Open Access Open Badges Research article

Impact of stem cell marker expression on recurrence of TACE-treated hepatocellular carcinoma post liver transplantation

Zhen Zeng12, Jinyu Ren2, Maura O’Neil3, Jie Zhao2, Brian Bridges2, Josiah Cox4, Bashar Abdulkarim5, Timothy M Schmitt5, Sean C Kumer5 and Steven A Weinman2*

Author affiliations

1 Beijing 302th Hospital, Beijing, 100039, People’s Republic of China

2 Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA

3 Department of Pathology, University of Kansas Medical Center, Kansas City, KS, 66160, USA

4 Department of Microbiology, University of Kansas Medical Center, Kansas City, KS, 66160, USA

5 Department of Surgery, University of Kansas Medical Center, Kansas City, KS, 66160, USA

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Citation and License

BMC Cancer 2012, 12:584  doi:10.1186/1471-2407-12-584

Published: 7 December 2012


Liver transplantation is the most effective therapy for cirrhosis-associated hepatocellular carcinoma (HCC) but its utility is limited by post-transplant tumor recurrence. Use of the Milan, size-based criteria, has reduced recurrence rate to less than 10% but many patients remain ineligible. Reduction of tumor size with local therapies has been used to “downstage” patients to allow them to qualify for transplantation, but the optimal criteria to predict tumor recurrence in these latter patients has not been established. The existence of a progenitor cell population, sometimes called cancer stem cells (CSCs), has been proposed to be one mechanism accounting for the chemotherapy resistance and recurrence of hepatocellular carcinoma. The aim of this study was to determine if transcatheter arterial chemoemolization (TACE) treated tumors have increased CSC marker expression and whether these markers could be used to predict tumor recurrence.

Formalin fixed specimens were obtained from 39 HCC liver explants (23 with no treatment and 16 after TACE). Immunohistochemical staining was performed for EpCAM, CD44, CD90, and CD133. Staining for each marker was scored 0–3 by evaluating the number and intensity of positive tumor cells in 5 hpf of tumor in each specimen.

TACE treated tumors displayed greater necrosis and fibrosis than non-TACE treated samples but there were no differences in morphology between the viable tumor cells of both groups. In TACE treated specimens, the staining of both EpCAM and CD133 was greater than in non-TACE specimens but CD44 and CD90 were the same. In the TACE group, the presence of high EpCAM staining was associated with tumor recurrence. Four of ten EpCAM high patients recurred while 0 of 6 EpCAM low patients recurred (P = 0.040). None of the other markers predicted recurrence.

High pre-transplant EpCAM staining predicted HCC recurrence. This suggests that the abundance of tumor cells with a CSC phenotype may be a critical factor in the likelihood of tumor recurrence in patients receiving liver transplantation after TACE.

Cancer stem cells; EpCAM; CD133; CD90; CD44; Transarterial chemoembolization