Fluctuation and significance of circulating endothelial cells during the therapeutic process of transarterial chemoembolization of hepatocellular carcinoma

Purpose: To investigate the predictive value of circulating endothelial cells (CECs) to evaluate the efficacy of transarterial chemoembolization (TACE) and their potential value to guide selection of the time interval of TACE. Materials and methods: 35 hepatocellular carcinoma (HCC) patients suitable for TACE and 10 healthy volunteers were enrolled in this study. Three milliliters of peripheral blood of patients were drawn 1 day before TACE and 3 days, 7 days, 14 days and 30 days after TACE respectively for assay of CECs. The basic level of controls and patients were compared. According to different clinical features such as age, sex, Child-pugh score, AFP, BCLC staging, the patients were classified into different groups. And the basic level of CECs of different groups was compared. Then we compared the level of CECs of 5 time points during the treatment period of TACE. 30 days after TACE we evaluated the efficacy of treatment using mRECIST criteria and analysed the relationship between level of CECs and clinical outcome. The relationship between AFP and CECs was also analysed. Results: The mean basic CECs level of patients was significantly higher than that of the control group (14.06±7.28 vs. 4.70±2.36, P=0.000). In comparisons between different groups according to the patients’ clinical features, the significant difference of the mean CECs levels was only found between Child-pugh A and B groups (12.52±5.51 vs. 19.25±10.25, P=0.019). The study exhibited a fluctuating decreasing tendency of CEC levels during effective therapies. The baseline level of CECs in good therapeutic effect and poor therapeutic effect group has no significant difference (15.05±7.74 vs. 12.88±6.77, P=0.381). While that of day 30 in good therapeutic effect group was significantly lower than poor therapeutic effect group (6.68±3.87 vs. 10.81±5.79, P=0.022). The basic and day 30 levels of CECs and AFP had both significant positive correlation (Pearson correlation coefficient =0.409, P=0.015; Pearson correlation coefficient =0.381, P=0.024). Conclusion: Our study suggests that the trend of CECs variations during therapeutic process could be an ideal marker to evaluate the efficacy of TACE and choose the optimal time point to carry out TACE.