Cheung ST et al. (2008) Albumin mRNA in plasma predicts post-transplant recurrence of patients with hepatocellular carcinoma. Transplantation 85: 81–87

Post-transplant recurrence of hepatocellular carcinoma (HCC) is common, despite routine use of patient-selection criteria based on pretransplantation radiological findings. HCC recurrence in the liver graft is probably caused by cancer cells circulating in the blood, and levels of cancer-derived nucleic acids in plasma are thought to reflect this circulating tumor-cell burden.

Cheung and colleagues analyzed prospectively collected data from 72 patients who underwent liver transplantation for HCC at Queen Mary Hospital, Hong Kong, between 1997 and 2005. They extracted RNA from plasma samples obtained from each patient immediately before surgery, as well as from 10 healthy control individuals and 10 non-HCC liver-transplant recipients. Perhaps surprisingly, albumin messenger RNA (mRNA) levels (but not alfafetoprotein mRNA levels) were significantly associated with post-transplant HCC recurrence (P = 0.029). The researchers calculated that the ability of preoperative plasma albumin mRNA levels to predict post-transplant HCC recurrence was superior to that of preoperative radiological assessments of tumor size and number, and comparable to that of pathological findings of vascular invasion (overall accuracy 71% for plasma albumin mRNA, compared with 74% for vascular invasion).

The authors note that preoperative assessments of vascular invasion require tumor biopsy, which is a risky procedure. By contrast, plasma albumin mRNA levels are simple and easy to measure. The authors have initiated a multicenter, prospective study in a large group of patients to evaluate their findings further.