Non-specificity of messenger RNA of alpha-fetoprotein in peripheral blood in detecting early spread of hepatocellular carcinoma in black Africans

Detection of MAGE-1, MAGE-3 and AFP mRNA as multimarker by real-time quantitative PCR assay: a possible predictor of hematogenous micrometastasis of hepatocellular carcinoma

BACKGROUND/AIMS

The aim of this study was to explore the relationship between MAGE-1, MAGE-3 and AFP mRNA in the peripheral blood of patients with hepatocellular carcinoma and micrometastasis in circulation, real-time quantitative-PCR (real-time Q-PCR) assay was applied to detect the expression of the multimarker.

METHODOLOGY

Peripheral blood samples were obtained from 86 patients with hepatocellular carcinoma (HCC) and real-time Q-PCR technique was used to detect the MAGE-1, MAGE-3, and AFP mRNA in the blood.

RESULTS

In 86 tumor specimens, the positivity for MAGE-1, MAGE-3, and AFP genes was 34.9% (30/86), 60.5% (52/86) and 69.8%(60/86) respectively, and all specimens expressed at least one marker. MAGE-1, MAGE-3, and AFP transcripts were detected in 12 (14.0%),18 (20.1%) and 29 (33.7%) of 86 blood specimens from hepatocellular carcinoma patients, respectively, while 45 specimens (52.3%) were positive for at least one marker. In addition, MAGE-1, MAGE-3 and AFP gene transcripts were not detected in any peripheral blood specimens from 25 chronic liver disease patients and 28 normal healthy volunteers. The positive rate correlated with the TNM clinical stages, extrahepatic metastasis and portal vein carcinothrombosis (p<0.05). No correlation was found between tumor size, tumor number, differentiation, serum a-fetoprotein (AFP) and the positive rate.

CONCLUSIONS

Our results indicate that a multimarker real-time Q-PCR assay with cancer-specific markers such as MAGE-1 and MAGE-3 in combination with a hepatocyte-specific AFP marker may be a promising diagnostic tool for monitoring hepato-cellular carcinoma patients with better sensitivity and specificity.

A prospective study of blood alpha-fetoprotein messenger RNA as a predictor of hepatocellular carcinoma in patients with cirrhosis

Blood alpha-fetoprotein messenger RNA (AFP mRNA) is thought to be a marker of hepatocellular carcinoma (HCC). Its value as a predictor of HCC in patients at risk is not known. A series of 201 patients with compensated cirrhosis (114 men, mean age 58 years) underwent surveillance with semi-annual ultrasound and serum alpha-fetoprotein measurements. Total RNA was extracted from peripheral blood mononuclear cells collected at different intervals and AFP mRNA was retrotranscribed and amplified by nested polymerase chain reaction. Ten patients with HCC and 30 blood donors were used as controls. Three patients with HCC, 39 with cirrhosis under surveillance and four blood donors circulated AFP mRNA (30, 20 and 13%, NS). During 50 months of surveillance, 27 patients with cirrhosis developed HCC: the tumour was detected more often in patients with higher than normal baseline serum AFP (> or =7 IU/L) than in those with normal AFP levels (21%vs 9%, P = 0.02). The incidence of HCC was the same in patients with and without AFP mRNA at baseline (15%vs 14%). In 53 patients, AFP mRNA was re-tested after 6-25 months of surveillance. HCC developed in two of 11 (18%) who were initially AFP mRNA positive and later became negative, in none of those who were initially negative and later became positive and in two of 39 (5%) who remained persistently negative. In conclusion, blood AFP mRNA is not a sensitive predictor of HCC in patients with compensated cirrhosis.

Postoperative detection of alpha-fetoprotein mRNA in blood as a predictor for metastatic recurrence of hepatocellular carcinoma

BACKGROUND

We tested for the presence of alpha-fetoprotein (AFP) mRNA by using nested RT-PCR in the peripheral blood of hepatocellular carcinoma (HCC) patients who had undergone curative surgery, and investigated the occurrence of intrahepatic and/or extrahepatic metastasis thereafter, to reveal the optimal timing of blood sampling for the prediction of metastatic recurrence.

METHODS

Twenty-nine patients with HCC, who had been operated on were analyzed with RT-PCR at several points during the clinical course, and examined for metastatic recurrence for 3-28 months (mean = 18.7 months) after surgery.

RESULTS

The presence of AFP mRNA before surgery was significantly correlated with the tumor size (P = 0.017). Metastatic recurrence was associated with the postoperative detection of AFP mRNA (P < 0.001), but not with the preoperative and/or perioperative detection. Furthermore, AFP mRNA was detected in some cases that showed low serum AFP levels at recurrence. The recurrence-free period after the detection of AFP mRNA varied from 1 to 12 months.

CONCLUSIONS

The postoperative detection of AFP mRNA is useful for the prediction of metastatic recurrence, and long-term follow up with this method should be conducted.