Purpose: To assess the role of epithelial cell adhesion molecule (EpCAM)-positive circulating tumor cell (CTC) count in predicting outcomes of transcatheter arterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC).
Materials and Methods: EpCAM-positive CTC counts were prospectively determined in peripheral blood of 97 patients with unresectable HCC treated with TACE, using CellSearch system. The impact of each cutoff point (each CTC value) on overall survival (OS) was evaluated by univariate Cox regression analysis. Based on the hazard ratio (HR), the patients were divided into 3 groups: low level (CTC=0 and 1), moderate level (CTC=2-5) and high level (CTC≥6) groups. Cox proportional hazards model was used to assess the correlation of CTC counts with outcomes.
Results: Eighty nine patients were enrolled according to patient-selection criteria. The low level group was used as control group for univariate Cox analysis. Mortality risk in the high level and moderate level groups was 4.164 (95% Confidence Interval [CI], 2.042-8.492, P=0.000) and 1.695 (95% CI, 0.883-3.253, P=0.113) times higher, respectively, than that in the low level group. On multivariate Cox regression analysis, CTC count was found to be an independent predictor of OS (P=0.049) and progression-free survival (PFS) (P=0.007) in patients treated with TACE. After adjustment for confounding factors, the mortality risk in the high level and moderate level groups was 2.819 times (95% CI, 1.218-6.526, P=0.016) and 1.301 times (95% CI, 0.630-2.685, P=0.477) higher than that in the low level group.
Conclusion: High EpCAM positive CTC count predicts poor prognosis of patients with unresectable HCC treated with TACE