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Figure S1. Dynamic change of the clustering status of circulating tumor cells (CTCs) along their circulating route. Figure S2. Variation of circulating tumor cell (CTC) clustering status between primary hepatocellular carcinoma (HCC) efferent and afferent micovessels. Example of circulating tumor microemboli (CTM) detected in microscopic hepatic vein (mHV, efferent vessel) and singular CTCs in microscopic hepatic artery (mHA, afferent vessel) stained for epithelial (E) and mesenchymal (M) markers. E-cad = E-cadherin, red; CK = cytokeratin, brown; vit = vimentin, brown. Scale bar: original magnification, 100μm; inserts, 25 μm. Figure S3. Determination of epithelial-mesenchymal transition (EMT)-related marker expression on hepatocellular carcinoma (HCC) cell lines. Figure S4. Circulating tumor cells (CTCs) isolated using the CELLSEARCH® system were verified by confocal microscopy. Figure S5. Scatter plots showing the comparison of the cell counts of each EMT-related CTC phenotype from five vascular sites, including HV, PA, PV, IHIVC, and PoV (*P

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Supplementary Data from CD24 Is a Novel Predictor for Poor Prognosis of Hepatocellular Carcinoma after Surgery

Supplementary Table S1. Correlation between the SII and clinicopathological characteristics (training cohort, n=133 and validation cohort, n=123). Supplementary Table S2. Correlation Between SII, NLR and PLR and clinicopathological characteristics in training and validation cohorts.

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Purpose: To investigate the expression of metadherin (MTDH) for its prognostic value in hepatocellular carcinoma (HCC) and its role in promoting HCC metastasis.Experimental Design: This study employed a tissue microarray containing samples from 323 HCC patients to examine the expression of MTDH and its correlation with other clinicopathologic characteristics. The role of MTDH in the regulation of HCC metastasis was investigated both in vitro and in vivo using short hairpin RNA (shRNA)–mediated downregulation of MTDH in HCC cell lines with various metastatic potentials.Results: The expression of MTDH was markedly higher in HCC tumors than in normal liver tissue. Particularly high MTDH expression was observed in tumors with microvascular invasion, pathologic satellites, poor differentiation, or tumor-node-metastasis stages II to III. Furthermore, the clinical outcome was consistently poorer for the MTDHhigh group than for the MTDHlow group in the 1-, 3-, and 5-year overall survival (OS) rates and in the 1-, 3-, 5-year cumulative recurrence rates. In a nude mice model, the shRNA-mediated downregulation of MTDH resulted in a reduced migratory capacity in HCC cell lines, as well as a reduction in pulmonary and abdominal metastasis. Furthermore, we found that the expression level of MTDH correlated with four epithelial–mesenchymal transition (EMT) markers. Knockdown of MTDH expression in HCC cell lines resulted in downregulation of N-cadherin and snail, upregulation of E-cadherin, and translocation of β-catenin.Conclusions: MTDH may promote HCC metastasis through the induction of EMT process and may be a candidate biomarker for prognosis as well as a target for therapy. Clin Cancer Res; 17(23); 7294–302. ©2011 AACR.

Purpose: This study aimed to construct a novel platform for the detection of circulating tumor cells (CTC) in patients with hepatocellular carcinoma (HCC) and to investigate the clinical significance of epithelial cell adhesion molecule mRNA-positive (EpCAMmRNA+) CTCs using this platform.Experimental Design: An optimized platform for CTC detection was constructed by evaluating different negative enrichment, mRNA isolation, and cDNA synthesis procedures and compared with the CellSearch system. A total of 299 patients with HCC were recruited into this prospective study; of these, 157 who received curative resection, 76 who received transcatheter arterial chemoembolization (TACE), and 66 who received radiotherapy were tested using our platform. The diagnostic value of EpCAMmRNA+ CTCs was investigated in 122 patients with HCC who underwent resection and 120 control subjects.Results: The optimized negative enrichment and quantitative real-time PCR (qRT-PCR)-based CTC detection platform had high sensitivity, specificity, and reproducibility and a low sample volume requirement. This platform showed a potential diagnostic value in patients with HCC and exhibited 76.7% consistency with the CellSearch system (r = 0.54, P < 0.050). Pretreatment CTC level showed prognostic significance in patients with HCC treated with resection, TACE, and radiotherapy (all P < 0.050). Most of the patients showed a decrease in CTC levels after treatment that reflected tumor response. In contrast, patients with an increased CTC level showed disease progression after treatment.Conclusions: We established an optimized platform based on negative enrichment and qRT-PCR for highly sensitive, specific, and reproducible CTC detection. This platform might be clinically useful in auxiliary diagnosis, treatment response assessment, and early decision-making to tailor the most effective antitumor strategies. Clin Cancer Res; 20(18); 4794–805. ©2014 AACR.

Table S1, Primer pairs and probes used for quantitative real-time PCR assays; Table S2, Diagnostic performance of CTC markers in training set by logistic regression; Table S3, Performance of CTC panel and serum AFP in diagnosing various BCLC stages of HCC; Table S4, Performance of CTC panel in diagnosing HCC, stratified by AFP status; Table S5. Cox regression analyses for time to recurrence in the training and validation groups; Figure S1, Multimarker CTC screening in patients with HCC; FigureS2, The detection of stem-like phenotypes CTC subpopulations with immunofluorescent method and single-cell transcriptional analysis; Figure S3, Expression of selected CTCs in training set; Figure S4, Expression of selected CTCs in validation set; Figure S5, CTC panel positivity rates in training and validation set; Figure S6, X-tile analysis of CTC panel in training set; Figure S7, Comparison of CTC panel and EpCAM for HCC diagnosis and prognosis in training and validation sets; Figure S8, Relative expression of EMT transition markers in patients with HCC and in healthy controls

Purpose: To investigate the role of CD24 in tumor invasion and prognostic significance in hepatocellular carcinoma (HCC).Experimental Design: CD24 expression was measured in stepwise metastatic HCC cell lines, tumor, peritumoral tissues, and normal liver tissues by quantitative real-time PCR and Western blot. The role of CD24 in HCC was investigated by CD24 depletion using small interfering RNA. Tumor tissue microarrays of 314 HCC patients who underwent resection between 1997 and 2000 were used to detect expression of CD24, β-catenin, and proliferating cell nuclear antigen. Prognostic significance was assessed using Kaplan-Meier survival estimates and log-rank tests.Results: CD24 was overexpressed in the highly metastatic HCC cell line and in tumor tissues of patients with recurrent HCC. Depletion of CD24 caused a notable decrease in cell proliferation, migration, and invasiveness in vitro. Univariate and multivariate analyses revealed that CD24 was a significant predictor for overall survival and relapse-free survival. CD24 expression was correlated with poor prognosis independent of α-fetoprotein, tumor-node-metastasis stage, and Edmondson stage. High CD24 expression was significantly associated with cytoplasmic and nuclear accumulation of β-catenin (P = 0.023), high tumor proliferative status (P = 0.018), and diffused intrahepatic recurrence and distant metastasis (P = 0.026). Adjuvant transcatheter arterial chemoembolization after surgery reduced the rate of early recurrence (≤1 year) in CD24+ HCC patients (P = 0.024) but had no significant effect in CD24− patients (P = 0.284).Conclusions: Overexpression of CD24 in HCC was associated with high invasiveness and metastatic potential, high tumor proliferation status, and activation of the Wnt/β-catenin pathway. CD24 may be a novel predictor for poor prognosis of HCC patients after surgery. (Clin Cancer Res 2009;15(17):5518–27)

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Purpose: We developed a novel systemic immune-inflammation index (SII) based on lymphocyte, neutrophil, and platelet counts and explored its prognostic value in hepatocellular carcinoma (HCC).Experimental Design: The SII was developed based on a retrospective study of 133 patients with HCC undergoing resection between 2005 and 2006, and validated in a prospective study of 123 patients enrolled from 2010 to 2011. The circulating tumor cell (CTC) level in the validation cohort was measured using the CellSearch system. Prediction accuracy was evaluated with area under the receiver operating characteristic curve (AUC).Results: An optimal cutoff point for the SII of 330 × 109 stratified the patients with HCC into high (≥330) and low SII (P = 0.029). In patients with detectable CTCs, those with SII ≥ 330 had higher recurrence rates and shorter survival time than patients with SII < 330.Conclusion: The SII was a powerful prognostic indicator of poor outcome in patients with HCC and is a promising tool for HCC treatment strategy decisions. The dismal outcome in patients with high SII scores might be related to higher CTC levels. Clin Cancer Res; 20(23); 6212–22. ©2014 AACR.

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Supplementary figure S2. Kaplan-Meier analysis of OS and RFS for (A) NLR and (B) PLR in the training cohort; Predictive ability of the SII was compared with other clinical parameters and the AUCs with 95% CI for TTR in the training (C) and validation cohorts (D) are shown. (*, P

Supplementary figure S1. The optimal cutoff value for the SII was selected by X-tile 3.6.1 software (Yale University, New Haven, CT, USA).

Background: In the present study, we assessed the clinical value of circulating tumor cells (CTC) with stem-like phenotypes for diagnosis, prognosis, and surveillance in hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC) by an optimized qPCR-based detection platform.Methods: Differing subsets of CTCs were investigated, and a multimarker diagnostic CTC panel was constructed in a multicenter patient study with independent validation (total n = 1,006), including healthy individuals and patients with chronic hepatitis B infection (CHB), liver cirrhosis (LC), benign hepatic lesion (BHL), and HBV-related HCC, with area under the receiver operating characteristic curve (AUC-ROC) reflecting diagnostic accuracy. The role of the CTC panel in treatment response surveillance and its prognostic significance were further investigated.Results: The AUC of the CTC panel was 0.88 in the training set [sensitivity = 72.5%, specificity = 95.0%, positive predictive value (PPV) = 92.4, negative predictive value (NPV) = 77.8] and 0.93 in the validation set (sensitivity = 82.1%, specificity = 94.2%, PPV = 89.9, NPV = 89.3). This panel performed equally well in detecting early-stage and α-fetoprotein–negative HCC, as well as differentiating HCC from CHB, LC, and BHL. The CTC load was decreased significantly after tumor resection, and patients with persistently high CTC load showed a propensity of tumor recurrence after surgery. The prognostic significance of the CTC panel in predicting tumor recurrence was further confirmed [training: HR = 2.692; 95% confidence interval (CI), 1.617–4.483; P < 0.001; and validation: HR = 3.127; 95% CI, 1.360–7.190; P = 0.007].Conclusions: Our CTC panel showed high sensitivity and specificity in HCC diagnosis and could be a real-time parameter for risk prediction and treatment monitoring, enabling early decision-making to tailor effective antitumor strategies. Clin Cancer Res; 24(9); 2203–13. ©2018 AACR.

Purpose: The spatial heterogeneity of phenotypic and molecular characteristics of CTCs within the circulatory system remains unclear. Herein, we mapped the distribution and characterized biological features of CTCs along the transportation route in hepatocellular carcinoma (HCC).Experimental Design: In 73 localized HCC patients, blood was drawn from peripheral vein (PV), peripheral artery (PA), hepatic veins (HV), infrahepatic inferior vena cava (IHIVC), and portal vein (PoV) before tumor resection. Epithelial and mesenchymal transition (EMT) phenotype in CTCs were analyzed by a 4-channel immunofluorescence CellSearch assay and microfluidic quantitative RT-PCR. The clinical significance of CTCs from different vascular sites was evaluated.Results: The CTC number and size gradient between tumor efferent vessels and postpulmonary peripheral vessels was marked. Tracking the fate of CTC clusters revealed that CTCs displayed an aggregated–singular-aggregated manner of spreading. Single-cell characterization demonstrated that EMT status of CTCs was heterogeneous across different vascular compartments. CTCs were predominantly epithelial at release, but switched to EMT-activated phenotype during hematogeneous transit via Smad2 and β-catenin related signaling pathways. EMT activation in primary tumor correlated with total CTC number at HV, rather than epithelial or EMT-activated subsets of CTCs. Follow-up analysis suggested that CTC and circulating tumor microemboli burden in hepatic veins and peripheral circulation prognosticated postoperative lung metastasis and intrahepatic recurrence, respectively.Conclusions: The current data suggested that a profound spatial heterogeneity in cellular distribution and biological features existed among CTCs during circulation. Multivascular measurement of CTCs could help to reveal novel mechanisms of metastasis and facilitate prediction of postoperative relapse or metastasis pattern in HCC. Clin Cancer Res; 24(3); 547–59. ©2017 AACR.

Supplementary Table S1. Sensitivity of two RNA isolation and two cDNA synthesis methods with the Hep3B cell line. Supplementary Table S2. Precision of the optimized system. Supplementary Table S3. Diagnostic value of EpCAMmRNA+ CTCs in HCC subgroups. Supplementary Table S4. Diagnostic value of the combination of EpCAMmRNA+ CTC and AFP in HCC subgroups. Supplementary Table S5. Univariate and multivariate Cox proportional regression analysis of factors associated with recurrence/progression.

Purpose: To illustrate the prognostic significance of hedgehog (Hh) signaling in patients with hepatocellular carcinoma (HCC) and to evaluate the efficacy of a novel nanoparticle-encapsulated inhibitor of the Hh transcription factor, Gli1 (NanoHHI) using in vitro and in vivo models of human HCCs.Experimental Design: Patched1 (Ptch1) expression was detected in tumor tissue microarrays of 396 patients with HCC who underwent curative surgical resection during February 2000 to December 2002. Prognostic significance was assessed using Kaplan–Meier survival estimates and log-rank tests. The effects of NanoHHI alone and in combination with sorafenib were investigated on HCC cell lines. Primary HCC tumor growth and metastasis were examined in vivo using subcutaneous and orthotopic HCC xenografts in nude mice.Results: Elevated expression of Ptch1 in HCC tissues was significantly related to disease recurrence, as well as a shorter time to recurrence in patients with HCC. In vitro, NanoHHI significantly inhibited the proliferation and invasion of HCC cell lines. NanoHHI potently suppressed in vivo tumor growth of HCC xenografts in both subcutaneous and orthotopic milieus, and in contrast to sorafenib, resulted in significant attenuation of systemic metastases in the orthotopic setting. Furthermore, NanoHHI significantly decreased the population of CD133-expressing HCC cells, which have been implicated in tumor initiation and metastases.Conclusion: Downstream Hh signaling has prognostic significance in patients with HCC as it predicts early recurrence. Gli inhibition through NanoHHI has profound tumor growth inhibition and antimetastatic effects in HCC models, which may provide a new strategy in the treatment of patients with HCC and prevention post-operative recurrence. Clin Cancer Res; 18(5); 1291–302. ©2011 AACR.

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Supplementary figure S3. (A) Kaplan-Meier analysis of OS and RFS for NLR in the validation cohort; (B) Kaplan-Meier analysis of OS and RFS for PLR in the validation cohort.

Purpose: The spatial heterogeneity of phenotypic and molecular characteristics of CTCs within the circulatory system remains unclear. Herein, we mapped the distribution and characterized biological features of CTCs along the transportation route in hepatocellular carcinoma (HCC). Experimental Design: In 73 localized HCC patients, blood was drawn from peripheral vein (PV), peripheral artery (PA), hepatic veins (HV), infrahepatic inferior vena cava (IHIVC), and portal vein (PoV) before tumor resection. Epithelial and mesenchymal transition (EMT) phenotype in CTCs were analyzed by a 4-channel immunofluorescence CellSearch assay and microfluidic quantitative RT-PCR. The clinical significance of CTCs from different vascular sites was evaluated. Results: The CTC number and size gradient between tumor efferent vessels and postpulmonary peripheral vessels was marked. Tracking the fate of CTC clusters revealed that CTCs displayed an aggregated–singular-aggregated manner of spreading. Single-cell characterization demonstrated that EMT status of CTCs was heterogeneous across different vascular compartments. CTCs were predominantly epithelial at release, but switched to EMT-activated phenotype during hematogeneous transit via Smad2 and β-catenin related signaling pathways. EMT activation in primary tumor correlated with total CTC number at HV, rather than epithelial or EMT-activated subsets of CTCs. Follow-up analysis suggested that CTC and circulating tumor microemboli burden in hepatic veins and peripheral circulation prognosticated postoperative lung metastasis and intrahepatic recurrence, respectively. Conclusions: The current data suggested that a profound spatial heterogeneity in cellular distribution and biological features existed among CTCs during circulation. Multivascular measurement of CTCs could help to reveal novel mechanisms of metastasis and facilitate prediction of postoperative relapse or metastasis pattern in HCC. Clin Cancer Res; 24(3); 547–59. ©2017 AACR.

Background: Lenvatinib is currently available as the first-line treatment for advanced unresectable hepatocellular carcinoma. The safety and efficacy of lenvatinib in preventing early recurrence after liver transplantation (LTx) beyond Milan criteria is still unclear. Methods: During August 2018 to September 2019, 181 patients who underwent LTx beyond Milan criteria at Zhongshan Hospital were retrospective analyzed. Among them, 30 patients were administered lenvatinib after LTx. Propensity score matching (PSM) strategy at 1:2 ratio was adopted to offset differences between two groups. Results: Before PSM, lenvatinib group (n = 30) tended to have more advanced tumors than control group (n = 151). In survival analysis, lenvatinib group showed comparable overall survival (OS) (P = 0.078) and time to recurrence (TTR) (P = 0.120) with control group. After PSM, the clinical baseline in lenvatinib group (n = 30) was similar with the control group (n = 60). We found that post-LTx lenvatinib administration could significantly reduce postoperative tumor recurrence and prolong median TTR (not reached vs. 14.60 months, P=0.019) after LTx, compared with untreated PSM controls. The rate of early recurrences (≤1 year) was also significantly deceased in the lenvatinib group (20.0% vs. 41.7%, p=0.041). We found that the patients with lenvatinib treatment had a propensity of improved OS compared with the matched control group (24-month OS, 92.5% vs 74.3%; P = 0.069). Multivariate regression analysis indicated that post-LTx lenvatinib was an independent protective factor for tumor recurrence after operation (HR = 0.388; 95%CI, 0.186-0.809; P = 0.012).We found that post-LTx lenvatinib administration could reduce tumor recurrence in the patients with tumor size>5cm (P=0.019), multiple tumor (P=0.016), tumor differentiation III-IV (P=0.033), without PVTT (P=0.009), and post-LTx AFP >20ng/ml (one month after LTx)(P=0.010). The treatment-related adverse events occurred in most patients (28/30, 93.3%) received post-LTx lenvatinib treatment, and grade 3 treatment-related adverse events occurred in nine (30.0%) patients. Apart from two (6.7%) patients withdrew lenvatinib due to unbearable adverse events and three (10.0%) patients get relieved after dose reduction, the other patients could tolerate adverse events after dealing with symptoms. Conclusion: Post-LTx lenvatinib could serve as a safety and effective therapy to reduce tumor recurrence after LTx in HCC patients beyond Milan criteria. Citation Format: Xin-Rong Yang, De-Zhen Guo, Jian Zhou, Jia Fan. The safety and efficacy of lenvatinib in preventing early recurrence after liver transplantation for hepatocellular carcinoma beyond Milan criteria: A single-center, retrospective, propensity-matched study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1456.

Introduction: Detection of circulating tumor cells (CTCs) and characterization of CTCs at single-cell resolution may benefit the clinical management of cancer patients. To make the CTC analysis a “bench-to-bedside” technology, we developed an integrated platform named ChimeraX®-i120 system for the high-throughput, automated, and clinical applicable CTC sorting and downstream single-cell genomic profiling. Methods: ChimeraX®-i120 system is designed based on negative enrichment strategy, integrating blood sample pre-processing, immunofluorescence staining, artificial intelligence (AI)-assisted CTC identification. CTCs enriched by this system is compatible with downstream single-cell whole genome sequencing (WGS) analysis. Performance of CTCs detection was evaluated by a series of analytical experiments, clinical utility was further verified. We validated our downstream molecular profiling pipeline of single CTC. Results: Analytical experiments showed that this system was featured with high accuracy, repeatability, sensitivity and anti-interference capability for CTC detection, achieving an average recovery rate of the spiked cells in 71.3%-83.2% (R2= 0.99). In clinical samples, this system effectively detected CTCs and CTC clusters (CTM) in 5 mL blood from cancer patients. The proportion of patients that were positive for CTCs (EpCAM+/pan-CK++CD45-+DAPI+), was 59.3% (86/145, avg. cell count 1.38 ± 2.01) for hepatocellular carcinoma (HCC), 63.2% (24/38, 1.42 ± 1.75) for intrahepatic cholangiocarcinoma (ICC), 63.6% (28/44, avg. 2.52 ± 3.93) for breast cancer (BRC), 61.5% (24/39, avg. 1.62 ± 2.11) in colorectal cancer (CRC), 78.9% (15/19, avg. 2.74 ± 4.46) in lung cancer (LC). Only 1 of 125 (0.8%) healthy volunteers had detectable CTC. The prognostic value of the system was assessed in HCC. Preoperative CTC ≥1/5mL blood was significantly associated with a higher 1-year recurrence rate (38.9% vs. 27.6%, P=0.042) in HCC patients after curative surgery. Low-pass WGS analysis was performed on CTCs and paired tumor tissues of 3 ICC, 3 HCC and 4 BRC. We observed concordance in CNAs (10%-61%) between CTCs and tissues. CTC profiling identified diverse intra- and inter-patient heterogeneity in CNAs pattern. Exclusive CNA patterns were identified in CTCs but not tissue, and vice versa. Multiple well-known oncogenes (e.g., BRAF, EGFR, BRCA1/2, MYC and MET) and tumor suppressor genes (e.g., FOXA1 and TRAF3) could be identified from CNAs in CTCs. For example, in one BRC patient, potentially actionable alterations of BRC such as BRAF, EGFR, MET, ERBB2, PIK3CA and MYC were only identified in CTCs but not tissues. Conclusion: Our results highlight the potential clinical utility of ChimeraX®-i120 system in both CTC detection and downstream genomic profiling. Genomic sequencing of CTCs allows blood-based tumor profiling in greater fraction of patients for clinical decision making. Citation Format: Pengxiang Wang, Yunfan Sun, Weixiang Jin, Haixiang Peng, Jian Zhou, Jia Fan, Xinrong Yang. An integrated platform for the clinical detection and molecular profiling of single circulating tumor cells [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5380.

Liver cancer is the second leading cause of cancer-related death in China and worldwide, where hepatocellular carcinoma (HCC) represents the major histological type. Previous studies have demonstrated that surveillance program combining serum marker AFP and ultrasound could greatly reduce liver cancer mortality. However, it is widely recognized that AFP has lower sensitivity for early stage of the disease and the specificity is also sub-optimal, limiting its application for early detection and timely intervention. Tumor-originated circulating cell-free DNA (ctDNA), harboring cancer-related genetic and epigenetic changes, provides new opportunity for non-invasive detection of liver cancer. In this study, we have performed parallel genetic and epigenetic profiling of cfDNA from Chinese hepatocellular carcinoma patients as well as healthy individuals by targeted bisulfite sequencing and by targeted ultra-deep sequencing. For methylome profiling, we first identified HCC-specific differentially methylated regions (DMRs) and then employed machine learning approaches to build diagnostic models to classify the plasma of HCC patients from that of healthy individuals. The training cohort consists of 148 hepatocellular carcinoma cases (median age of 63) and 84 healthy individuals (median age of 60). A random forest classifier achieved an AUC of 0.94±0.04 with 10-fold cross-validation using a panel of 21 DMR markers. Meanwhile, cfDNA mutation profiling achieved a sensitivity of 50.8% and a specificity of 95.3% in the training cohort, providing an inferior diagnostic performance compared to the methylation assay. Further analyses were performed in an independent validation cohort, including HCC patients (n=112) as well as healthy control (n=96). The cfDNA methylation model achieved a sensitivity of 82.9%, and a specificity of 93.8%; all stage sensitivity excluding BCLC stage 0 was 92.8%. On the other hand, the diagnostic model based on mutation profile achieved a sensitivity of 43.8% and a specificity of 97.9% in this cohort. Furthermore, we found that the methylation model had a sensitivity of 76.6% for early HCC (BCLC stage 0 + A), while serum AFP level (>20ng/ml) had a sensitivity of 27.3%. In conclusion, our results suggest that cancer-derived abnormal methylation pattern of cfDNA provides promising biomarkers for the diagnosis of HCC with high sensitivity and specificity. Citation Format: Yuying Wang, Yupeng Wang, Ao Huang, Ruijingfang Jiang, Jianchao Zheng, Zhilong Li, Jiaxi Peng, Jianlong Sun, Chichuan Liu, Guanghui Yang, Jie Yuan, Xinrong Yang, Jian Zhou, Jia Fan. The genetic and epigenetic abnormalities of plasma cfDNA as liquid biopsy biomarkers to diagnose hepatocellular carcinoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 782.

Purpose: This study aimed to construct a novel platform for the detection of circulating tumor cells (CTC) in patients with hepatocellular carcinoma (HCC) and to investigate the clinical significance of epithelial cell adhesion molecule mRNA-positive (EpCAMmRNA+) CTCs using this platform. Experimental Design: An optimized platform for CTC detection was constructed by evaluating different negative enrichment, mRNA isolation, and cDNA synthesis procedures and compared with the CellSearch system. A total of 299 patients with HCC were recruited into this prospective study; of these, 157 who received curative resection, 76 who received transcatheter arterial chemoembolization (TACE), and 66 who received radiotherapy were tested using our platform. The diagnostic value of EpCAMmRNA+ CTCs was investigated in 122 patients with HCC who underwent resection and 120 control subjects. Results: The optimized negative enrichment and quantitative real-time PCR (qRT-PCR)-based CTC detection platform had high sensitivity, specificity, and reproducibility and a low sample volume requirement. This platform showed a potential diagnostic value in patients with HCC and exhibited 76.7% consistency with the CellSearch system (r = 0.54, P < 0.050). Pretreatment CTC level showed prognostic significance in patients with HCC treated with resection, TACE, and radiotherapy (all P < 0.050). Most of the patients showed a decrease in CTC levels after treatment that reflected tumor response. In contrast, patients with an increased CTC level showed disease progression after treatment. Conclusions: We established an optimized platform based on negative enrichment and qRT-PCR for highly sensitive, specific, and reproducible CTC detection. This platform might be clinically useful in auxiliary diagnosis, treatment response assessment, and early decision-making to tailor the most effective antitumor strategies. Clin Cancer Res; 20(18); 4794–805. ©2014 AACR.

Hepatocellular carcinoma (HCC) poses a major public health problem worldwide and novel, effective therapeutic approaches for this devastating disease are urgently needed. The overexpression or activation of the MDM2 oncogene frequently occurs in HCC and is linked to cancer growth, poor survival, metastasis, and resistance to treatment. We have hypothesized that MDM2 is a promising therapeutic target for HCC therapy. We have recently discovered that the transcription factor NFAT1 upregulates MDM2 expression, promoting cancer cell growth, migration, invasion, and angiogenesis. The present study was designed to demonstrate the role of the NFAT1-MDM2 pathway in HCC progression and its value in developing HCC targeted therapy. We systemically investigated the expression and association of MDM2 and NFAT1 in 254 pairs of human HCC and matched non-cancerous tissue samples. High-throughput virtual and cell-based screenings were carried out for search for lead compounds targeting both NFAT1 and MDM2. The in vitro and in vivo anti-HCC activities and underlying mechanisms of action were further evaluated in HCC cell lines with various p53 backgrounds. Our results demonstrated that, compared with the non-malignant peritumoral tissues MDM2 and NFAT1 were overexpressed in HCC tissues, which were correlated with poor prognosis and increased metastasis. Based on molecular modeling study, Biacore assay, and pull-down assays, one of the lead compounds, named MA242, was identified as a potent and selective MDM2 and NFAT1 dual inhibitor. Mechanistically, M242 directly bound to MDM2 and NFAT1 proteins with high affinity and induced their protein degradation. MA242 also inhibited NFAT1-mediated MDM2 transcription. At cellular level, MA242 decreased cell proliferation, and induced apoptosis and G2/M phase arrest in various HCC cell lines, regardless of the p53 status. Furthermore, M242 inhibited the tumor growth and metastasis in orthotopic and patient-derived xenograft (PDX) models of HCC, without any obvious host toxicity. In conclusion, MDM2 and NFAT1 expression can serve as predictors of survival in patients with HCC. Dual MDM2 and NFAT1 inhibitors may represent a first-in-class clinical candidates for the treatment of HCC, including tumors lacking functional p53. This project is supported by NIH R01 CA186662 and R01 CA214019 and ACS RSG-15-009-01-CDD. Citation Format: Wei Wang, Jianwen Cheng, Jiang-Jiang Qin, Bo Hu, Bhavitavya Nijampatnam, Sadanandan Velu, Xin-Rong Yang, Jia Fan, Ruiwen Zhang. Inflammation and oncogene in hepatocellular carcinoma: Clinical relevance and experimental targeted therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3858.

Purpose: To investigate the expression of metadherin (MTDH) for its prognostic value in hepatocellular carcinoma (HCC) and its role in promoting HCC metastasis. Experimental Design: This study employed a tissue microarray containing samples from 323 HCC patients to examine the expression of MTDH and its correlation with other clinicopathologic characteristics. The role of MTDH in the regulation of HCC metastasis was investigated both in vitro and in vivo using short hairpin RNA (shRNA)–mediated downregulation of MTDH in HCC cell lines with various metastatic potentials. Results: The expression of MTDH was markedly higher in HCC tumors than in normal liver tissue. Particularly high MTDH expression was observed in tumors with microvascular invasion, pathologic satellites, poor differentiation, or tumor-node-metastasis stages II to III. Furthermore, the clinical outcome was consistently poorer for the MTDHhigh group than for the MTDHlow group in the 1-, 3-, and 5-year overall survival (OS) rates and in the 1-, 3-, 5-year cumulative recurrence rates. In a nude mice model, the shRNA-mediated downregulation of MTDH resulted in a reduced migratory capacity in HCC cell lines, as well as a reduction in pulmonary and abdominal metastasis. Furthermore, we found that the expression level of MTDH correlated with four epithelial–mesenchymal transition (EMT) markers. Knockdown of MTDH expression in HCC cell lines resulted in downregulation of N-cadherin and snail, upregulation of E-cadherin, and translocation of β-catenin. Conclusions: MTDH may promote HCC metastasis through the induction of EMT process and may be a candidate biomarker for prognosis as well as a target for therapy. Clin Cancer Res; 17(23); 7294–302. ©2011 AACR.

Hepatocellular carcinoma (HCC) poses a major health problem worldwide and novel, effective therapeutic approaches are urgently needed. The MDM2 oncogene is amplified and overexpressed in HCC and associated with its initiation, progression, metastasis, and chemoresistence. MDM2 has been demonstrated to be as a promising therapeutic target for the treatment of HCC. However, most of the current MDM2 inhibitors have been designed to block the binding between MDM2 and p53, and have limited efficacy against tumors with mutant or deficient p53. We recently performed a high-throughput virtual and cell-based screening, yielding a novel MDM2 inhibitor, termed SP141. The present study was designed to evaluate the anti-HCC activity of SP141, its potential to chemosensitize HCC cells to other anticancer agents, and to determine the underlying mechanism(s) of action of SP141 in various in vitro and in vivo models with different backgrounds of p53 (wildtype, mutant or null). Our results demonstrated that SP141 inhibited cell growth and prevented cell migration and invasion, independent of p53. Mechanistically, SP141 directly bound to the MDM2 protein and promoted MDM2 degradation. The inhibition of MDM2 by SP141 also increased the sensitivity of HCC cells to sorafenib. In addition, in orthotopic and patient-derived xenograft (PDX) models, SP141 inhibited MDM2 expression and suppressed tumor growth and metastasis, without any host toxicity. Furthermore, mechanistic study demonstrated that the inhibition of MDM2 by SP141 was essential for its anti-HCC activities. In conclusion, MDM2 inhibition by SP141 resulted in the inhibition of HCC tumor growth and metastasis and sensitization of HCC cells to chemotherapy, regardless of their p53 status. These results provide support for the further development of SP141 as a lead candidate for the treatment of HCC. (Supported by NIH R01 CA186662 and R01CA214019 and ACS RSG-15-009-01-CDD.) Citation Format: Wei Wang, Bo Hu, Jiang-Jiang Qin, Jianwen Cheng, Xin Li, Ming Hu, John Buolamwini, Xin-Rong Yang, Jia Fan, Ruiwen Zhang. Treating hepatocellular carcinoma metastasis and overcoming chemoresistance through inhibiting the MDM2 oncogene [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4867.

The prognosis of hepatocellular carcinoma (HCC) is closely linked to the occurrence of recurrent, metastatic disease. Metastasis has been proposed to be initiated by circulating tumor cells (CTCs); however, the transcriptomic plasticity and adaptive mechanisms of CTCs in systemic circulation are not well defined. Here, we established single-cell RNA-sequencing profiles of 113 CTCs isolated from four key vascular sites along the dissemination route in ten HCC patients. In our study, we found that single CTCs displayed profound spatial transcriptional heterogeneity within the circulatory system, which is associated with increased transcriptional activity, cell cycle progression, and chemokine-induced immune escape programs. In particular, CTCs dynamically drove chemokine (C-C motif) ligand 5 (CCL5) expression over the course of circulation. We demonstrated that increased CCL5 expression in turn recruited regulatory T cells to facilitate immune evasion and metastatic progression, as rigorously validated by our in vitro and in vivo models. Finally, we identified an inherently dormant CTC subset with an epithelial-mesenchymal transition and immune-evasive phenotype, and demonstrated its potential prognostic implications. Collectively, our results reveal the previously unappreciated spatial heterogeneity of CTCs, and define its role in diverse regulatory programs and cellular states. Our study offers new insight into metastatic mechanisms, highlighting the potential utility of anti-CTC therapeutic strategies. Citation Format: Liang Wu, Miaomiao Jiang, Yunfan Sun, Xinrong Yang, Yong Hou, Jia Fan, Shiping Liu. Dissecting the spatial heterogeneity of circulating tumor cells reveals CCL5-Treg-mediated immune evasion in hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4601.

Purpose: Cytokeratin 10 (CK10) was found to be expressed differently in human hepatocellular carcinoma (HCC) cell lines with different metastatic potentials in our previous research. The aim of this study was to assess the value of CK10 alone or in combination with cytokeratin 19 (CK19) in predicting tumor recurrence after curative resection in HCC patients. Experimental Design: CK10 expression in stepwise metastatic HCC cell lines and tumor tissues from 50 HCC patients was investigated using immunofluorescence assay, quantitative real-time reverse transcription-PCR, and Western blot analyses. Tumor tissue microarrays of 300 HCC patients who underwent curative resection between 1997 and 2000 were used to detect the expressions of CK10 and CK19. Clinicopathologic data for these patients were evaluated. The prognostic significance was assessed using Kaplan-Meier survival estimates and log-rank tests. Results: CK10 was overexpressed in the high metastatic HCC cell line and in tumor tissues of recurrent patients. Both univariate and multivariate analyses revealed that CK10 was a significant predictor for overall survival (OS) and disease-free survival, and that CK19 was a significant predictor for OS. CK10 expression was correlated with poor prognosis regardless of α-fetoprotein, tumor-node-metastasis stage, and vascular invasion. The 7-year OS and disease-free survival rates in CK10+ and/or CK19+ patients were 30.0% and 37.6%, respectively, which were significantly lower than that of CK10−/CK19− patients (56.1% and 60.0%, respectively; P < 0.001). Conclusion: CK10 is associated with HCC invasiveness. CK10 alone, or in combination with CK19, can be a novel predictor for poor prognosis of HCC patients after curative resection.