8.6 ± 6.7 (range, 0.7-36) months. Multivariate analysis identified preoperative AFP mRNA (HR = 2.54; P = 0.006) as an independent risk factor for HCC recurrence. Preoperative AFP mRNA expression was a significant predictor of HCC recurrence in the MR/EX group (P = 0.029) but not in the SR group (P = 0.467). Conclusions: Detection of AFP mRNA expression in peripheral blood before surgery for HCC is a useful predictor of multiple or extrahepatic HCC recurrences.
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