Background and Study Aims

To investigate whether the measurement of liver stiffness (LSM) using fibroscan and the serum Cancer Stem Cells (CSC): Ep-CAM and cytokeratin-19, could predict the recurrence of hepatocellular carcinoma (HCC) and their impact on clinical outcome and overall survival.

Patients and Methods

This is a prospective study, including 179 HCV-related HCC patients. All patients were treated following the BCLC guidelines. All HCC patients had transient elastography, measurements of Ep-CAM and cytokeratin-19 before and six months post-treatment. We looked for predictors of recurrence and performed a survival analysis using Kaplan-Meier estimates.

Results

TACE was the most common procedure (77.1%), followed by microwave ablation (15.6%). Complete ablation was achieved in 97 patients; 55 of them developed HCC recurrence. After treatment, LSM increased significantly with a significant reduction in CSCs levels in complete and partial response groups. The median time to observe any recurrence was 14 months. LSM increased significantly post-treatment in patients with recurrence versus no recurrence. Higher levels of CSCs were recorded at baseline and post-treatment in patients with recurrence but without statistical significance. We used univariate analysis to predict the time of recurrence by determining baseline CK-19 and platelet levels as the key factors, while the multivariate analysis determined platelet count as a single factor. The univariate analysis for prediction of overall survival included several factors, LSM and EpCAM (baseline and post-ablation) among them, while multivariate analysis included factors such as Child score B and incomplete ablation.

Conclusion

Dynamic changes were observed in LSM and CSCs levels in response to HCC treatment and tumour recurrence. Child score and complete ablation are factors that significantly affect survival.

中文翻译：

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肝细胞癌复发和生存的预测因素：前瞻性研究，包括瞬时弹性成像和癌症干细胞标志物。

背景和学习目标

调查使用纤维扫描和血清癌干细胞（CSC）：Ep-CAM和cytokeratin-19进行的肝硬度（LSM）测量是否可以预测肝细胞癌（HCC）的复发及其对临床结局和总体生存的影响。

患者和方法

这是一项前瞻性研究，包括179名与HCV相关的HCC患者。所有患者均按照BCLC指南进行治疗。所有HCC患者在治疗前和治疗后六个月均进行了瞬时弹性成像，Ep-CAM和细胞角蛋白-19的测定。我们寻找复发的预测因素，并使用Kaplan-Meier估计进行了生存分析。

结果

TACE是最常见的手术（77.1％），其次是微波消融（15.6％）。97例患者完全消融；其中55例发生HCC复发。治疗后，完全和部分反应组的LSM显着增加，而CSCs水平显着下降。观察到任何复发的中位时间为14个月。与未复发相比，复发患者的LSM显着增加。复发但无统计学意义的患者在基线和治疗后记录了更高水平的CSC。我们使用单变量分析通过确定基线CK-19和血小板水平作为关键因素来预测复发时间，而多变量分析将血小板计数确定为一个因素。

结论

观察到响应HCC治疗和肿瘤复发的LSM和CSCs水平发生动态变化。儿童评分和完全消融是显着影响生存的因素。