Detection of oncogenic mutations in paired circulating tumor DNA and circulating tumor cells in patients with hepatocellular carcinoma

Zhouhong Ge; Jean C A Helmijr; Maurice P H M Jansen; Patrick P C Boor; Lisanne Noordam; Maikel Peppelenbosch; Jaap Kwekkeboom; Jaco Kraan; Dave Sprengers

doi:10.1016/j.tranon.2021.101073

Detection of oncogenic mutations in paired circulating tumor DNA and circulating tumor cells in patients with hepatocellular carcinoma

Transl Oncol. 2021 Jul;14(7):101073. doi: 10.1016/j.tranon.2021.101073. Epub 2021 Apr 26.

Authors

Zhouhong Ge¹, Jean C A Helmijr², Maurice P H M Jansen², Patrick P C Boor¹, Lisanne Noordam¹, Maikel Peppelenbosch¹, Jaap Kwekkeboom¹, Jaco Kraan², Dave Sprengers³

Affiliations

¹ Departments of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Wytemaweg 80, Rotterdam 3015 CN, The Netherlands.
² Departments of Medical Oncology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
³ Departments of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Wytemaweg 80, Rotterdam 3015 CN, The Netherlands. Electronic address: d.sprengers@erasmusmc.nl.

Abstract

Background and aims: Circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA) may be used for diagnostic or prognostic purposes in patients with hepatocellular carcinoma (HCC). We aim to determine whether CTCs or ctDNA are suitable to determine oncogenic mutations in HCC patients.

Methods: Twenty-six mostly advanced HCC patients were enrolled. 30 mL peripheral blood from each patient was obtained. CellSearch system was used for CTC detection. A sequencing panel covering 14 cancer-relevant genes was used to identify oncogenic mutations. TERT promoter C228T and C250T mutations were determined by droplet digital PCR.

Results: CTCs were detected in 27% (7/26) of subjects but at low numbers (median: 2 cells, range: 1-15 cells) and ctDNA in 77% (20/26) of patients. Mutations in ctDNA were identified in several genes: TERT promoter C228T (77%, 20/26), TP53 (23%, 6/26), CTNNB1 (12%, 3/26), PIK3CA (12%, 3/26) and NRAS (4%, 1/26). The TERT C228T mutation was present in all patients with one or more ctDNA mutations, or detectable CTCs. The TERT C228T and TP53 mutations detected in ctDNA were present at higher levels in matched primary HCC tumor tissue. The maximal variant allele frequency (VAF) of ctDNA was linearly correlated with largest tumor size and AFP level (Log10). CtDNA (or TERT C228T) positivity was associated with macrovascular invasion, and positivity of ctDNA (or TERT C228T) or CTCs (≥ 2) correlated with poor patient survival.

Conclusions: Oncogenic mutations could be detected in ctDNA from advanced HCC patients. CtDNA analysis may serve as a promising liquid biopsy to identify druggable mutations.

Keywords: Circulating tumor DNA; Circulating tumor cells; Hepatocellular carcinoma; Macrovascular invasion; TERT promoter mutations.