60 ± 0.43 to 1.00 ± 0.36, P < 0.05) was observed 1 month after resection. Patients with consistent CTC7.5 <2 had lower recurrence rates than those with values consistently ≥2 (15.5% versus 87.50%, P < 0.001). EpCAM+ CTCs displayed cancer stem cell biomarkers (CD133 and ABCG2), epithelial-mesenchymal transition, Wnt pathway activation, high tumorigenic potential, and low apoptotic propensity. Conclusion: selleck Stem cell–like phenotypes are observed in EpCAM+ CTCs, and a preoperative CTC7.5 of ≥2 is a novel predictor for tumor recurrence in HCC patients after surgery, especially in patient subgroups with AFP levels of ≤400 ng/mL or low tumor recurrence

risk. EpCAM+ CTCs may serve Proteasome purification as a real-time parameter for monitoring treatment response and a therapeutic target in HCC recurrence. (HEPATOLOGY 2013) Hepatocellular carcinoma (HCC) is one of the most prevalent malignancies worldwide, and associated morbidity and mortality rates have escalated in recent years.1 Despite improvements in surveillance and clinical treatment strategies, the prognosis of HCC remains very poor due to high incidence of recurrence and

metastasis.2 Traditional clinicopathological parameters such as tumor morphology, histopathological features, and tumor staging system offer limited information for predicting postoperative recurrence and fail to monitor the therapeutic response in a real-time 上海皓元医药股份有限公司 manner.3 Therefore, it is imperative to develop novel approaches for discriminating high-risk factors of recurrent patients and continuous surveillance of antitumor treatment response. The spread of circulating tumor cells (CTCs) in the blood plays a major role in the initiation of metastases and tumor recurrence after surgery.3 Recent studies have reported that stem cell markers are frequently overexpressed in CTCs of metastatic breast cancer.4 In addition, clinical observations and animal model studies indicate that although thousands of tumor cells disseminate into the circulation, only a small population with stem cell–like properties survives migration

to establish secondary colonies.5, 6 Therefore, CTCs with stem cell properties might be potential sources for cancer relapse and distant metastasis, consistent with the cancer stem cell (CSC) hypothesis.7 AFP, alpha-fetoprotein; AUC, area under the curve; BCLC, Barcelona Clinical Liver Cancer; CI, confidence interval; CK, cytokeratin; CSC, cancer stem cell; CTC, circulating tumor cell; DAPI, 4′,6-diamidino-2-phenylindole; EpCAM+, epithelial cell adhesion molecule–positive; HCC, hepatocellular carcinoma; mRNA, messenger RNA; NOD/SCID, nonobese diabetic/severe combined immunodeficiency; qRT-PCR, quantitative real-time polymerase chain reaction; ROC, receiver operating characteristic; TACE, transcatheter arterial chemoembolization; TTR, time to recurrence.