Detection and indications of circulating tumor cells in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death due to late diagnosis, high recurrence rate and poor response to systemic therapy. Although surgery is still the optimal therapy, only a small number of HCC patients are eligible for radical resection at the time of diagnosis. Even those receiving liver resection are likely to suffer from recurrence within one year, and they account for most mortalities. It is urgent to develop powerful tools for early HCC diagnosis and real-time monitoring. Currently, detection of circulating tumor cells (CTCs) shows great potential in early HCC detection and treatment response, both for initial diagnosis and recurrences. Because detection is non-invasive, CTCs can present real-time monitoring of tumor progress. At the same time, as intact tumor cells in circulation, detection of CTCs may lead to an understanding of the mechanisms of HCC recurrence and metastasis. In this review, we discuss the developments in CTC detection and application, with a particular focus on clinical implications in HCC.