Relationship between Circulating Tumor Cells in Peripheral Blood and Pathological Features,and Postoperative Recurrence in Patients with Primary Liver Cancer

LI Zhihong; XIE Dekun; XIE Guilong; CHEN Ying; ZHANG Kui; HE Yu

doi:10.3639/j.issn.2095-3097.2025.08.016

Abstract：Objective To analyze the relationship between circulating tumor cells(CTC)in peripheral blood and the pathological features as well as postoperative recurrence in patients with primary liver cancer.Methods A total of 98 patients with liver cancer(malignant group)and 50 patients with benign hepatic lesions(benign group)who were admitted to Ganzi Tibetan Autonomous Prefecture People's Hospital from April 2014 to March 2024 were retrospectively selected.The number and types of CTC were compared.The relationship between the number of CTC and pathological parameters in liver cancer patients was analyzed.According to the presence or absence of postoperative recurrence after 1 year of follow-up,patients were divided into recurrence group and non-recurrence group.The correlation between CTC and postoperative recurrence was analyzed.Logistic regression analysis was used to identify independent risk factors influencing recurrence in liver cancer patients;receiver operating characteristic(ROC)curves were plotted to analyze the diagnostic efficacy of CTC and other factors in predicting recurrence of liver cancer patients.Results The number of CTC and the CTC positive rate in the malignant group were higher than that in the benign group,and the proportions of mesenchymal and hybrid CTC subtypes in the malignant group were higher than those in the benign group(P<0.05).Among liver cancer patients,the number of CTC was higher in patients with Barcelona Clinic Liver Cancer(BCLC)stage C,poor differentiation,alpha fetoprotein(AFP)>400 ng/mL,carcinoembryonic antigen(CEA)>5.0 ng/mL,carbohydrate antigen 199(CA199)>37.0 IU/mL,distant metastasis,or microvascular cancer thrombus than in patients with BCLC stage A-B,moderate/high differentiation,AFP≤400 ng/mL,CEA≤5.0 ng/mL,CA199≤37.0 IU/mL,no distant metastasis,or no microvascular cancer thrombus(P<0.05).At admission,the number of CTC and levels of AFP,CEA,and CA199 in the recurrence group were significantly higher than those in the non-recurrence group(P<0.05).Binary logistic regression analysis showed that the number of CTC and AFP were independent risk factors for recurrence in liver cancer patients(OR=1.774,95%CI:1.164-2.703;OR=1.306,95%CI:1.063-1.604,P<0.05).ROC curve analysis showed that the area under the curve(AUC)of CTC for predicting recurrence in liver cancer patients was higher than that of AFP,CEA,or CA199,but the difference was not statistically significant(P>0.05).The AUC of CTC for diagnosing recurrence in liver cancer patients was 0.876(95%CI:0.803-0.949),with a sensitivity of 85.34%,specificity of 78.96%,and optimal cutoff value of 25.Conclusion CTC in peripheral blood are closely related to pathological features in liver cancer patients.A higher number of CTC also indicates a greater risk of postoperative recurrence.Monitoring CTC is of significant clinical importance.