Abstract
Hepatocellular carcinoma (HCC) is ranked as the sixth most common cancer around the world. With the emergence of the state-of-the-art modalities lately, such as liver transplantation, image-guided ablation, and chemoembolization, the death rate is still high due to high metastasis rate after therapy. Observation by biannual ultrasonography allows effective diagnosis at an early stage for candidates with no extrahepatic metastasis, but its effectiveness still remains unsatisfactory. Developing a new test with improved effectiveness and specificity is urgently needed for HCC diagnosis, especially for patients after first line therapy. Circulating tumor cells (CTCs) are a small sub-population of tumor cells in human peripheral blood, they release from the primary tumor and invade into the blood circulatory system, thereby residing into the distal tissues and survive. As CTCs have specific and aggressive properties, they can evade from immune defenses, induce gene alterations, and modulate signal transductions. Ultimately, CTCs can manipulate tumor behaviors and patient reactions to anti-tumor treatment. Given the fact that in HCC blood is present around the immediate vicinity of the tumor, which allows thousands of CTCs to release into the blood circulation daily, so CTCs are considered to be the main cause for HCC occurrence, and are also a pivotal factor for HCC prognosis. In this review, we highlight the characteristics and enrichment strategies of CTCs, and focus on the use of CTCs for tumor evaluation and management in patients with HCC.
Highlights
There are improvements in the treatment strategy and patient stratification, hepatocellular carcinoma (HCC) still contributes to a significant burden of disease for both patients and health services.The global age-standardized incidence has increased to 10.1 cases per 100,000 person-years since2012 [1]
Given the fact that the liver is supplemented by the blood, circulating tumor cells (CTCs) are considered to be the main cause for HCC occurrence, and are a pivotal factor for prognosis
The liquid biopsy of CTCs provides an opportunity for timely diagnosis and treatment, especially in the context of metastasis or recurrence
Summary
There are improvements in the treatment strategy and patient stratification, hepatocellular carcinoma (HCC) still contributes to a significant burden of disease for both patients and health services. The molecular and genetic characteristics of these cells or organelles should ideally provide dynamic assessments of tumor behaviors and information on prognosis, metastasis, and possible drug resistance to drug treatment This information potentially predicts accurate patient risk stratification and allow a timely transition of therapy selection, which allow the optimization of personalized therapeutic treatment and reduction in patient morbidity from unnecessary treatments [11]. CTCs have been used for prognosis in patients at an early stage or with metastatic disease to identify suitable adjuvant therapy or surveillance, and to act as a substitute biomarker during therapy [10] Another crucial use for CTC detection and characterization is to serve as a “liquid biopsy” representative of the tumor. Our aim is to provide the current understanding of CTCs in HCC, so this can contribute to the translation of experimental data into clinical studies
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