Is liquid biopsy the future commutator of decision-making in liver transplantation for hepatocellular carcinoma?

Abstract

Liver transplant (LT) is the most favorable treatment option for patients with early stage hepatocellular carcinoma (HCC). Numerous attempts have been pursued to establish eligibility criteria and select HCC patients for LT, leading to various systems that essentially integrate clinico-morphological variables. Lacking of sufficient granularity to recapitulate the biological complexity of the disease, all these alternatives display substantial limitations and are thus undeniably imperfect. Liquid biopsy, defined as the molecular analysis of circulating analytes released by a cancer into the bloodstream, was revealed as an incomparable tool in the management of cancers, including HCC. It appears as an ideal candidate to refine selection criteria of LT in HCC. The present comprehensive review analyzed the available literature on this topic. Data in the field, however, remain scarce with only 17 studies. Although rare, these studies provided important and encouraging findings highlighting notable prognostic values and supporting the contribution of liquid biopsy in this specific clinical scenario. These results underpinned the critical and urgent need to intensify and accelerate research on liquid biopsy, in order to determine whether and how liquid biopsy may be integrated in the decision-making of LT in HCC.

European Society for Organ Transplantation Consensus Statement on Biomarkers in Liver Transplantation

“…"Liquid biopsy" is promising tool in this regard, as it represents a minimally invasive approach to analyzing tumor components (cells or small pieces of DNA, RNA, or other molecules released by tumor cells) without need for tissue [43][44][45]. Liquid biopsy is dynamic and may be assessed at different peri-and post-LT time points [46].…”

Effect of various hepatectomy procedures on circulating tumor cells in postoperative patients: a case-matched comparative study

“…While two surgical methods, laparoscopic hepatectomy (LAP) and open hepatectomy (OPEN), are available, the 5-year survival rate of HCC patients remains low due to the high early recurrence rate. Research has demonstrated that recurrence after tumor resection and shorter recurrence-free survival are closely associated with circulating tumor cells (CTCS) ( 3 , 4 ). Consequently, assessing CTCS before and after radical hepatectomy is essential to improve the prognosis of HCC patients ( 5–8 ).…”

“…HCC is one of the most common malignancies around the world (1). The treatment of HCC is developing rapidly and includes hepatectomy, targeted system treatment, new internal and external radiotherapy technologies and liver transplantation (2). Radical hepatectomy remains the primary treatment for primary hepatocellular carcinoma (HCC).…”