Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD 21201, USA.
Franciscan Health Olympia Fields, Olympia Fields, IL 60461, USA.
Int J Mol Sci. 2023 Jun 26;24(13):10644. doi: 10.3390/ijms241310644.
Hepatocellular carcinoma (HCC) is an aggressive malignancy with poor outcomes when diagnosed at an advanced stage. Current curative treatments are most effective in early-stage HCC, highlighting the importance of early diagnosis and intervention. However, existing diagnostic methods, such as radiological imaging, alpha-fetoprotein (AFP) testing, and biopsy, have limitations that hinder early diagnosis. AFP elevation is absent in a significant portion of tumors, and imaging may have low sensitivity for smaller tumors or in the presence of cirrhosis. Additionally, as our understanding of the molecular pathogenesis of HCC grows, there is an increasing need for molecular information about the tumors. Biopsy, although informative, is invasive and may not always be feasible depending on tumor location. In this context, liquid biopsy technology has emerged as a promising approach for early diagnosis, enabling molecular characterization and genetic profiling of tumors. This technique involves analyzing circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), or tumor-derived exosomes. CTCs are cancer cells shed from the primary tumor or metastatic sites and circulate in the bloodstream. Their presence not only allows for early detection but also provides insights into tumor metastasis and recurrence. By detecting CTCs in peripheral blood, real-time tumor-related information at the DNA, RNA, and protein levels can be obtained. This article provides an overview of CTCs and explores their clinical significance for early detection, prognosis, treatment selection, and monitoring treatment response in HCC, citing relevant literature.
肝细胞癌 (HCC) 是一种侵袭性恶性肿瘤，在晚期诊断时预后较差。目前的治愈性治疗方法在早期 HCC 中最有效，这凸显了早期诊断和干预的重要性。然而，现有的诊断方法，如影像学、甲胎蛋白 (AFP) 检测和活检，存在局限性，阻碍了早期诊断。在相当一部分肿瘤中，AFP 升高并不明显，而影像学对较小的肿瘤或肝硬化的敏感性较低。此外，随着我们对 HCC 分子发病机制的理解不断加深，对肿瘤分子信息的需求也越来越大。活检虽然具有信息性，但具有侵入性，并且根据肿瘤位置的不同，并不总是可行的。在这种情况下，液体活检技术作为一种有前途的早期诊断方法已经出现，能够对肿瘤进行分子特征分析和基因谱分析。该技术涉及分析循环肿瘤细胞 (CTC)、循环肿瘤 DNA (ctDNA) 或肿瘤来源的外泌体。CTC 是从原发性肿瘤或转移部位脱落并在血液中循环的癌细胞。它们的存在不仅允许早期检测，还可以深入了解肿瘤转移和复发。通过检测外周血中的 CTC，可以实时获得肿瘤相关的 DNA、RNA 和蛋白质水平的信息。本文综述了 CTCs，并探讨了它们在 HCC 早期检测、预后、治疗选择和监测治疗反应方面的临床意义，引用了相关文献。
