Influence Of Hematogenous Dissemination Of Tumor Cells In Patients With Small Primary Hepatocellular Carcinoma Performed By Surgical Resection And Microwave Ablation

PURPOSE To study the influence of percutaneous microwave coagulation therapy(PMCT) and surgical resection for patients with small primary hepatocellular carcinoma(PHC) on disseminating tumor cells in peripheral blood by demonstrating AFP mRNA.MATERIALS AND METHODS Patients selection, Patients with small PHC(The maximal diameter> 5 cm) confirmed histologically were selected to the study. Every patient had single node only and no intrahepatic/extrahepatic metastasis. 19 patients performed by PMCT and 21 by surgical resection were tested before treatment just, 30 min after the mass ablated/resected, 1 and 7 days later by Nested-RT-PCR and RDT-RT-PCR. The CD3, CD4 CD8 and CD4/CD8 in blood, and hepatic function were tested at the same times too.RESULT Hepatic function, surgical resection caused the ALT and AST in blood serum increasing more than PMCT, and the peak values were in 1 day after treatment. The total protein and albumen in blood serum were similar in two groups. Total and direct bilirubins became higher 1 day after PMCT and 7 days after surgical than pre-treatment.Immune function CD3 in blood became lower in the patients by surgery 30 min, 1 day and 7 days after resection. CD4 and CD4/CD8 decreased 30 min and 1 day and recovered 7 days after SURGERY. But CD3,CD4 and CD4/CD8 kept the same as pre-PMCT in patients performed by PMCT.AFP mRNA tested by Nested-RT-PCR, 40%(16/40) of all the patients showed positive AFP mRNA in blood pre-treatment. The blood AFP mRNA in 3 patients performed by PMCT and 3 by surgery who were negative before treatment turned into positive after therapy, and changed to be positive again 7 days later. Some patients(2/6 in PMCT group and 3/9 in surgical group) with AFP mRNA positive became negative 7 day after therapy. There was no different between two groups.AFP mRNA tested by RTD-RT-PCR, 67. 5%(27/40) of all the patients showed AFP mRNA copies in blood before treatment. The AFP mRNA copies in Some patients with or without AFP mRNA copies before therapy increased after treatment, and the peak value was in 30 min after treatment. The AFP mRNA copies in Some patients with AFP mRNA copies decreased 7 days after treatment. There was no different between the two groups.FOLLOW UP The patients were followed up for 1-16 months. One patient had extrahepatic metastasis 8 months later, one had liver recurrence, and one died from pulmonary infection 10 days later in PMCT group. There were two patients with liver recurrence 4 and 5 months later in surgical group. The 4 patients with extrahepatic metastasis or liver recurrence had higher persistently elevated AFP mRNA.CONCLUSION The levels of AFP mRNA in peripheral venous blood were higher after surgical resection and microwave ablation in patients with small PHC, and the peak value were 30 min after therapy, which indicated PHC cells disseminating into the blood circulation. There was no different between two groups. The cellular immune function in peripheral blood decreased 30 min, 1 day and 7 days after surgical resection , and the lowest vale was in 30 min after surgery. The immune function were kept at the same level as pre-treatment in PMCT group. Surgical resection damaged liver function more than PMCT. The patients with higher persistently elevated AFP mRNA in peripheral blood had higher probability of intrahepatic/extrahepatic metastasis.