Prognostic value of AFP mRNA in patients with HCC : real benefit or academic exercise?

Our goal was to investigate expression and prognostic value of AFP-mRNA in the blood circulation of patients with HCC and liver cirrhosis following liver resection or thermal-ablation. Seventy-eight patients with Hepato-cellular carcinoma (HCC) suitable for curative treatment (resection or thermal-ablation) were prospectively enrolled in the study. Peripheral blood samples were taken immediately before (PRE) and after the operation (POST) and then at 90 days (CTRL). AFP-mRNA was extracted from all blood samples and detected with the Real-Time Reverse Transcription polymerase chain reaction (RT-PCR) procedure The overall rate of AFP-mRNA expression was very low (6,7%), namely 4% PRE, 5% POST, 12% CTRL. There was no difference in marker expression based on type of surgical method or clinical and pathological features. Despite the limits of the low expression rate, a more aggressive trend was observed in the positive PRE group in terms of short-term and local recurrence, namely 100% versus 33% (p=0.00001) and 66% versus 9% (p=0.00001). Moreover, patients with overall AFP- mRNA negative expression had a better survival rate (3-year survival 49% versus 26%, p=0.2862), with a significant difference for the negative CTRL group (p=0.0422). Considering the expression rate of AFP-mRNA, its routine use as prognostic factor for patients with HCC is not justified. However, our study shows that the disease takes an aggressive course in patients with positive PRE-AFP-mRNA expression, suggesting that those markers may be effective, but only if supported by further studies.